Patients may be depressed and should be questioned to gauge risk of suicide. Obtain a mental history since there is a strong association with depression and substance abuse. Often, the family will bring in the patient because many patients may refuse to seek help or may have no insight into their problem. Recurrent patients may recognize their problem and present spontaneously for therapy. Behaviorally, these patients often have a flat affect and display psychomotor retardation.
Etiology is thought to be a combination of psychological, biological, and social factors.
Biological factors are not well described, but progressive starvation and subsequent abnormal metabolism of protein and fat substrates seem to perpetuate the anorexic state. Social factors relate to societal as well as intrafamilial emphasis on thinness as a requirement for acceptability. A complete blood count may reveal a normocytic normochromic anemia due to bone marrow suppression of starvation as well as a mild leukopenia. A chemistry panel may demonstrate a severe hypokalemia due to laxative abuse or due to alkalemia from vomiting. In addition, dehydration may result in significant electrolyte abnormalites including sodium and chloride.