Joughin et al described the clinical features of late onset anorexia nervosa. The presence of classic anorexia may go unrecognized in older women simply because people are unaware that it occurs. The authors are from St. George's Hospital in London.


Features of late-onset anorexia nervosa:

(1) age at onset >= 30 years (it may not appear until the patient is elderly)

(2) low body weight with a phobic avoidance of normal body weight

(3) may have concomitant bulimia and/or excessive exercise

(4) problem with sexuality (fear or distaste for sexuality, dislike of a feminine role, etc)

(5) poor prognosis if not diagnosed



(1) The patient may not have a history of adolescent onset anorexia.

(2) Diagnosis may be difficult and usually is delayed.

(3) Many patients have had children, with onset after done being fertile.

(4) It does not appear to be due to suppressed homosexuality.


Differential diagnosis:

(1) depression (which may coexist but does not respond to antidepressant therapy)

(2) physical illness

(3) persistence of early onset anorexia


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