Anorexia Nervosa 341
Associated Features Supporting Diagnosis
The semi-starvation of anorex ia nervosa, and the purging behaviors sometimes associated
with it, can result in significant and potentially life-threatening medical conditions. The
nutritional compromise associated with this  disorder affects most  major organ systems
and can produce a variety of disturbances. Ph ysiological disturbances, including amenor-
rhea and vital sign abnormalities, are comm on. While most of the physiological distur-
bances associated with malnutrition are reversible with nutritiona l rehabilitation, some,
including loss of bone mineral density, are often not completely re versible. Behaviors such
as self-induced vomiting and misuse of laxa tives, diuretics, and enemas may cause a num-
ber of disturbances that lead to abnormal la boratory findings; howe ver, some individuals
with anorexia nervosa exhibit no laboratory abnormalities. 
When seriously underweight, ma ny individuals with anorex ia nervosa have depressive
signs and symptoms such as depressed mood, so cial withdrawal, irrita bility, insomnia, and
diminished interest in sex. Because these feat ures are also observed in individuals without
anorexia nervosa who are significantly undern ourished, many of the depressive features
may be secondary to the physiological sequelae of semi-starvation, although they may also
be sufficiently severe to warr ant an additional diagnosis of major depressive disorder. 
Obsessive-compulsive features, both related and unrelated to food, are often prominent.
Most individuals with anorexia nervosa are pr eoccupied with thoughts of food. Some col-
lect recipes or hoard food. Ob servations of behaviors associated with other forms of star-
vation suggest that obsessions and compulsi ons related to food may be exacerbated by