Anxiety Symptoms and Comorbid Anxiety Disorders in Adolescents with Anorexia Nervosa: A Scoping Review and Proposal for a Management Algorithm

Background: Anorexia nervosa (AN) frequently begins in adolescence and is commonly associated with anxiety symptoms. Their management remains insufficiently established: the overlap between the symptoms of AN, undernutrition and anxiety disorders makes comorbid disorders difficult to diagnose, and no management strategy has been formalized. This work aims to map how international clinical practice guidelines and the recent literature address anxiety symptoms and comorbid anxiety disorders in adolescents with AN, and to propose a management algorithm on that basis. Methods: A total of 11 clinical practice guidelines on AN published in French or English were identified, two of them specific to children and adolescents, and were supplemented by a PubMed and Embase search covering January 2023 to January 2026 (n = 18 publications) following the PRISMA methodology for scoping review. Results: The guidelines consistently recommend screening for comorbid anxiety disorders, while acknowledging how difficult it is to disentangle symptoms due to undernutrition, to AN itself, or to a comorbid disorder. They recommend considering nutritional status and the course of anxiety symptoms during weight restoration before introducing any psychotropic medication, and treating comorbid disorders according to their severity and to the guidelines specific to each. No trial has evaluated the treatment of a comorbid anxiety disorder in adolescents with AN. Conclusions: Based on this review and the guidelines on anxiety disorders, we designed a therapeutic algorithm for isolated anxiety symptoms, uncertain situations, and established comorbid diagnoses, indicating the basis of each step.