Hyperactivity in anorexia nervosa: A fundamental clinical feature

Abstract

Toward the goal of assessing the prevalence and chronology of heightened physical activity in primary anorexia nervosa, we reviewed the charts of 33 patients hospitalized with this illness during the past 10 years. Fifteen of these patients, or their parents, were also interviewed at least 1 year after the hospitalization. In 25 of the 33 charts, the presence of “hyperactivity” during the present illness was recorded; only one patient was specifically noted to show unremarkable physical activity. Twenty-one of the 25 patients were also described as having been unusually active physically prior to the onset of dieting and weight loss. The 15 follow-ups revealed two deaths, one patient by suicide and the other from complications of malnutrition. Among the 13 patients interviewed directly, ten described themselves as continuing to be highly active physically—this despite significant weight gain in eight and complete subsidence of both eating symptomatology and amenorrhea in three. Physical activity appeared to be more extensive, disorganized, and aimless during the acute phase of anorexia nervosa, when excessive and bizarre dieting and rapid weight loss are occurring, than during the premorbid or weight recovery phases. However, these preliminary findings suggest that “hyperactivity” is an early and enduring clinical feature of anorexia nervosa and not merely secondary to either a conscious attempt to lose weight or weight loss per se.