31st January 2024

Starvation Syndrome

The presentation of the physical health complications of Anorexia Nervosa, sometimes ARFID will be that of starvation syndrome, namely. Symptoms include:

• Amenorrhea
• Lack of adolescent growth
• Fainting, especially during exercise

Signs on examination:

• Emaciation
• Cold extremities
• Hair thinning or loss
• Growth of fine ‘lanugo’ hair over the face and body
• Proximal muscles weakness
• Bradycardia
• Hypotension and orthostatic hypotension
• Hypothermia

Muscle power is measured by the sit-up-squat-stand (SUSS) test – see image below. A score of <2 is indication of proximal muscle weakening

Sit up: sit up from lying unaided by arms.                            Stand-Squat-Stand: squat without using hands

Scoring: 0 – unable. 1 – able only with hands  2- with difficulty 3 – no difficulty

Adapted from Royal College of Psychiatrists (2022). MEED. Medical Emergencies in Eating Disorders. RCPsych Guideline CR 233