This systematic review assesses the effectiveness of antipsychotic medication for improving core psychopathology and behavioral symptoms of anorexia nervosa. The Cochrane Depression, Anxiety and Neurosis Group Trials Register, reference lists of retrieved studies and conference abstracts were searched. Four randomized controlled trials comparing typical or atypical antipsychotic medication to other interventions were included. Clinical heterogeneity precluded meta-analysis. Overall, there is insufficient evidence to either support or refute the use of antipsychotic medication in anorexia nervosa. Further trials may be justified but should be designed with a clear theoretical framework to guide use of antipsychotic medication.