Anorexia nervosa or pediatric acute-onset neuropsychiatric syndrome? A case report.
- 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. [email protected].
- 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Abstract
Background
Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) is a rare heterogeneous condition characterized by rapid onset obsessions/compulsions and/or food restriction with at least two accompanying acute-onset neuropsychiatric symptoms. PANS is currently considered an exclusionary diagnosis with considerable overlap with psychiatric disorders including obsessive compulsive disorder, tics, and eating disorders. Little is known about the crossover between eating disorders and PANS, and there is minimal guidance on diagnostic and treatment considerations for these patients.Case presentation
This case report describes a 9-year-old female who presented for an initial assessment to a specialty outpatient eating disorder treatment center due to restrictive eating, fear of weight gain, body image disturbance, and obsessive-compulsive compensatory behaviors. She met diagnostic criteria for other specified feeding and eating disorder (OSFED)/atypical nervosa (AAN) and received family-based treatment (FBT) to target food restriction through parent-led refeeding. Despite weight stabilization and nutritional improvement in FBT, the patient experienced severe progressive functional deterioration. The patient was subsequently evaluated by an immune behavioral health (IBH) clinic and diagnosed with PANS. Treatment included gradual transition in care from the eating disorder clinic for AAN to IBH and sleep clinics for management of remaining neuropsychiatric symptoms.Conclusions
This report highlights a unique case of a patient with PANS features and body image/weight-driven food refusal. This case has potential implications for how eating disorder specialty providers asses for possible overlapping PANS. Criteria prompting consideration for PANS may include a combination of acute-onset restrictive eating, prepubertal body image disturbance, and progressive functional impairment and/or developmental regression despite weight restoration. This case also highlights implications of care coordination and triage across specialty clinics.
Related
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- Clinical deterioration after revisiting childhood sexual abuse during psychotherapy for restrictive anorexia nervosa: a case report.
- A sociohistorical and epistemological analysis of anorexia 150 years after the birth of the anorexia nervosa diagnosis: Is this form of suffering still in metamorphosis?
- Thesis presentation. Anorexia nervosa, deconstructing a concept to rethink care: A historical and anthropological approach
- Interoceptive mechanisms of body image disturbance in anorexia nervosa: Study protocol of a randomized parallel-group trial
BibTeX
@article{fischer2026anorexia,
title = {{Anorexia nervosa or pediatric acute-onset neuropsychiatric syndrome? A case report.}},
author = {Megan M Ruiz Fischer and Jennifer L Derenne and Melissa A Silverman and Anne Claire Grammer and Brittany Matheson},
journal = {Journal of eating disorders},
year = {2026},
month = sep,
doi = {10.1186/s40337-026-01783-8},
url = {https://europepmc.org/article/MED/42972472},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Anorexia nervosa or pediatric acute-onset neuropsychiatric syndrome? A case report.
AU - Megan M Ruiz Fischer
AU - Jennifer L Derenne
AU - Melissa A Silverman
AU - Anne Claire Grammer
AU - Brittany Matheson
PY - 2026
DA - 2026/09/29
JO - Journal of eating disorders
DO - 10.1186/s40337-026-01783-8
UR - https://europepmc.org/article/MED/42972472
AB - Background Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) is a rare heterogeneous condition characterized by rapid onset obsessions/compulsions and/or food restriction with at least two accompanying acute-onset neuropsychiatric symptoms. PANS is currently considered an exclusionary diagnosis with considerable overlap with psychiatric disorders including obsessive compulsive disorder, tics, and eating disorders. Little is known about the crossover between eating disorders and PANS, and there is minimal guidance on diagnostic and treatment considerations for these patients.Case presentation This case report describes a 9-year-old female who presented for an initial assessment to a specialty outpatient eating disorder treatment center due to restrictive eating, fear of weight gain, body image disturbance, and obsessive-compulsive compensatory behaviors. She met diagnostic criteria for other specified feeding and eating disorder (OSFED)/atypical nervosa (AAN) and received family-based treatment (FBT) to target food restriction through parent-led refeeding. Despite weight stabilization and nutritional improvement in FBT, the patient experienced severe progressive functional deterioration. The patient was subsequently evaluated by an immune behavioral health (IBH) clinic and diagnosed with PANS. Treatment included gradual transition in care from the eating disorder clinic for AAN to IBH and sleep clinics for management of remaining neuropsychiatric symptoms.Conclusions This report highlights a unique case of a patient with PANS features and body image/weight-driven food refusal. This case has potential implications for how eating disorder specialty providers asses for possible overlapping PANS. Criteria prompting consideration for PANS may include a combination of acute-onset restrictive eating, prepubertal body image disturbance, and progressive functional impairment and/or developmental regression despite weight restoration. This case also highlights implications of care coordination and triage across specialty clinics.
SN - 2050-2974
ER -