Unintentional onset of anorexia nervosa

OBJECTIVE: The purpose of this article is to report a series of patients with an onset of anorexia nervosa precipitated by unintended weight loss rather than the more typical onset following intentional dieting, or the occasional iatrogenic beginning. METHOD: Retrospectively, case notes of 66 consecutive outpatient evaluations at an eating disorder diagnostic clinic between 2002 and 2006 were reviewed. RESULTS: Five cases, 7.6%, of inadvertent onset anorexia nervosa were identified. Causes of the inadvertent weight loss were varied: the mourning of a death, a parasitic infection, medication side effects and surgery. None had intended to lose weight. CONCLUSIONS: We postulate that inadvertent weight loss may be as powerful a trigger as intentional dieting to initiating anorexia nervosa in predisposed individuals; self-induced weight loss may not be a necessary precursor to anorexia nervosa.