Identification, Assessment & Management of Anorexia Nervosa

Case: Assessment & Diagnosis

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Knowledge Translation Commentary

Excessive exercise is very common in patients with anorexia nervosa.

It is often overlooked or even encouraged by physicians who may be unaware of the vital role exercise can play in precipitating and perpetuating anorexia nervosa.

Patients with anorexia nervosa typically choose socially isolating and solitary forms of exercise such as running or other intense aerobic activity.

Patients frequently also spend hours walking, pacing, and fidgeting to burn excess calories and cope with high anxiety so it is important to ask about these symptoms.

When patients with anorexia nervosa are exercising, it is extremely important to ask about cardiac symptoms such as palpitations, chest pain, shortness of breath, and lightheadedness AND to regularly monitor cardiac status with objective tests including an ECG, electrolyte levels, and hydration. Patients are at risk of sudden cardiac death from arrhythmias and ischemia.