Objective: The aim of the present study was to investigate the prevalence risk for developing anorexia nervosa (AN) in a very wide sample of adolescents aged 15-19 years, obtaining a psychological profile of these at-risk subjects, as assessed by the Italian Offer Self-Image Questionnaire (OSIQ). Method: Data were extracted from ESPAD-Italia ® 2005 database (European School Survey Project on Alcohol and Other Drugs). The study (17,866 adolescents, 15-19 years old; 47.8% males), also evaluated gender, age, weight, height and Eating Attitude Test-26 (EAT-26). The OSIQ psychometric qualities were evaluated. Multinomial analysis assessed self-image risk of AN association. Results: Adolescents at risk approached 1.4% (2.2% of girls and 0.5% of boys); 19-and 17-year-old females exhibited a higher prevalence. Overall adolescent risk included: impulse control, family relationships and psychopathology. Critical areas in the AN developing showed age and gender differences: body image for younger females, impulse control for the older, psychopathology for young males and sexual attitudes for the older represented the poorer adjustment dimensions. Discussion: Results support screening procedures and tailored school-based prevention.