Chronic anorexia nervosa: medical mimic.

While anorexia nervosa is typically construed as an acute, dramatic disorder of younger women, long-term follow-up studies indicate that morbidity is chronic or relapsing in 30 percent to 50 percent of cases and sometimes leads to death. In older patients or those with atypical clinical features or obscure complications, chronic starvation may mimic other diseases, and rigid adherence to current diagnostic criteria may impede recognition and appropriate treatment. Anorexia nervosa should be viewed as a spectrum of disorders, with varying courses and presentations, in order that clinicians in nonpsychiatric settings may be equipped to provide adequate care of patients with this complex psychosomatic disease.