["European Eating Disorders Review, EarlyView. ", "\nABSTRACT\n\nObjective\nTo investigate real‐world psychopharmacological prescribing patterns among Italian adolescents with anorexia nervosa (AN) compared with psychiatric controls without eating disorders, and to examine whether AN diagnosis independently predicts medication use after accounting for psychiatric comorbidities. Participants were recruited from two Italian Child and Adolescent Neuropsychiatry services to improve the representativeness of prescribing practices across different clinical settings within the Italian healthcare system.\n\n\nMethod\nThis cross‐sectional cohort study included 298 female adolescents (aged 12–18 years) from 2017 to 2025. Participants were classified into AN (n = 149) and control (n = 149) groups based on DSM‐5/DSM‐5‐TR diagnoses. Sociodemographic, clinical, and pharmacological data were collected. Multivariable logistic regression models examined associations between diagnosis and prescription of any psychotropic medication, specific drug classes, and polypharmacy (≥ 2 psychotropic classes), adjusting for psychiatric comorbidities while accounting for potential site‐related differences in local prescribing practices.\n\n\nResults\nPsychotropic medication use was more frequent among controls in unadjusted analyses. In multivariable models, AN diagnosis was not independently associated with the prescription of any psychotropic medication, antipsychotics, or antidepressants. In contrast, AN group showed a significantly higher likelihood of receiving benzodiazepines (aOR = 2.76, 95% CI 1.43–5.47) and polypharmacy (aOR = 2.37, 95%CI 1.23–4.64) compared with controls. Polypharmacy was also independently associated with psychotic disorders, personality disorders, and depressive disorders.\n\n\nDiscussion\nIn this multicenter Italian real‐world cohort, psychopharmacological treatment in adolescents with AN appeared to be primarily driven by psychiatric comorbidities rather than AN diagnosis itself. However, benzodiazepine use and higher rates of polypharmacy in AN may reflect disorder‐specific clinical features and unmet treatment needs. These findings highlight the complexity of pharmacological management in adolescent AN and the need for more robust, disorder‐specific evidence to guide clinical practice.\n\n"]