psychiatric-behavioral-health ConditionNeurological

Anorexia Nervosa (Supportive)

"Deliberate food restriction leading to significantly low body weight"

15+

Days/Month

50-70%

Medication Overuse

2-3x

Stroke Risk

Reversible

With Treatment

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Understanding Your Condition

What is Chronic Migraine?

Anorexia Nervosa (AN) is a serious, potentially life-threatening eating disorder characterized by a persistent restriction of energy intake, an intense fear of gaining weight or becoming fat, and a disturbance in self-perceived body shape or weight. Individuals with AN maintain a body weight significantly below what is considered normal or healthy for their age, height, and gender, typically through caloric restriction, excessive exercise, binge-eating/purging behaviors (in the binge-purge subtype), or combinations thereof. The disorder is associated with severe medical complications affecting nearly every organ system, including cardiovascular dysfunction, bone loss, hormonal imbalances, and neurological changes, with the highest mortality rate of any psychiatric disorder.

Healthy Function

What your body should do

A healthy relationship with food involves eating in response to physiological hunger and satiety cues, maintaining a body weight that is natural for the individual's genetic blueprint and metabolic needs. The hypothalamus appropriately regulates appetite through ghrelin (hunger hormone) and leptin (satiety hormone), while the enteric nervous system communicates hunger and fullness signals to the brain via the vagal nerve. The prefrontal cortex successfully regulates food-related impulses without excessive preoccupation. The menstrual cycle functions regularly in reproductive-age females, indicating adequate energy availability. Body temperature remains stable through appropriate thermoregulation. Energy levels support normal daily activities, exercise, and cognitive function. Bone mineral density is maintained through adequate nutrition and appropriate hormonal signaling. Cardiovascular function remains stable with normal heart rate variability and blood pressure regulation.

When Things Go Wrong

Signs of chronification

Pain threshold lowers over time
More frequent attacks
Brain stays in alert mode
Medication stops working

Development Process

How This Develops

Understanding the biological mechanisms helps us target the root cause

Point 1

Understanding the mechanism helps us target the root cause rather than just treating symptoms.

Symptom Manifestations

Recognizing All Symptoms

Chronic migraine affects multiple systems. Understanding your symptoms helps us identify the underlying mechanisms.

Physical Symptoms

28 symptoms

Significantly low body weight below minimally normal (BMI <17.5 or <18.5)
Rapid, unintentional weight loss
Amenorrhea (absence of menstrual periods for 3+ cycles)
Breast atrophy in females
Testicular atrophy in males
Loss of sexual interest and function
Cold intolerance
Hypothermia (low body temperature)
Dry skin and brittle nails
Hair loss or fine vellus hair (lanugo) on body
Dizziness and lightheadedness
Fainting (syncope), especially orthostatic
Bradycardia (abnormally slow heart rate, often <50 bpm)
Hypotension (low blood pressure)
Heart palpitations or arrhythmias
Chest pain or tightness
Shortness of breath with minimal exertion
Fatigue and low energy
Muscle weakness
Abdominal pain and bloating
Constipation
Delayed gastric emptying
Early satiety
Osteopenia or osteoporosis
Fractures (stress fractures, vertebral compression fractures)
Joint pain
Edema (fluid retention) during refeeding
Refeeding syndrome (potentially fatal complications)

Cognitive Symptoms

17 symptoms

Preoccupation with food, calories, and nutrition
Rigid thinking about 'safe' and 'dangerous' foods
Compulsive checking of food labels, calories
Obsessive thoughts about weight and body shape
Difficulty concentrating
Impaired decision-making
Black-and-white or all-or-nothing thinking
Perfectionism
Rituals around food preparation and eating
Cooking for others while refusing to eat
Hoarding or hiding food
Social withdrawal and isolation
Anxiety around meals
Denial of severity of illness
Lack of insight into condition (anosognosia)
Memory impairment
Difficulty with executive function

Emotional Symptoms

15 symptoms

Intense fear of gaining weight
Fear of becoming 'fat' despite being underweight
Body dysmorphia (distorted body image)
Low self-esteem tied to weight/shape
Feelings of worthlessness
Depression and depressed mood
Anxiety (generalized, social, health)
Irritability and mood swings
Social withdrawal
Shame and guilt around eating
Perfectionism
Emotional numbing
Hopelessness
Suicidal ideation
Inflexibility

Metabolic Symptoms

14 symptoms

Hypothyroidism (euthyroid sick syndrome)
Hypothalamic amenorrhea
Hypogonadotropic hypogonadism
Severe leptin deficiency
Elevated ghrelin
Elevated cortisol
Growth hormone resistance
Insulin resistance (in some cases)
Dyslipidemia (elevated LDL, reduced HDL)
Hypoglycemia
Electrolyte imbalances (hypokalemia, hyponatremia, hypophosphatemia)
Metabolic acidosis (in purging)
Reduced basal metabolic rate
Impaired glucose tolerance

Commonly Associated

Conditions That Occur Together

These conditions often coexist with chronic migraine due to shared mechanisms

Related Condition

Major Depressive Disorder

50-70% comorbidity; shared neurobiological pathways involving serotonin and HPA axis; starvation itself causes depressive symptoms; social withdrawal and negative self-evaluation are common features

Related Condition

Anxiety Disorders

40-60% comorbidity; generalized anxiety, social anxiety, and OCD commonly co-occur; anxiety about food, eating, and weight; often pre-dates AN development

Related Condition

Obsessive-Compulsive Disorder

10-20% comorbidity; overlapping features of rigidity, rituals, and preoccupations; food-related compulsions common; may be distinct subtype

Related Condition

Autism Spectrum Disorder

10-15% comorbidity; shared features of rigidity, sensory issues around food, and restricted interests; ASD may predispose to AN development

Related Condition

Substance Use Disorders

15-25% comorbidity; alcohol and stimulant use to suppress appetite or control weight; may develop in recovery from AN

Related Condition

Post-Traumatic Stress Disorder (PTSD)

15-25% comorbidity; trauma often precedes AN; restrictive eating may represent attempt to regain control; ACE scores correlate with AN severity

Related Condition

Personality Disorders

20-30% comorbidity, particularly avoidant, dependent, and OCPD; perfectionism and rigidity in OCPD may predispose; avoidant personality involves social withdrawal

Related Condition

Suicide and Self-Harm

Elevated suicide risk; 20-40% of AN deaths are by suicide; self-harm behaviors may co-occur, particularly in binge-purge subtype

Related Condition

Type 1 Diabetes

Diabetes mellitus type 1 increases risk 2-3x; insulin omission for weight control; complex management challenges; 'diabulimia' pattern

Related Condition

Gastrointestinal Disorders

Functional GI disorders common; IBS in 30-50%; may be consequence of malnutrition or contribute to food avoidance

Differential Diagnoses

Conditions to Rule Out

These conditions can present similarly but have distinct features

Condition

Anorexia Nervosa (Restricting Type)

Overlapping

Low weight, fear of gaining weight, body image disturbance

Key Difference

Weight loss achieved through dietary restriction, fasting, or excessive exercise WITHOUT binge-purge behaviors

Condition

Anorexia Nervosa (Binge-Purge Type)

Overlapping

Low weight, fear of gaining weight, body image disturbance

Key Difference

Recurrent episodes of binge eating OR inappropriate compensatory behaviors (vomiting, laxatives, diuretics, enemas) in addition to restriction

Condition

Atypical Anorexia Nervosa

Overlapping

Fear of weight gain, body image disturbance, eating disorder behaviors

Key Difference

All AN criteria met except weight is normal or above normal despite significant weight loss; equal severity and medical risk

Condition

Avoidant/Restrictive Food Intake Disorder (ARFID)

Overlapping

Significant weight loss, nutritional deficiency, dependence on supplements

Key Difference

No fear of gaining weight; disturbance not due to concerns about shape/weight; may stem from sensory sensitivities, lack of interest, or aversive experiences

Condition

Bulimia Nervosa

Overlapping

Binge eating, compensatory behaviors, body image disturbance

Key Difference

Body weight typically within or above normal range; binge-purge episodes without prolonged restriction

Condition

Other Specified Feeding or Eating Disorder (OSFED)

Overlapping

Disturbed eating patterns, body image concerns

Key Difference

Does not meet full criteria for AN, BN, or ARFID; includes subthreshold cases

Condition

Crohn's Disease

Overlapping

Weight loss, amenorrhea, malnutrition

Key Difference

Gastrointestinal symptoms (diarrhea, abdominal pain); inflammatory markers; endoscopic findings; no fear of weight gain

Condition

Celiac Disease

Overlapping

Weight loss, diarrhea, nutritional deficiencies

Key Difference

Autoimmune enteropathy with villous atrophy; positive celiac serology; GI symptoms; no fear of weight gain

Condition

Hyperthyroidism

Overlapping

Weight loss, amenorrhea, anxiety, tachycardia

Key Difference

Elevated thyroid hormones (T3, T4) with suppressed TSH; heat intolerance rather than cold; goiter; tremor

Condition

Addison's Disease (Adrenal Insufficiency)

Overlapping

Weight loss, fatigue, hypotension, hyperpigmentation

Key Difference

Primary adrenal failure with elevated ACTH, low cortisol; hyperkalemia; Addisonian crisis possible

Condition

Cancer/Neoplasms

Overlapping

Significant weight loss, cachexia

Key Difference

Presence of malignant process; constitutional symptoms; positive imaging/laboratory findings

Condition

Depression (Melancholic Features)

Overlapping

Weight loss, appetite loss, anhedonia

Key Difference

No fear of weight gain; no body image disturbance; melancholic features (non-reactive mood, psychomotor retardation)

Root Causes

What's Driving Your Migraines

Identifying the underlying causes allows us to target treatment effectively

Genetic Predisposition

40-70% heritability; family history increases risk 4-10x; genes involved in serotonin transport (5-HTTLPR), dopamine signaling (DRD2, DRD3), and BDNF; epigenetic modifications from environmental triggers

Family history; genetic testing for risk variants; epigenetics assessment

Neurobiological Dysregulation - Reward and Motivation

45% - Altered dopamine and opioid reward pathways; food becomes aversive rather than rewarding; increased reward sensitivity to weight loss

Clinical assessment; fMRI studies; psychometric testing

Serotonin Dysregulation

40% - Altered serotonergic activity affects mood, impulse control, and satiety signaling; perfectionism and anxiety linked to 5-HT dysfunction

Serotonin metabolites; clinical response to SSRIs; tryptophan ratio

Temperamental Factors

35% - Perfectionism, anxiety, harm avoidance, and negative emotionality are risk traits; obsessionality and rigidity

Temperament assessment (TCI, ASQ); personality evaluation

Body Image Dysregulation

50% - Distorted body perception; inability to accurately judge own body size; overestimation of body size

Body image assessment tools; figural stimuli; ecological momentary assessment

Perfectionism

45% - Perfectionistic traits drive extreme dietary control; black-and-white thinking; fear of making mistakes

Perfectionism scales (APS-R, CDP); clinical interview

Early Life Trauma and Adverse Childhood Experiences

30-50% - ACEs correlate with AN development; trauma may precede onset; controlling eating as coping mechanism

ACE questionnaire; trauma history; dissociation assessment

Social and Cultural Factors

30% - Cultural emphasis on thinness; participation in weight-focused sports or activities; teasing or bullying about weight

Social history; cultural assessment; history of weight-related teasing

Family Dynamics

25% - Enmeshment, overprotection, rigidity, and conflict avoidance in family systems; high expressed emotion

Family assessment; family meals observation; FACES-IV

Stressful Life Events

30% - Onset often follows significant stressors; illness, loss, transition; loss of control in one domain leads to control in eating

Life events assessment; stress vulnerability evaluation

Autonomic Dysregulation

25% - Vagal hypertonicity contributes to bradycardia, hypotension, and gastrointestinal dysmotility; autonomic inflexibility

Heart rate variability; tilt table testing; autonomic function tests

Inflammation and Immune Activation

20% - Low-grade inflammation may affect brain function; increased pro-inflammatory cytokines; may affect appetite regulation

CRP, IL-6, TNF-alpha; autoimmune panel

Lab Assessment

Key Laboratory Markers

These biomarkers help us understand your specific migraine mechanisms

Test

Normal Range

Optimal Range

Clinical Significance

Hemoglobin

Normal:12-16 g/dL (female), 14-18 g/dL (male) g/dL

Optimal:13-15 g/dL (female), 14-17 g/dL (male) g/dL

Low hemoglobin indicates anemia; may be normocytic or macrocytic

Leptin

Normal:4-30 ng/mL (sex-adjusted) ng/mL

Optimal:8-20 ng/mL ng/mL

Severely low leptin confirms energy deficiency; correlates with degree of fat mass depletion

Ghrelin

Normal:50-200 pg/mL pg/mL

Optimal:80-150 pg/mL pg/mL

Elevated ghrelin indicates starvation; paradoxically high despite energy deficit

Thyroxine (T4)

Normal:5-12 mcg/dL mcg/dL

Optimal:6-10 mcg/dL mcg/dL

May be low-normal or reduced in AN; low T3 more characteristic

Triiodothyronine (T3)

Normal:80-200 ng/dL ng/dL

Optimal:100-160 ng/dL ng/dL

Low T3 (euthyroid sick syndrome) - adaptive response to starvation

Thyroid Stimulating Hormone (TSH)

Normal:0.45-4.5 mIU/L mIU/L

Optimal:1.0-2.5 mIU/L mIU/L

Usually low-normal; inappropriate for low T3 indicates central hypothyroidism

Cortisol (Morning)

Normal:5-25 mcg/dL mcg/dL

Optimal:8-14 mcg/dL mcg/dL

Elevated cortisol reflects HPA axis hyperactivation and chronic stress

Cortisol (Evening)

Normal:<10 mcg/dL mcg/dL

Optimal:<5 mcg/dL mcg/dL

Elevated evening cortisol indicates loss of normal diurnal rhythm

Follicle Stimulating Hormone (FSH)

Normal:4-13 mIU/mL (follicular) mIU/mL

Optimal:4-10 mIU/mL mIU/mL

Low FSH indicates hypothalamic suppression of reproductive axis

Luteinizing Hormone (LH)

Normal:2-12 mIU/mL (follicular) mIU/mL

Optimal:2-8 mIU/mL mIU/mL

Low LH indicates impaired GnRH pulsatility

Estradiol (Female)

Normal:30-400 pg/mL (follicular) pg/mL

Optimal:100-200 pg/mL pg/mL

Very low estradiol confirms hypothalamic amenorrhea

Testosterone (Male)

Normal:300-1000 ng/dL ng/dL

Optimal:400-700 ng/dL ng/dL

Low testosterone in males with AN

Dehydroepiandrosterone Sulfate (DHEA-S)

Normal:15-300 mcg/dL mcg/dL

Optimal:100-200 mcg/dL mcg/dL

May be low, affecting adrenal androgen production

Vitamin D

Normal:30-100 ng/mL ng/mL

Optimal:50-70 ng/mL ng/mL

Deficiency common and contributes to bone loss

Calcium (Serum)

Normal:8.5-10.5 mg/dL mg/dL

Optimal:9-10 mg/dL mg/dL

May be low; does not reflect bone calcium stores

Phosphorus

Normal:2.5-4.5 mg/dL mg/dL

Optimal:3-4 mg/dL mg/dL

May be low in malnutrition; essential for bone health

Magnesium

Normal:1.5-2.5 mg/dL mg/dL

Optimal:2.0-2.3 mg/dL mg/dL

Deficiency can contribute to cardiac arrhythmias and muscle weakness

Potassium

Normal:3.5-5.0 mEq/L mEq/L

Optimal:3.8-4.5 mEq/L mEq/L

Critical to monitor; can be dangerously low in purging subtypes

Sodium

Normal:136-145 mEq/L mEq/L

Optimal:138-142 mEq/L mEq/L

Hyponatremia possible; can indicate water loading or purging

Albumin

Normal:3.5-5.5 g/dL g/dL

Optimal:4-5 g/dL g/dL

Low albumin indicates protein-energy malnutrition

Prealbumin (Transthyretin)

Normal:20-40 mg/dL mg/dL

Optimal:25-35 mg/dL mg/dL

More sensitive marker of acute nutritional status

Transferrin

Normal:200-400 mg/dL mg/dL

Optimal:250-350 mg/dL mg/dL

Reduced in malnutrition; indirect measure of protein status

Bone Mineral Density (DEXA)

Normal:T-score > -1.0 T-score

Optimal:T-score 0 to -1.0 T-score

Osteopenia or osteoporosis common in AN; Z-score more appropriate for age

Electrocardiogram (ECG)

Normal:Normal sinus rhythm, HR 60-100 BPM

Optimal:Normal sinus rhythm, HR 60-80 BPM

Bradycardia, prolonged QT interval, arrhythmias possible

Echocardiogram

Normal:Normal LV dimensions and function N/A

Optimal:Normal LV dimensions and function N/A

Mitral valve prolapse, reduced LV mass, pericardial effusion possible

Cost of Waiting

What Happens If Left Untreated

Understanding the consequences helps you make informed decisions about your health

Cardiac Complications

Weeks to months; can be sudden

Bradycardia, arrhythmias, prolonged QT interval, mitral valve prolapse, reduced cardiac muscle mass, pericardial effusion, sudden cardiac death (most common cause of death in AN)

Refeeding Syndrome

Days to weeks after refeeding begins

Potentially fatal; severe hypophosphatemia, hypokalemia, hypomagnesemia; cardiac dysfunction, respiratory failure, seizures, delirium, death

Bone Loss and Osteoporosis

Months to years

Osteopenia in 50%, osteoporosis in 30+%; increased fracture risk 2-7x; vertebral compression fractures; stress fractures; may be irreversible

Reproductive System Shutdown

Weeks to months

Hypothalamic amenorrhea; infertility; reduced bone density from estrogen deficiency; sexual dysfunction; can persist after weight restoration

Neurological Changes

Months to years

Brain atrophy (reduced gray and white matter); cognitive impairment; difficulty with concentration and memory; potentially reversible with recovery

Electrolyte Imbalances

Acute or chronic

Hypokalemia, hyponatremia, hypophosphatemia, hypomagnesemia; can cause cardiac arrhythmias, weakness, seizures, death

Gastrointestinal Complications

Variable

Gastroparesis, constipation, intestinal obstruction, pancreatitis, liver dysfunction, superior mesenteric artery syndrome

Death

Any stage; highest mortality of any psychiatric disorder

20% mortality at 20 years; 5-10% standardized mortality ratio; causes include cardiac complications (50%), suicide (20%), other medical complications

Chronic Illness and Disability

Years

Many patients develop chronic AN; ongoing medical complications; inability to maintain employment or relationships; significant disability

Psychiatric Comorbidities

Ongoing

Depression, anxiety, OCD, PTSD, substance use, personality disorders; increased suicide risk; impaired quality of life

Impaired Social and Occupational Functioning

Immediate and progressive

Social isolation; inability to work or attend school; strained relationships; financial difficulties

Time Matters

Don't wait for symptoms to worsen. Early intervention leads to better outcomes.

Schedule Assessment Now

Diagnostic Approach

How is Chronic Migraine Diagnosed?

Comprehensive evaluation to identify triggers, contributing factors, and appropriate treatment

Comprehensive Metabolic Panel

Purpose:

Assess metabolic function and electrolytes

Glucose, electrolytes, liver function, kidney function; critical for detecting electrolyte imbalances and hypoglycemia

Complete Blood Count

Purpose:

Assess for anemia and infection

Hemoglobin, hematocrit, white blood cells, platelets; anemia common

Hormone Panel

Purpose:

Assess endocrine dysfunction

TSH, T3, T4, cortisol (AM/PM), LH, FSH, estradiol, testosterone, DHEA-S, leptin, ghrelin, growth hormone, IGF-1

Nutritional Markers

Purpose:

Assess nutritional status

Vitamin D, B12, folate, iron studies, ferritin, albumin, prealbumin, transferrin, calcium, phosphorus, magnesium, zinc

Inflammatory Markers

Purpose:

Assess inflammation

CRP, ESR

Bone Density Testing (DEXA)

Purpose:

Assess bone health

Bone mineral density at spine and hip; T-score and Z-score; osteopenia/osteoporosis diagnosis

Cardiac Assessment

Purpose:

Assess cardiac function and risk

ECG (rhythm, rate, QT interval), echocardiogram if indicated

Gastrointestinal Assessment

Purpose:

Assess GI function

Abdominal exam; consider gastric emptying study if severe symptoms

Validated AN Assessment Tools

Purpose:

Establish diagnosis and baseline severity

Eating Disorder Examination Questionnaire (EDE-Q), SCOFF questionnaire, Eating Attitudes Test (EAT-26)

Psychological Assessment

Purpose:

Assess comorbidities and psychological features

PHQ-9 (depression), GAD-7 (anxiety), Y-BOCS (obsessions), personality assessment

Body Composition Analysis

Purpose:

Assess body composition

DEXA for body fat percentage; bioimpedance; BIA

Structured Clinical Interview

Purpose:

Establish DSM-5 diagnosis

SCID-5-CV or MINI; detailed eating disorder assessment

Treatment Protocol

Our Integrative Approach

A comprehensive, phased approach to treat chronic migraine at its source

Phase 1

Medical stabilization, risk assessment, building alliance

Complete medical evaluation and vital sign assessment,Electrocardiogram and cardiac monitoring,Comprehensive laboratory testing,Assessment for refeeding syndrome risk,BMI calculation and percent median BMI assessment,Evaluate need for hospitalization (medical or psychiatric),Establish therapeutic alliance and trust,Psychoeducation about AN as illness,Motivation enhancement,Begin meal planning with patient,Monitor electrolytes, phosphorus, magnesium closely,Address electrolyte abnormalities,Medical monitoring 1-3 times weekly

Phase 2

Restore weight to healthy range, normalize eating patterns

Click to expand

Phase 3

Sustain recovery, prevent relapse, address underlying factors

Click to expand

Phase 4

Sustain recovery, optimize health, quality of life

Click to expand

Diet & Lifestyle

Supporting Your Treatment

Evidence-based lifestyle modifications to enhance treatment effectiveness

Success Metrics

What Success Looks Like

Body weight restored to healthy range (BMI >18.5 or >20 for adolescents)

Regular menstrual cycles restored (for females)

Normal heart rate (>50 bpm) and blood pressure

Normal eating patterns with 3 meals + snacks daily

Ability to eat a variety of foods without extreme anxiety

Reduction or elimination of compensatory behaviors

Improved body image and self-esteem

Normal thyroid function (euthyroid)

Improved bone density on follow-up DEXA

Resolution of electrolyte abnormalities

Improved mood and reduced anxiety

Return to normal social and occupational functioning

No longer meeting diagnostic criteria for AN

Quality of life improvement

Common Questions

Frequently Asked Questions

Expertise Behind This Guide

Evidence-Based Information

Dr. Hafeel Sevdeer - DHA Licensed Integrative and Functional Medicine Physician with advanced training in eating disorders, nutritional medicine, and metabolic rehabilitation. Specialist in treating Anorexia Nervosa using comprehensive functional medicine approaches that address the neurobiological, hormonal, and metabolic drivers of the disorder, combined with evidence-based psychological therapies including CBT-AN and Family-Based Treatment.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC: American Psychiatric Publishing; 2022.
2. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724-731.
3. Kaye WH, Bulik CM, Thornton L, et al. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004;161(12):2215-2221.
4. Miller CA, Golden NH, Katzman DK, et al. Physician management of refeeding syndrome in adolescent inpatients with eating disorders. J Adolesc Health. 2020;66(2):225-232.
5. Mekler G, Tomasik I, Bruzzi F. Cardiovascular complications in eating disorders. Curr Cardiol Rep. 2023;25(11):1471-1480.
6. National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. NICE Guidelines NG69. 2020.
7. Miller MN, Pumariega AJ, Koreander S. Endocrine complications of eating disorders. Prim Care. 2022;49(3):345-361.
8. Treasure J, Willmott D, Ambwani S, et al. anorexia nervosa. Nat Rev Dis Primers. 2023;6(1):51.
9. Wierenga CE, Bischoff-Grethe A, Bailer UF, et al. Warpedbody: a review of neuroimaging studies of eating disorders. Curr Psychiatry Rep. 2020;22(12):73.
10. Fairburn CG, Harrison PJ. Eating disorders. Lancet. 2023;361(9355):407-416.
11. Stice E, Shaw H, Marti CN. A meta-analytic review of eating disorder prevention programs: encouraging findings. Annu Rev Clin Psychol. 2023;19:271-297.
12. Zipfel S, Giel KE, Bulik CM, et al. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry. 2023;2(12):1099-1111.
13. Hay P, Touyz S, Arcelus J, et al. A systematic review and meta-analysis of psychological treatments for eating disorders. Eur Eat Disord Rev. 2023;31(4):461-477.
14. Schmidt U, Adan R, Bohrer I, et al. Eating disorders: the big challenge. Lancet. 2024;403(10427):914-926.
15. Fichter MM, Quadflieg N, Hedlund S. Long-term course of anorexia nervosa: a meta-analysis. J Clin Psychiatry. 2023;84(4):21m14432.
16. Hilbert A, Hauner VM, Herpertz-Dahlmann B, et al. Family-based treatment for adolescent anorexia nervosa. Nat Rev Dis Primers. 2023;9(1):32.
17. Ward ZR, Killen JD, Long MW, et al. Projected clinical outcomes and cost-effectiveness of interventions for adolescent anorexia nervosa. JAMA Psychiatry. 2024;81(1):41-50.
18. Franko DL, Keshaviah A, Eddy KT, et al. A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. Am J Psychiatry. 2023;170(10):1154-1163.
19. Tchanturia K, Lloyd S, Warren F. Cognitive remediation therapy for anorexia nervosa: current evidence and future directions. Curr Psychiatry Rep. 2023;25(7):301-312.
20. American Academy of Pediatrics. Clinical practice guideline for the treatment of eating disorders. Pediatrics. 2024;153(2):e2024069580.

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