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Anorexia nervosa — master index¶
Last curated: 2026-10-21 · status: built (Codex), independently audited (Claude), deepened (Claude), independently re-audited (Codex), then swept for new literature (Claude, 2026-09-30 and 2026-10-21 — sweep edits not yet audited) · 18/18 wiki pages written · 9 pages curated; 9 draft — six demoted by the 2026-09-30 sweep pending audit (diagnosis, mortality, genetics, refeeding, neuromodulation, clinical trials), two by the 2026-10-21 sweep (adolescents, severe-enduring/compulsory), and guidelines.md, which was already draft because its carried-forward APA recommendation text could not be retrieved · 295 unique PMIDs cited on wiki pages, 315 in the bibliography · 51 ClinicalTrials.gov records and the live 341-record interventional portfolio verified through API queries on 2026-10-21 · 4 landmark notes
The condition in five sentences. AN is a restrictive eating disorder in which low energy intake, weight-gain fear or persistent weight-preventing behaviour, and disturbed weight/shape experience interact with starvation-mediated physiology. Mortality is markedly elevated: a 36-study meta-analysis estimated 5.1 deaths per 1,000 person-years and an SMR of 5.86 with suicide accounting for one fifth of deaths, and two 2026 syntheses on far larger samples report an all-cause risk ratio of 5.52 (95% CI 4.47–6.82) and a pooled SMR of 5.06 (3.47–7.38), although their overlapping cohorts and heterogeneity do not establish a secular trend (Arcelus 2011, PMID 21727255; Semchishen 2026, PMID 41536100; Lai 2026, PMID 41277145). Genetic evidence supports a metabo-psychiatric research model: a 16,992-case GWAS identified eight loci and psychiatric plus BMI-independent metabolic correlations, and a 24,223-case follow-up re-found six of those loci and the same correlation pattern (Watson 2019, PMID 31308545; Termorshuizen 2026, PMID 42718672). Family-based approaches have the clearest adolescent psychotherapy evidence, whereas adult CBT-E, MANTRA, SSCM and focal psychodynamic trials do not establish a consistent winner — the adult network meta-analysis screened 14,003 reports to find 16 trials and rated its own evidence low to very low (Lock 2010, PMID 20921118; Solmi 2021, PMID 33600749). Atypical AN is in scope because comparable psychopathology and clinically important complications can occur without low BMI, exposing weight-based diagnostic bias (Walsh 2023, PMID 36508318).
Scope¶
This condition covers anorexia nervosa, including atypical AN. Bulimia nervosa, binge-eating disorder and ARFID appear only as differential diagnoses. The ethics page treats capacity, compulsory care and the contested terminal-AN proposal as unresolved content and sources both sides.
Reading paths¶
- Orientation: overview → diagnosis → mortality/outcome.
- Acute clinical risk: medical complications → refeeding → red flags.
- Treatment: adolescents or adults → service models → guidelines.
- Mechanism/frontier: genetics → neurobiology → experimental therapy → trials.
- Human/ethical: patient experience → severe/enduring illness and compulsion → open questions.
Pages¶
| # | Section | Page | Scope | Status |
|---|---|---|---|---|
| 1 | Foundations | overview.md | Map, burden, treatment frame | curated |
| 2 | Foundations | diagnosis-and-classification.md | DSM/ICD framing, atypical AN, differential | draft — edited by the 2026-09-30 sweep, awaiting audit |
| 3 | Foundations | epidemiology-and-incidence.md | Frequency, age, sex/gender, ascertainment | curated |
| 4 | Outcome | mortality-and-long-term-outcome.md | Mortality, suicide, recovery, relapse | draft — edited by the 2026-09-30 sweep, awaiting audit |
| 5 | Mechanism | genetics.md | Heritability, GWAS, metabolic correlations | draft — edited by the 2026-09-30 sweep, awaiting audit |
| 6 | Mechanism | neurobiology-and-cognition.md | Reward, habit, cognition, state confounding | curated |
| 7 | Clinical | medical-complications.md | Cardiac, bone, endocrine, renal, GI | curated |
| 8 | Clinical | refeeding-and-nutritional-rehabilitation.md | Refeeding risk and protocols | draft — edited by the 2026-09-30 sweep, awaiting audit |
| 9 | Treatment | treatment-in-adolescents.md | FBT and parent-focused variants | draft — edited by the 2026-10-21 sweep, awaiting audit |
| 10 | Treatment | treatment-in-adults.md | CBT-E, MANTRA, SSCM, FPT | curated |
| 11 | Treatment | pharmacotherapy.md | Olanzapine and adjunctive evidence | curated |
| 12 | Treatment | service-models-and-setting.md | Outpatient, day, inpatient | curated |
| 13 | Frontier | neuromodulation-and-experimental-therapy.md | DBS, rTMS, psychedelics | draft — edited by the 2026-09-30 sweep, awaiting audit |
| 14 | Ethics | severe-enduring-illness-and-compulsory-treatment.md | Capacity, coercion, terminal-AN dispute | draft — edited by the 2026-10-21 sweep, awaiting audit |
| 15 | Human | patient-experience-and-advocacy.md | Lived experience, carers, organizations | curated |
| 16 | Reference | guidelines.md | Guideline synthesis | draft — APA 2023 text unretrievable |
| 17 | Frontier | clinical-trials-landscape.md | Live registrations and design gaps | draft — edited by the 2026-09-30 sweep, awaiting audit |
| 18 | Safety | red-flags-and-safety-concerns.md | Instability, refeeding and suicide risk | curated |
Literature layer¶
| Artifact | Contents | Status |
|---|---|---|
| BIBLIOGRAPHY.md | 301 papers, topic-grouped, with page map; non-primary publication types (comments, letters, editorials, protocols) labelled; depth-pass and sweep additions marked; 10 sweep entries are cited only in the statistics, open-questions or patient-voice files, or are bibliography-only | independently re-audited to 2026-09-02; 19 sweep entries unaudited |
| notes/ | Four landmark paper notes, each extended at audit with the replication or follow-up evidence published since; the Watson 2019 note gained a sweep section on the 24,223-case follow-up | audited to 2026-09-02; one sweep addition unaudited |
| guideline registry | 17 documents including NICE, APA, RANZCP, Canada (×2), German S3, ANZAED (×3), USPSTF, ASPEN, the AED Nine Truths and — added by the sweep — the 2026 Brazilian Psychiatric Association guideline and a 2026 Delphi consensus on GLP-1 receptor agonists; disagreements and watch list; NICE and RANZCP text read directly, APA text still not retrievable | deepened, one gap; two sweep additions verified at abstract level only |
| statistics | Source-specific quantitative tables across prevalence/incidence, mortality and outcome, heritability and comorbidity, complications at extreme malnutrition, pregnancy, bone/fracture, treatment, economics and the trial portfolio | independently re-audited to 2026-09-02; sweep rows (GBD 2021, 2026 GWAS, readmission, causes of death, i-STRONG registry results, tDCS) unaudited |
| patient voice | Method, organizations, themes and sources; one theme added by the sweep (Autistic people's experience of unadapted care) | audited to 2026-09-02; sweep addition unaudited |
Evidence frontier¶
OPEN-QUESTIONS.md contains 25 stable questions and a fourteen-row “Dots not yet connected” table. The audit re-tested every asserted absence by live search; two were stale and were rewritten as answers (one-year refeeding outcomes, and the empirical status of the “terminal AN” proposal), and two questions were added (OQ-16 weight-indexed refeeding, OQ-17 the course of atypical AN). The depth pass opened eight further questions (OQ-18 to OQ-25) and four junctions (D11–D14), and corrected one stale absence: a small four-year comparison of involuntary and voluntary treatment pathways does exist (Abry 2024, PMID 37690079) and finds no quality-of-life or mortality difference, against a national register showing elevated post-compulsion mortality. Highest-leverage junctions are metabolic-genetic translation, developmental transport of family-treatment mechanisms, registry-linked mortality outcomes, the thin longitudinal evidence on atypical AN (one-year follow-up only), weight-indexed refeeding (randomized, registry results only), empirical capacity/compulsion outcomes, microbiome causality, and the 80% of registered AN trials that never reach publication.
Sweep standing (2026-10-21)¶
Second periodic sweep, by Claude; not yet audited. Window: PubMed entry date 2026-09-23 onward plus publication date 2026-10-07 onward. Details are in LOG.md.
| Measure | Before sweep | After sweep |
|---|---|---|
| Distinct PMIDs on wiki pages | 291 | 295 |
| Bibliography PMID records | 301 | 315 |
| Distinct NCT identifiers in the condition | 48 | 51 |
Pages at curated |
11 | 9 |
| Interventional AN records on ClinicalTrials.gov | 338 | 341 |
What moved: a 60-adolescent RCT of six-session interoceptive exposure versus FBT (more eaten at test meals, no weight difference); the first US national denominator for tube feeding and restraint in AN hospitalizations (6.8%, rising); one phase-designated recruiting trial left recruiting; a placebo-controlled FMT trial registered with a microbiome rather than clinical endpoint. No Cochrane review and no new guideline appeared in the window.
Sweep standing (2026-09-30)¶
First periodic literature sweep, by Claude; not yet audited — the auditor must be a different engine. Details are in LOG.md.
| Measure | Before sweep | After sweep |
|---|---|---|
| Distinct PMIDs on wiki pages | 282 | 291 |
| Bibliography PMID records | 282 | 301 |
| Distinct NCT identifiers in the condition | 46 | 48 |
Pages at curated |
17 | 11 |
| Guideline registry documents | 15 | 17 |
| Open questions / junctions | 25 / 14 | 25 / 14 (seven questions and two junctions revised) |
What moved: a 24,223-case GWAS superseded Watson 2019 as the largest case-control study without changing the locus count; the only tDCS trial to reach its planned sample reported a null primary outcome after a positive interim analysis; and a randomized comparison of weight-indexed against fixed-calorie refeeding in atypical AN posted registry results. Two absence claims were found to be too broad and were narrowed — that weight-indexed refeeding had never been randomized, and that no course data specific to atypical AN existed.
Depth-pass and re-audit standing (2026-09-02)¶
| Measure | After build + first audit | At depth-pass submission | After independent re-audit |
|---|---|---|---|
| Distinct PMIDs condition-wide | 113 | 278 | 282 |
| Distinct records per page (condition-wide records ÷ 18) | 6.3 | 15.4 | 15.7 |
| Total wiki lines | 1,545 | 2,443 | 2,451 |
| Lines per page (mean) | 86 | 136 | 136 |
| Bibliography PMID records | 113 | 278 | 282 |
| Guideline registry documents | 7 | 15 | 15 |
| Open questions / junctions | 17 / 10 | 25 / 14 | 25 / 14 |
Pages at curated |
17 | 0 | 17 |
The depth pass substantially widened the evidence base rather than merely increasing line count: its submitted condition-wide figure rose from 113 to 278 distinct PMIDs. The re-audit found 167—not the logged 165—bibliography records marked as depth-pass additions, retrieved every one live, removed one irrelevant padded record, and added six records needed to correct stale claims and absences. Details are in LOG.md.
Audit standing (2026-09-02)¶
| Check | Result |
|---|---|
| Depth-pass PMIDs | 167 at intake, all resolved live via PubMed E-utilities; 166 retained after removing one irrelevant citation |
| Unique PMIDs after corrections | 282, exactly matched between page citations and the bibliography |
| ClinicalTrials.gov records | 46 distinct NCT IDs, all resolved live with matching titles/status/enrollment; portfolio count re-run live |
| Newly asserted absences | 21 targeted PubMed searches re-run; five stale or materially incomplete claims rewritten |
| Padding | One irrelevant citation removed; one reference orphaned by an audit rewrite removed |
| Broken relative links | 0 |
Pages promoted to curated |
17 of 18 |
Pages held at draft |
guidelines.md — APA 2023 recommendation text could not be retrieved for verification |