Anorexia Nervosa: Clinical Course, Comorbidities, and Current Treatment Approaches

Year 2025, Volume: 27 Issue: 2, 231 - 238, 25.08.2025

Hande Çeri Gülegen

https://doi.org/10.24938/kutfd.1657593

Abstract

Eating disorders are serious conditions with significant physical and psychological effects during childhood and adolescence, posing a potential threat to life. According to the DSM-5, Anorexia Nervosa (AN) is characterized by an intense fear of gaining weight and restrictive eating behaviors. The etiology of AN remains unclear, and the course of the illness is variable; while 46% of patients achieve full recovery, 20% develop a chronic course. AN is frequently associated with psychiatric comorbidities such as anxiety disorders and depression and may lead to severe medical complications, particularly affecting the cardiovascular, endocrine, gastrointestinal, and neurological systems. Treatment requires a multidisciplinary approach, with nutritional rehabilitation, psychotherapy, and pharmacotherapy being the most crucial components. Cognitive Behavioral Therapy (CBT) is a widely used treatment method for AN. Antipsychotics like olanzapine have been shown to aid in weight gain, though the efficacy of other medications remains controversial. Antidepressants may be beneficial in managing anxiety and depressive symptoms, but evidence supporting their direct effect on eating behaviors is limited. Due to the risk of refeeding syndrome, the refeeding process must be carefully planned. Long-term follow-up and patient adherence remain among the most challenging aspects of treatment. This review addresses the clinical course, comorbidities, medical complications, and current treatment approaches for anorexia nervosa.

Keywords

Anorexia nervosa , eating disorders , cognitive behavioral therapy , pharmacotherapy

ANOREKSİYA NERVOZA: ETİYOLOJİ, KLİNİK SEYİR, KOMORBİDİTELER VE GÜNCEL TEDAVİ YAKLAŞIMLARI

Abstract

Yeme bozuklukları, çocukluk ve ergenlik döneminde önemli fiziksel ve psikolojik etkileri olan, yaşamı tehdit edebilen ciddi hastalıklardır. DSM-5’e göre Anoreksiya Nervoza (AN), kilo alma korkusu ve yiyecek kısıtlaması ile karakterizedir. AN’nin etiyolojisi kesin olarak belirlenmemiş olup, hastalığın seyri değişkendir; tam iyileşme oranı %46 iken, %20’sinde hastalık kronikleşmektedir. AN, anksiyete bozuklukları ve depresyon gibi psikiyatrik komorbiditelerle sık görülür ve ciddi tıbbi komplikasyonlara yol açabilir. Özellikle kardiyovasküler, endokrin, gastrointestinal ve nörolojik sistemler bu hastalıktan etkilenir. Tedavi multidisipliner bir yaklaşım gerektirir; beslenme rehabilitasyonu, psikoterapi ve farmakoterapi en önemli bileşenlerdir. Bilişsel Davranışçı Terapi (BDT), Anoreksiya Nervoza yaygın kullanılan bir tedavi yöntemidir. Olanzapin gibi antipsikotiklerin kilo alımına yardımcı olabileceği gösterilmiştir. Antidepresanlar, anksiyete ve depresyon belirtilerinde faydalı olabilir ancak yeme davranışını doğrudan iyileştirdiğine dair kanıtlar sınırlıdır. Yeniden beslenme sendromu riski nedeniyle beslenme süreci dikkatli planlanmalıdır. Uzun vadeli takip ve hasta uyumu tedavi sürecinin en zorlu aşamalarından biridir. Bu derlemede; anoreksiya nervoza klinik seyri, komorbiditeleri, tıbbi komplikasyonları ve güncel tedavi yaklaşımları ele alınmıştır.

Keywords

Anoreksiya nervoza , yeme bozuklukları , bilişsel davranışçı terapi , farmakoterapi

Ethical Statement

Sayın Yetkili, Ben, Dr. Hande Çeri Gülegen, Anoreksiya Nervoza: Etiyoloji, Klinik Seyir, Komorbiditeler Ve Güncel Tedavi Yaklaşımları başlıklı derleme makalesinin yazarıyım. Makalemizde hasta, kontrol grubu ve herhangi bir bütçe gerektirecek çalışma bulunmamaktadır. Bu nedenle, söz konusu çalışma için etik kurul onayına gerek olmadığını bildirmek isterim. Gereğini bilgilerinize arz eder, saygılarımı sunarım.

References

• Hornberger LL, Lane WG, Halleran JL, Emans SJ. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021;147.
• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., Text Revision. Washington, DC: American Psychiatric Publishing; 2022.
• Bell CC. DSM-IV: Diagnostic and statistical manual of mental disorders. JAMA. 1994;272(10):828-829.
• Steinhausen HC. Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am. 2009;18(1):225-242.
• Blinder BJ, Cumella EJ, Sanathara VA. Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med. 2006;68(3):454-462.
• Kountzzi F, Kollias C, Tzavara C, Kiousi A, Douzenis A, Michopoulos I. Psychiatric comorbi-dity in adolescent inpatients with anorexia nervosa: a cross-sectional study. Psychiatriki. 2017;28(1):17–25.
• Fiacco S, Bortolotti S, Rossi G, Pellegrino F, Cavicchioli M, Maffei C. Psychiatric symptom severity and comorbidity in adolescents with anorexia nervosa: a clinical profile. Eur Eat Di-Sord Rev. 2024;32(2):189–198.
• Kountza M, Garyfallos G, Ploumpidis D, Varsou E, Gkiouzepas I. The psychiatric comorbidity of anorexia nervosa: a comparative study in a population of French and Greek anorexic pati-ents. L'Encephale. 2017;43(2):134–141.
• Fiacco G, Catone G, Salerno F, et al. Internalizing psychiatric comor-bidities among adolescents with anorexia nervosa. Int J Pediatr Child Health. 2024;57(1):45–52.
• Longo P, Toppino F, Martini M, et al. Diagnostic concordance between research and clinical-based assessments of psychiatric comorbidity in anorexia nervosa. J Clin Med. 2022;11(5):1245–1252.
• Swinbourne JM, Touyz SW. The co-morbidity of eating disorders and anxiety disorders: a re-view. Eur Eat Disord Rev. 2007;15(4):253–274.
• Fuentebella J, Kerner JA. Refeeding syndrome. Pediatr Clin North Am. 2009;56(5):1201-1210.
• Boateng AA, Sriram K, Meguid MM, Crook M. Refeeding syndrome: Treatment considerati-ons based on collective analysis of literature case reports. Nutrition. 2010;26(2):156-167.
• Sachs M, Mehler PS, Langeluddecke P, et al. Cardiovascular complications of anorexia nervo-sa: a systematic review. Int J Eat Disord. 2016;49(3):238–247.
• Męczekalski B, Niwczyk O, Battipaglia C, et al. Neuroendocrine disturbances in women with functional hypothalamic amenorrhea: an update and future directions. Endocrine. 2023;85(3):458–468.
• Gormez A, Kurtulmus A, Kirpinar I. Iron metabolism and haematological changes in anorexia nervosa: an adult case report. Eat Weight Disord. 2018;23(3):395–398.
• Ercan ES, Coşkun A, Yıldırım Y, editors. Çocuk ve ergen psikiyatrisi. Ankara: Akademisyen Kitabevi; 2020:597-600.
• Kaya A, Özdemir F. Multidisipliner yaklaşım ve anoreksiya nervozada tedavi süreci. Psikiyatri Derg. 2021;35(2):123–130.
• Attia E, Walsh BT. Behavioral management for anorexia nervosa. N Engl J Med. 2009;360(5):500-506.
• Mehler PS, Winkelman AB, Andersen DM, Gaudiani JL. Nutritional rehabilitation: Practical guidelines for refeeding the anorectic patient. J Nutr Metab. 2010; 2010:625782.
• Kameoka N, Iwasa K, Kondo M, et al. Risk factors for refeeding hypophosphatemia in Japanese inpatients with anorexia nervosa. Int J Eat Disord. 2016;49(4):402-406.
• Ornstein RM, Golden NH, Jacobson MS. Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: Implications for refeeding and monitoring. J Adolesc Health. 2003;32(1):83-84.
• da Silva JSV, Seres DS, Sabino K, et al. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020;35(2):178-195.
• Garber AK, Michihata N, Hetnal K, Shafer M-A, Moscicki A-B. A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord. 2016;49(3):293-310.
• Schmidt U, Oldershaw A, Jichi F, et al. Out-patient psychological therapies for adults with anorexia nervosa: Randomised controlled trial. Br J Psychiatry. 2012;201(5):392-399.
• American Psychiatric Association. Treatment of patients with eating disorders. 3rd ed. Am J Psychiatry. 2006;163(7 Suppl):4-54.
• Carter FA, Jordan J, McIntosh VV, et al. The long-term efficacy of three psychotherapies for anorexia nervosa: A randomized, controlled trial. Int J Eat Disord. 2011;44(7):647-654.
• Couturier J, Kimber M, Szatmari P. Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. Int J Eat Disord. 2013;46(1):3-11.
• Key AC, George CL, Beattie D, Stammers K, Lacey H, Waller G. Body image treatment within an inpatient program for anorexia nervosa: the role of mirror exposure in the desensitization process. Int J Eat Disord. 2002;31(2):185-190.
• Linardon J, Shatte A, Messer M, Firth J, Fuller-Tyszkiewicz M. E-mental health interventions for the treatment and prevention of eating disorders: A systematic review and meta-analysis. J Consult Clin Psychol. 2020;88(3):263-279.
• Berman A, Boutelle K, Crow S. Acceptance and commitment therapy in anorexia nervosa: a case series. J Clin Psychol. 2009;65(5):512-522.
• Dolhanty J, Greenberg LS. Emotion-focused therapy for anorexia nervosa: a case study. Psychother Res. 2009;19(5):601-612.
• Fairburn CG. Cognitive behavior therapy and eating disorders. New York: Guilford Press; 2008.
• Waller G, Cordery H, Corstorphine E, et al. Cognitive-behavioral therapy for eating disorders: a review of the evidence. Behav Res Ther. 2007;45(9):2105-2126.
• National Guideline Alliance (UK). Eating disorders: recognition and treatment. London: National Institute for Health and Care Excellence (NICE); 2017.
• Dunican KC, DelDotto D. The role of olanzapine in the treatment of anorexia nervosa. Ann Pharmacother. 2007;41(1):111-115.
• Attia E, Steinglass JE, Walsh BT, et al. Olanzapine versus placebo in adult outpatients with anorexia nervosa: a randomized clinical trial. Am J Psychiatry. 2019;176(6):449-456.
• Bissada H, Tasca GA, Barber AM, Bradwejn J. Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2008;165(10):1281-1288.
• Brambilla F, Monteleone P, Bortolotti F. Olanzapine therapy in anorexia nervosa: psychobiological effects. Int Clin Psychopharmacol. 2007;22(4):197-204.
• Hagman J, Grishkat HL, Fortune S, Ryst E. A double-blind, placebo-controlled study of risperidone for the treatment of adolescents and young adults with anorexia nervosa: a pilot study. J Am Acad Child Adolesc Psychiatry. 2011;50(9):915-924.
• Pruccoli J, Bergonzini L, Pettenuzzo I, Parmeggiani A. The role of risperidone in the treatment of children and adolescents with anorexia nervosa. J Psychopharmacol. 2023;37(6):551-560.
• Pruccoli J, Bergonzini L, La Tempa A, Parmeggiani A. Antipsychotics in the treatment of children and adolescents with anorexia nervosa: a systematic review. Biomedicines. 2022;10(12):3167.
• Powers PS, Klabunde M, Kaye W. Double-blind placebo-controlled trial of quetiapine in anorexia nervosa. Eur Eat Disord Rev. 2012;20(4):331-334.
• Dold M, Li C, Giegling I, et al. Quetiapine for the treatment of schizophrenia: A meta-analysis of randomized controlled trials. Schizophr Res. 2015;164(1-3):1-9.
• Powers A, Joseph J, Redd W, et al. Quetiapine for treatment of anorexia nervosa: A randomized double-blind placebo-controlled trial. Psychopharmacology (Berl). 2012;223(3):323-329.
• Kishi T, Matsunaga S, Iwata N. Quetiapine for schizophrenia: A systematic review and meta-analysis of randomized controlled trials. Psychopharmacology (Berl). 2012;219(4):899-908.
• Frank GK, Shott ME, DeGuzman MC, et al. The partial dopamine D2 receptor agonist aripiprazole is associated with weight gain in adolescent anorexia nervosa. Int J Eat Disord. 2017;50(4):447-450.
• Yazıcı KU, Yulaf Y, Özbaran B, Karakaya I. Aripiprazole treatment in adolescents with anorexia nervosa: a retrospective chart review. Clin Psychopharmacol Neurosci. 2020;18(4):662–667.
• Frank GK. Aripiprazole, a partial dopamine agonist to improve adolescent anorexia nervosa—A case series. Int J Eat Disord. 2016;49(6):529–533.
• Tahıllıoğlu A, Özcan T, Yüksel G, Majroh N, Köse S, Özbaran B. Is aripiprazole a key to unlock anorexia nervosa? A case series. Clin Case Rep. 2020;8(12):2827–2834.
• Aigner M, Treasure J, Kaye W, Kasper S, WFSBP Task Force on Eating Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders. World J Biol Psychiatry. 2011;12(6):400-443.
• Marvanova M, Gramith K. Role of antidepressants in the treatment of adults with anorexia nervosa. Ment Health Clin. 2018;8(3):127-137.
• Himmerich H, Kan C, Au K, Treasure J. Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition, and physical health consequences. Pharmacol Ther. 2021;217:107667.
• Steinglass J, Kaplan S, Liu Y, Wang Y, Walsh BT. The lack of effect of alprazolam on eating behavior in anorexia nervosa: a preliminary report. Int J Eat Disord. 2014;47(8):901-904.
• Knatz Peck S, Shao S, Gruen T, et al. Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study. Nat Med. 2023;29(8):1947–1953.
• Scolnick B, Zupec-Kania B, Calabrese L, Aoki C, Hildebrandt T. Remission from chronic anorexia nervosa with ketogenic diet and ketamine: case report. Front Psychiatry. 2020;11:763.
• Jaššová K, Albrecht J, Papežová H, Anders M. Repetitive transcranial magnetic stimulation (rTMS) treatment of depression and anxiety in a patient with anorexia nervosa. Med Sci Monit. 2018;24:5279–5281.
• Fazeli PK, Lawson EA, et al. Treatment With a Ghrelin Agonist in Outpatient Women With Anorexia Nervosa: A Randomized Clinical Trial. J Clin Psychiatry. 2018;79(1):17m11585
• Guastella AJ, Howard AL, Dadds MR, Mitchell P, Carson DS. A randomized controlled trial of intranasal oxytocin as an adjunct to exposure therapy for social anxiety disorder. Psychoneuroendocrinology. 2009;34(6):917-23.
• Andries A, Frystyk J, Flyvbjerg A, Støving RK. Dronabinol in severe, enduring anorexia nervosa: a randomized controlled trial. Int J Eat Disord. 2014;47(1):18-23