Possible Findings on Physical Examination in Children and Adolescents With Eating Disorders

Anorexia NervosaBulimia Nervosa
BradycardiaSinus bradycardia
Orthostatic by pulse or blood pressureOrthostatic by pulse or blood pressure
Cardiac murmur (one third with mitral valve prolapse)Cardiac murmur (mitral valve prolapse)
Dull, thinning scalp hairHair without shine
Sunken cheeks, sallow skinDry skin
Atrophic breasts (postpubertal)Russell’s sign (callous on knuckles from self-induced emesis)
Atrophic vaginitis (postpubertal)Mouth sores
Pitting edema of extremitiesPalatal scratches
Emaciated, may wear oversized clothesDental enamel erosions
Flat affectMay look entirely normal
Cold extremities, acrocyanosisOther cardiac arrhythmias