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The Medical Complications of Anorexia Nervosa

Published online by Cambridge University Press:  02 January 2018

C. W. Sharp*
Affiliation:
University of Edinburgh, Department of Psychiatry, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF
C. P. L. Freeman
Affiliation:
Royal Edinburgh Hospital, Edinburgh
*
Correspondence

Abstract

The physical complications of anorexia nervosa are common and can be life threatening, but psychiatrists and the increasing number of non-medical therapists involved in treatment programmes often overlook these complications. Cardiovascular complications are the most common, and the most likely to result in fatalities, particularly in those patients who vomit, purge or abuse diuretics, because of the electrolyte abnormalities induced. Osteoporosis is an early and perhaps irreversible consequence of severe weight loss. Further, there are dangers in rapid intravenous hyperalimentation.

Type
Review Article
Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

Alcalay, J., Ingber, A. & Sandbank, M. (1986) Mask–phenomenon: postemesis facial purpura. Cutis, 38, 28.Google ScholarPubMed
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III-R). Washington, DC: APA.Google Scholar
Amrein, P.C. & Ellman, L. (1979) Anorexia nervosa and acanthocytosis (letter). Journal of American Medical Association, 242, 2760.CrossRefGoogle Scholar
Amrein, P.C. Friedman, R., Kosinski, K., et al (1979) Haematologic changes in anorexia nervosa. Journal of American Medical Association, 241, 21902191.Google Scholar
Anyan, W.R. (1974) Changes in the erythrocyte sedimentation rate and fibrinogen during anorexia nervosa. Journal of Pediatrics, 85, 525527.CrossRefGoogle ScholarPubMed
Arik, T.H., Dresser, K.B. & Benchimol, A. (1985) Cardiac complications of intensive dieting and eating disorders. Arizona Medicine, 42, 7274.Google Scholar
Bachrach, L.K., Guido, D., Katzman, D., et al (1990) Decreased bone density in adolescent girls with anorexia nervosa. Pediatrics, 86, 440447.CrossRefGoogle ScholarPubMed
Backett, S.A. (1985) Acute pancreatitis and gastric dilatation in a patient with anorexia nervosa. Postgraduate Medical Journal, 61, 3940.CrossRefGoogle Scholar
Berkman, J.M. (1930) Anorexia nervosa, anorexia, inanition and low basal metabolic rate. American Journal of Medical Sciences, 180, 411424.CrossRefGoogle Scholar
Berkman, J.M. (1945) Anorexia nervosa: the diagnosis and treatment of inanition resulting from functional disorders. Annals of Internal Medicine, 22, 679691.Google Scholar
Beumont, P.J.V., Friesen, H.G., Gelder, M.G., et al (1974) Plasma prolactin and luteinizing hormone levels in anorexia nervosa. Psychological Medicine, 4, 219221.CrossRefGoogle ScholarPubMed
Beumont, P.J.V., George, G.C.W., Pimstone, B.L., et al (1976) Body weight and the pituitary response to hypothalamic releasing hormones in patients with anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 43, 487496.CrossRefGoogle ScholarPubMed
Biller, B.M.K., Saxe, V., Herzog, D.B., et al (1989) Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 68, 548554.Google Scholar
Bose, J.P., De, U.N. & Mukerjee, P. (1946) Preliminary study of biochemical changes in starvation cases. Indian Journal of Medical Research, 34, 143150.Google ScholarPubMed
Bowers, T.K. & Eckert, E. (1978) Leukopenia in anorexia nervosa. Lack of increased risk of infection. Archives of Internal Medicine, 138, 15201523.CrossRefGoogle ScholarPubMed
Boyar, R.M. & Bradlow, H.L. (1977) Studies of testosterone metabolism in anorexia nervosa. In Anorexia Nervosa (ed. Vigersky, R. A.), pp. 263270. New York: Raven Press.Google Scholar
Boyar, R.M. & Katz, J. (1977) Twenty–four hour gonadotrophin secretory patterns in anorexia nervosa. In Anorexia Nervosa (ed. Vigersky, R. A.), pp. 177187. New York: Raven Press.Google ScholarPubMed
Boyar, R.M., Hellman, L.D., Roffwarg, H., et al (1977) Cortisol secretion and metabolism in anorexia nervosa. New England Journal of Medicine, 296, 190193.CrossRefGoogle ScholarPubMed
Bradlow, H.L., Boyar, R.M., O'Connor, J., et al (1976) Hypothyroid–like alterations in testosterone metabolism in anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 43, 571574.CrossRefGoogle ScholarPubMed
Brincat, M., Parsons, V. & Studd, J. (1983) Anorexia nervosa. British Medical Journal, 287, 1306.CrossRefGoogle ScholarPubMed
Brotman, A.W. & Stern, T.A. (1985) Osteoporosis and pathologic fractures in anorexia nervosa. American Journal of Psychiatry, 142, 495496.Google ScholarPubMed
Brotman, A.W. & Stern, T. A. & Brotman, D. L. (1986) Renal disease and dysfunction in two patients with anorexia nervosa. Journal of Clinical Psychiatry, 47, 433434.Google ScholarPubMed
Clark, D.C. (1985) Oral complications of anorexia nervosa and/or bulimia: with a review of the literature. Journal of Oral Medicine, 40, 134138.Google Scholar
Conn, J.W. (1940) Interpretation of the glucose tolerance test. The necessity of a standard preparatory diet. American Journal of Medical Sciences, 199, 555564.CrossRefGoogle Scholar
Cook, G.C. & Hutt, M.S.R. (1967) The liver after kwashiorkor. British Medical Journal, 3, 454457.CrossRefGoogle ScholarPubMed
Cooke, J.N.C., James, V.H.T., Landon, J., et al (1964) Adrenocortical function in chronic malnutrition. British Medical Journal, 1, 662666.CrossRefGoogle ScholarPubMed
Crisp, A.H. (1965) Some aspects of the evolution, presentation and follow–up of anorexia nervosa. Proceedings of the Royal Society of Medicine, 58, 814820.CrossRefGoogle ScholarPubMed
Crisp, A.H. (1969) Some skeletal measurements in patients with primary anorexia nervosa. Journal of Psychosomatic Research, 13, 125142.CrossRefGoogle ScholarPubMed
Crisp, A.H., Blendis, L.M. & Pawan, G.L.S. (1968) Aspects of fat metabolism in anorexia nervosa. Metabolism, 17, 11091118.CrossRefGoogle ScholarPubMed
Crisp, A.H., Stonehill, E. & Fenton, G.W. (1970) An aspect of the biological basis of the mind–body apparatus: the relationship between sleep, nutritional state and mood in disorders of weight. Psychotherapy and Psychosomatics, 18, 161175.CrossRefGoogle ScholarPubMed
Croxson, M.S. & Ibbertson, H.K. (1977) Low serum triiodothyronine (T3) and hypothyroidism in anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 44, 167174.Google Scholar
Cuellar, R.E. & Van Thiel, D.H. (1986) Gastrointestinal consequences of the eating disorders: anorexia nervosa and bulimia. American Journal of Gastroenterology, 81, 11131124.Google Scholar
Cumming, A.D., Farquhar, J.R. & Bouchier, I.A.D. (1987) Refeeding hypophosphataemia in anorexia nervosa and alcoholism. British Medical Journal, 295, 490491.Google Scholar
Cummings, S.R., Kelsey, J.L., Nevitt, M.C., et al (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiologic Reviews, 7, 178208.CrossRefGoogle ScholarPubMed
Cummings, J.H., Sladen, G.E., James, O.F.W., et al (1974) Laxative–induced diarrhoea: a continuing clinical problem. British Medical Journal, i, 537541.Google Scholar
Dalsky, G.P. (1990) Effect of exercise on bone: permissive influence of estrogen and calcium. Medicine and Science in Sports and Exercise, 22, 281285.Google Scholar
Dubois, A., Gross, H.A., Ebert, M.H., et al (1979) Altered gastric emptying and secretion in primary anorexia nervosa. Gastroenterology, 77, 319323.CrossRefGoogle ScholarPubMed
Evans, G. (1945) Physiology and treatment of starvation. Experiences in war–starved Europe. British Medical Journal, i, 818820.Google Scholar
Fairburn, C.G. & Hope, R.A. (1988) Disorders of eating and weight. In Companion to Psychiatric Studies (eds Kendell, R. E. & Zealley, A. K.), pp. 588604. Edinburgh: Churchill Livingstone.Google Scholar
Fichter, M.M., Doerr, P., Pirke, K.M., et al (1982) Behaviour, attitude, nutrition and endocrinology in anorexia nervosa. A longitudinal study in 24 patients. Acta Psychiatrica Scandinavica, 66, 429444.CrossRefGoogle Scholar
Fleming, B.J., Genuth, S.M., Gould, A.B., et al (1975) Laxative–induced hypokalemia, sodium depletion and hyperreninemia. Effects of potassium and sodium replacement on the renin-angiotensin-aldosterone system. Annals of Internal Medicine, 83, 6062.CrossRefGoogle ScholarPubMed
Fohlin, L. (1977) Body composition, cardiovascular and renal function in adolescent patients with anorexia nervosa. Acta Paediatrica Scandinavica (suppl. 268), 120.Google Scholar
Fonseca, V. & Havard, C.W.A. (1985) Electrolyte disturbances and cardiac failure with hypomagnesaemia in anorexia nervosa. British Medical Journal, 291, 16801682.CrossRefGoogle ScholarPubMed
Fries, H. (1977) Studies on secondary amenorrhea, anorectic behaviour and body–image perception: importance for the early recognition of anorexia nervosa. In Anorexia Nervosa (ed. Vigersky, R. A.), pp. 163176. New York: Raven Press.Google Scholar
Frisch, R. E. & McArthur, J. W. (1974) Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science, 185, 949951.CrossRefGoogle ScholarPubMed
George, G.C.W., Zabow, T. & Beumont, P.J.V. (1975) Scurvy in anorexia nervosa. South African Medical Journal, 49, 1420.Google ScholarPubMed
Gerner, R.H. & Gwirtsman, H.E. (1981) Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa. American Journal of Psychiatry, 138, 650653.Google Scholar
Gillin, J.C., Sitaram, N., Wehr, T.A., et al (1984) Sleep and affective illness. In Neurobiology of Mood Disorders (eds Post, R. M. & Ballenger, J. C.), pp. 157189. Baltimore: Williams and Wilkins.Google Scholar
Gold, P.W., Kaye, W., Robertson, G.L., et al (1983) Abnormalities in plasma and cerebrospinal–fluid arginine vasopressin in patients with anorexia nervosa. New England Journal of Medicine, 308, 11171123.CrossRefGoogle ScholarPubMed
Gold, P.W., Gwirtsman, H., Avgerinos, P.C., et al (1986) Abnormal hypothalamic–pituitary-adrenal function in anorexia nervosa. New England Journal of Medicine, 314, 13351342.Google Scholar
Gould, L., Reddy, C.V., Singh, B.K., et al (1980) Evaluation of cardiac conduction in anorexia nervosa. Pace, 3, 660665.CrossRefGoogle ScholarPubMed
Gupta, M.A., Gupta, A.K. & Haberman, H.F. (1987) Dermatologic signs in anorexia nervosa and bulimia nervosa. Archives of Dermatology, 123, 13861390.Google Scholar
Hall, R.C.W. & Beresford, T.P. (1989) Medical complications of anorexia and bulimia. Psychiatric Medicine, 7, 165192.Google ScholarPubMed
Hall, R.C.W., Hoffman, R.S., Beresford, T.P., et al (1989) Physical illness encountered in patients with eating disorders. Psychosomatics, 30, 174191.CrossRefGoogle ScholarPubMed
Hay, P.J., Hall, A., Delahunt, J.W., et al (1989) Investigation of osteopaenia in anorexia nervosa. Australian and New Zealand Journal of Psychiatry, 23, 261268.Google Scholar
Heizer, W.D., Warshaw, A.L., Waldmann, T.A., et al (1968) Protein–losing gastroenteropathy and malabsorption associated with factitious diarrhea. Annals of Internal Medicine, 68, 839852.CrossRefGoogle ScholarPubMed
Hellstrom, I. (1977) Oral complications in anorexia nervosa. Scandinavian Journal of Dental Research, 85, 7186.Google ScholarPubMed
Hoffman, R.S. & Hall, R.C.W. (1989) Reversible E.K.G. changes in anorexia nervosa. Psychiatric Medicine, 7, 211216.Google Scholar
Holt, S., Ford, M.J., Grant, S., et al (1981) Abnormal gastric emptying in primary anorexia nervosa. British Journal of Psychiatry, 139, 550552.CrossRefGoogle ScholarPubMed
Hsu, L.K.G., Crisp, A.H. & Harding, B. (1979) Outcome of anorexia nervosa. Lancet, i, 6165.CrossRefGoogle Scholar
Hudson, J.I. & Hudson, M.S. (1984) Endocrine dysfunction in anorexia nervosa and bulimia: comparison with abnormalities in other psychiatric disorders and disturbances due to metabolic factors. Psychiatric Developments, 4, 237272.Google Scholar
Hudson, J.I., Pope, H.G., Jonas, J.M., et al (1987) Sleep EEG in bulimia. Biological Psychiatry, 22, 820828.CrossRefGoogle ScholarPubMed
Hurst, P.S., Lacey, J.H. & Crisp, A.H. (1977) Teeth, vomiting and diet: a study of the dental characteristics of seventeen anorexia nervosa patients. Postgraduate Medical Journal, 53, 298305.CrossRefGoogle Scholar
Isner, J.M., Roberts, W.C., Heymsfield, S.B., et al (1985) Anorexia nervosa and sudden death. Annals of Internal Medicine, 102, 4952.Google Scholar
Ivarsson, S.A., Nilson, K. & Persson, P.H. (1983) Ultrasonography of the pelvic organs in prepubertal and postpubertal girls. Archives of Disease in Childhood, 58, 352354.Google Scholar
Kalucy, R.S., Crisp, A.H., Chard, T., et al (1976) Nocturnal hormonal profiles in massive obesity, anorexia nervosa and normal females. Journal of Psychosomatic Research, 20, 595604.CrossRefGoogle ScholarPubMed
Katz, J.L., Boyar, R., Roffwarg, H., et al (1978) Weight and circadian luteinizing hormone secretory pattern in anorexia nervosa. Psychosomatic Medicine, 40, 549567.CrossRefGoogle ScholarPubMed
Katz, J.L., Kuperberg, A., Pollack, C.P., et al (1984) Is there a relationship between eating disorder and affective disorder? New evidence from sleep recordings. American Journal of Psychiatry, 141, 753759.Google Scholar
Kay, J. & Stricker, R.B. (1983) Haematologic and immunologic abnormalities in anorexia nervosa. Southern Medical Journal, 76, 10081010.Google Scholar
Keane, S.B.V., Fennel, J.S. & Tomkin, G.H. (1978) Acute pancreatitis, acute gastric dilatation, duodenal ileus following re–feeding in anorexia nervosa. Irish Journal of Medical Sciences, 147, 191192.Google Scholar
Keys, A., Brozek, J., Heuschel, A., et al (1950) The Biology of Human Starvation, Vol. 2. Minneapolis: University of Minnesota Press.CrossRefGoogle Scholar
Kim, Y. & Michael, A.F. (1975) Hypocomplementemia in anorexia nervosa. Journal of Pediatrics, 87, 582585.CrossRefGoogle ScholarPubMed
Klinefelter, H.F. (1965) Hypercholesterolemia in anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 25, 15201521.CrossRefGoogle ScholarPubMed
Kupfer, D.J. & Foster, F.G. (1972) Interval between sleep onset and rapid eye movement sleep as an indicator of depression. Lancet, ii, 684686.Google Scholar
Lacey, J.H., Crisp, A.H., Hart, G., et al (1979) Weight and skeletal maturation – a study of radiological and chronological age in an anorexia nervosa population. Postgraduate Medical Journal, 55, 381385.CrossRefGoogle Scholar
Lacey, J.H., Crisp, A.H., Kalucy, R.S., et al (1975) Weight gain and the sleeping electroencaphalogram: study of 10 patients with anorexia nervosa. British Medical Journal, iv, 556558.Google Scholar
Lachelin, G.C.L. & Yen, S.S.C. (1978) Hypothalamic chronic anovulation. American Journal of Obstetrics and Gynaecology, 130, 825831.CrossRefGoogle ScholarPubMed
Levin, P.A., Falko, J.M., Dixon, K., et al (1980) Benign parotid enlargement in bulimia. Annals of Internal Medicine, 93, 827829.CrossRefGoogle ScholarPubMed
Levy, A.B., Dixon, K.N. & Schmidt, H.S. (1987) REM and delta sleep in anorexia nervosa and bulimia. Psychiatry Research, 20, 189197.Google Scholar
Levy, A.B., Dixon, K.N. & Schmidt, H.S. (1988) Sleep architecture in anorexia nervosa and bulimia. Biological Psychiatry, 23, 99101.CrossRefGoogle ScholarPubMed
Loudon, I. (1984) The disease called chlorosis. Psychological Medicine, 14, 2736.CrossRefGoogle ScholarPubMed
McCallum, R.W., Grill, B.B., Lange, R., et al (1985) Definition of a gastric emptying abnormality in patients with anorexia nervosa. Digestive Diseases and Sciences, 30, 713722.Google Scholar
McClaren, D.S., Faris, R. & Zekian, B. (1968) The liver during recovery from protein–calorie malnutrition. Journal of Tropical Medicine and Hygiene, 71, 271281.Google Scholar
Mant, M.J. & Faragher, B.S. (1972) The haematology of anorexia nervosa. British Journal of Haematology, 23, 737749.Google Scholar
Mars, D.R., Anderson, N.H. & Riggall, F.C. (1982) Anorexia nervosa: a disorder with severe add–base derangements. Southern Medical Journal, 75, 10381042.CrossRefGoogle Scholar
Mecklenburg, R.S., Loriaux, D.L., Thompson, R.H., et al (1974) Hypothalamic dysfunction in patients with anorexia nervosa. Medicine (Baltimore), 53, 147159.CrossRefGoogle ScholarPubMed
Mitchell, J.E., Pyle, R.L., Eckert, E.D., et al (1983) Electrolyte and other physiological abnormalities in patients with bulimia. Psychological Medicine, 13, 273278.Google Scholar
Moshang, T., Parks, J.S., Baker, L., et al (1975) Low serum triiodothyronine in patients with anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 40, 470473.Google Scholar
Neil, J.F., Merikangas, J.R., Foster, F.G., et al (1980) Waking and all–night sleep EEGs in anorexia nervosa. Clinical Electroencephalography, 11, 915.Google Scholar
Nestel, P.J. (1974) Cholesterol metabolism in anorexia nervosa and hypercholesterolemia. Journal of Clinical Endocrinology and Metabolism, 38, 325328.CrossRefGoogle ScholarPubMed
Oster, J.R., Materson, B.J. & Rogers, A.I. (1980) Laxative abuse syndrome. American Journal of Gastroenterology, 74, 451458.Google ScholarPubMed
Overby, K.J. & Litt, I.F. (1988) Mediastinal emphysema in an adolescent with anorexia nervosa and self–induced emesis. Pediatrics, 81, 134136.CrossRefGoogle Scholar
Palmer, R.L., Crisp, A., MacKinnon, P.C., et al (1974) Gonadotrophin response to luteinizing hormone/follicle stimulating hormone releasing hormone during weight gain in patients with anorexia nervosa. Journal of Endocrinology, 63, 32.Google ScholarPubMed
Patton, G.C. (1988) Mortality in eating disorders. Psychological Medicine, 18, 947951.Google Scholar
Peters, H. (1979) The human ovary in childhood and early maturity. European Journal of Obstetrics and Gynecology, 9, 137144.Google Scholar
Pops, M.A. & Schwabe, A.D. (1968) Hypercarotenemia in anorexia nervosa. Journal of the American Medical Association, 205, 533534.Google Scholar
Rapaport, M.J. (1985) Pellagra in a patient with anorexia nervosa. Archives of Dermatology, 121, 255257.CrossRefGoogle Scholar
Riad, M., Barton, J.R., Wilson, J.A., et al (1991) Parotid salivary secretion pattern in bulimia nervosa. Acta Otolaryngologia, 111, 392395.Google Scholar
Rich, L.M., Caine, M.R., Findling, J.W., et al (1990) Hypoglycemic coma in anorexia nervosa. Case report and review of the literature. Archives of Internal Medicine, 150, 894895.CrossRefGoogle ScholarPubMed
Rieger, W., Brady, J.P. & Weisberg, E. (1978) Hematologic changes in anorexia nervosa. American Journal of Psychiatry, 135, 984985.Google Scholar
Rigotti, N.A., Nussbaum, S.R., Hertzog, D.B., et al (1984) Osteoporosis in women with anorexia nervosa. New England Journal of Medicine, 311, 16011606.Google Scholar
Rigotti, N.A., Neer, R.M. & Jameson, L. (1986) Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism. Journal of American Medical Association, 256, 385388.Google Scholar
Robboy, M.S., Sato, A.S. & Schwabe, A.D. (1974) The hypercarotenemia in anorexia nervosa: a comparison of vitamin A and carotene levels in various forms of menstrual dysfunction and cachexia. American Journal of Clinical Nutrition, 27, 362367.Google Scholar
Russell, G.F.M. (1969) Metabolic, endocrine and psychiatric aspects of anorexia nervosa. Scientific Basis of Medicine: Annual Reviews, 1, 236255.Google Scholar
Russell, G.F.M. (1979) Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine, 9, 429448.Google Scholar
Russell, G.F.M., Szmukler, G.I., Dare, C., et al (1987) An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 44, 10471056.CrossRefGoogle ScholarPubMed
Sandstead, H.R., Koehn, C.J. & Sessions, S.M. (1955) Enlargement of the parotid gland in malnutrition. American Journal of Clinical Nutrition, 3, 198214.CrossRefGoogle ScholarPubMed
Savvas, M., Treasure, J., Studd, J., et al (1989) The effect of anorexia nervosa on skin thickness, skin collagen and bone density. British Journal of Obstetrics and Gynaecology, 96, 13921394.CrossRefGoogle ScholarPubMed
Schocken, D.D., Holloway, J.D. & Powers, P.S. (1989) Weight loss and the heart. Effects of anorexia nervosa and starvation. Archives of Internal Medicine, 149, 877881.Google Scholar
Schwabe, A.D. & Pops, M.A. (1975) The role of the gastrointestinal tract in carotene metabolism and vitamin A metabolism. Arquivos de Gastroenterologia, 12, 269272.Google Scholar
Schwabe, A.D. & Pops, M.A., Lippe, B.M., Chang, R.J., et al (1981) Anorexia nervosa. Annals of Internal Medicine, 94, 371381.Google Scholar
Scobie, B.A. (1972) Acute dilatation of the stomach (abstract). Australia and New Zealand Journal of Medicine, 2, 335.Google Scholar
Scobie, B.A. (1973) Acute gastric dilatation and duodenal ileus in anorexia nervosa. Medical Journal of Australia, 2, 932934.CrossRefGoogle ScholarPubMed
Sheinin, J.C. (1986) Medical aspects of eating disorders. Adolescent Psychiatry, 13, 405421.Google Scholar
Shur, E., Alloway, R., Obrecht, R., et al (1988) Physiological complications in anorexia nervosa. Haematological and neuromuscular changes in 12 patients. British Journal of Psychiatry, 153, 7275.Google Scholar
Silber, T.J. & Kass, E.J. (1984) Anorexia nervosa and nephrolithiasis. Journal of Adolescent Health Care, 5, 5052.Google Scholar
Silverman, J.A. (1983) Clinical and metabolic aspects of anorexia nervosa. International Journal of Eating Disorders, 2, 159166.Google Scholar
Silvis, S.E. & Paragas, P.D., Jr. (1972) Paresthesias, weakness, seizures and hypophosphatemia in patients receiving hyperalimentation. Gastroenterology, 62, 513520.CrossRefGoogle ScholarPubMed
Sirisinha, S., Suskind, R., Edelman, R., et al (1973) Complement and C3–proactivator levels in children with protein-calorie malnutrition and effect of dietary treatment. Lancet, i, 10161020.Google Scholar
Smith, S.R., Bledsoe, T. & Chetri, M.K. (1975) Cortisol metabolism and the pituitary–adrenal axis in adults with proteincalorie malnutrition. Journal of Clinical Endocrinology and Metabolism, 40, 4352.CrossRefGoogle Scholar
Szmukler, G.I., Brown, S.W., Parsons, V., et al (1985) Premature loss of bone in chronic anorexia nervosa. British Medical Journal, 290, 2627.Google Scholar
Theander, S. (1983) Research on outcome and prognosis of anorexia nervosa and some results from a Swedish long–term study. International Journal of Eating Disorders, 2, 167174.Google Scholar
Theander, S. (1985) Outcome and prognosis in anorexia nervosa and bulimia: some results of previous investigations, compared with those of a Swedish long–term study. Journal of Psychiatric Research, 19, 493508.CrossRefGoogle ScholarPubMed
Treasure, J.L., Gordon, P.A.L., King, E.A., et al (1985) Cystic ovaries: a phase of anorexia nervosa. Lancet, ii, 13791382.Google Scholar
Treasure, J.L., Russell, G.F.M., Fogelman, I., et al (1987) Reversible bone loss in anorexia nervosa. British Medical Journal, 295, 474475.CrossRefGoogle ScholarPubMed
Vigersky, R.A., Loriaux, D.L., Andersen, A.E., et al (1976) Anorexia nervosa: behavioural and hypothalamic aspects. Clinics in Endocrinology and Metabolism, 5, 517535.Google Scholar
Walsh, T. (1980) The endocrinology of anorexia nervosa. Psychiatric Clinics of North America, 3, 299309.CrossRefGoogle Scholar
Walsh, B.T., Croft, C.B. & Katz, J.L. (1981) Anorexia nervosa and salivary gland enlargement. International Journal of Psychiatry and Medicine, 11, 255261.CrossRefGoogle ScholarPubMed
Walsh, B.T., Goetz, R., Roose, S.P., et al (1985) EEG–monitored sleep in anorexia nervosa and bulimia. Biological Psychiatry, 20, 947956.Google Scholar
Warren, S.E. & Steinberg, S.M. (1979) Acid–base and electrolyte disturbances in anorexia nervosa. American Journal of Psychiatry, 136, 415418.Google Scholar
Warren, M.P. & Vande Wiele, R.L. (1973) Clinical and metabolic features of anorexia nervosa. American Journal of Obstetrics and Gynecology, 117, 435449.Google Scholar
Warren, M.P., Jewelewicz, R., Dyrenfurth, I., et al (1975) The significance of weight loss in the evaluation of pituitary response to LH–RH in women with secondary amenorrhea. Journal of Clinical Endocrinology and Metabolism, 40, 601611.Google Scholar
Warren, M.P., Shane, E., Lee, M.J., et al (1990) Femoral head collapse associated with anorexia nervosa in a 20–year-old ballet dancer. Clinical Orthopaedics, 251, 171176.Google Scholar
Webber, B.L. & Freiman, I.D.A. (1974) The liver in kwashiorkor. A clinical and electron microscopical study. Archives of Pathology, 98, 400408.Google Scholar
Wheeler, M.J., Crisp, A.H., Hsu, L.K.G., et al (1983) Reproductive hormone changes during weight gain in male anorexics. Clinical Endocrinology, 18, 423429.Google Scholar
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