ndersen er an - Gundersen Health System

Childhood Anorexia
shape concerns also decreased dramatically. The only aspect that
did not decrease was weight concerns, which parallels the results of
studies of adolescents receiving similar therapy. 8
More research is needed in order to find out whether behavior
and family therapy are effective for children with AN. Children
with AN present differently from other AN patients, so they might
respond to treatment differently, as well. For example, because
children tend to rely on their parents more than do adolescents
and adults, family therapy might be more effective in children
than in older AN patients. Addressing family issues and control
may have great implications in the treatment of early-onset of
AN. Another consideration for children with AN is the eventual
onset of adolescence and puberty, a period of transition that can be
difficult for AN patients. Even patients who have been treated for
AN and are doing well might benefit from booster sessions during
this period.
Outcome
Research on the outcome of individuals with early-onset
AN has shown conflicting results. 9,27 One study used a modified
version of the outcome status ratings Morgan and Russell used on
adults with AN to examine children with a 2- to 5-year followup.
Outcome was based on the individual’s ratings on 5 different
scales: nutritional status, menstruation, mental state, psychosocial
adjustment, and psychosexual adjustment. 27,28 Overall outcome
was based on these 5 scales. 27,28 The child study found that 11
(70.6%) of the 17 subjects had an overall “good” outcome. 27
Outcome based solely on mental state or menstruation had the
highest number of individuals in the “poor” category (n = 4). 27 Poor
ratings in these categories signified a grossly abnormal mental state
and virtually absent menstruation. 27,28 Another study also reported
that a small majority of individuals with early-onset AN were
categorized as having a good outcome (57%). In follow-up 2 of
18 patients reported suicide attempts, which is very concerning. 29
Likewise, in a study done by Theander, 9 2 individuals in the earlyonset
group had died at follow-up — 1 at 24 years after onset, and
the other at 20 years after onset. In comparison, no individuals in
the late-onset group had died. The patient who died 24 years after
onset had been doing well for 12 years following treatment. 9 Thus,
follow-up studies 2 to 5 years after treatment may not reflect longterm
outcomes for some patients.
In his 1982 review of the literature, Swift concluded that
there was insufficient evidence to show that the outcome of earlyonset
AN patients was better or worse than that of late-onset AN
patients. 30 Many studies done to date do not directly compare earlyonset
patient results to those of late-onset patients, thus making
it difficult to directly compare the 2 groups. However, based on
his review of the literature, Swift concluded that the long-term
outcome of early-onset patients was equivalent to that of other AN
patients. 30 In a comparison follow-up of individuals with earlyonset
and late-onset AN, it was found that 45% of individuals
with late-onset AN were “good” at examination 4 to 10 years later,
while 2% had died. These results echo the findings of another
follow-up study examining early-onset AN patients. 31
The assertion that outcomes for early-onset and late-onset AN
patients are similar is not promising. The results are especially
concerning when one considers that the longer an individual has
symptoms of AN, the more difficult it is to intervene. 9 Intervention
occurred at a young age for the subjects examined in these outcome
studies. But if AN symptoms are not recognized and treatment
sought, the course of the disorder may be irreversible and produce
detrimental effects years later.
Conclusion
Diagnosis is an important issue with AN. More leniency in
the criteria for diagnosis of early-onset AN may allow intervention
before the disorder progresses to a point where there are irreversible
side effects. In order to intervene as early and as effectively as
possible, however, more research is needed on treatment that
targets younger individuals with AN.
Although early-onset patients represent a minority of AN
patients, the illness can have serious and irreversible health
consequences. 15 Future research should seek to clarify the
differences between early-onset and late-onset AN and to identify
the most effective treatments for AN patients of all ages.
REFERENCES
1. Lucas AR, Beard CM, O’Fallon WM, Kurland LT. 50-year trends in the incidence
of anorexia nervosa in Rochester, Minn.: a population-based study. Am J Psychiatry.
1991;148(7):917-922.
2. Lucas AR, Crowson CS, O’Fallon WM, Melton LJ 3rd. The ups and downs of
anorexia nervosa. Int J Eat Disord. 1999;26(4):397-405.
3. Bostic JQ, Muriel AC, Hack S, Weinstein S, Herzog D. Anorexia nervosa in a
7-year-old girl. J Dev Behav Pediatr. 1997;18(5):331-333.
4. Arnow B, Sanders MJ, Steiner H. Premenarcheal versus postmenarcheal anorexia
nervosa: a comparative study. Clin Child Psychol Psychiatry. 1999;4(3):403- 414.
5. Nicholls D, Chater R, Lask B. Children into DSM don’t go: a comparison of
classification systems for eating disorders in childhood and early adolescence. Int J
Eat Disord. 2000;28(3):317-324.
6. Matsumoto H, Takei N, Kawai M, et al. Differences of symptoms and standardized
weight index between patients with early-onset and late-onset anorexia nervosa.
Acta Psychiatr Scand. 2001;104(1):66-71.
7. Peebles R, Wilson JL, Lock JD. How do children with eating disorders differ
from adolescents with eating disorders at initial evaluation? J Adolesc Health.
2006;39(6):800-805.
8. Lock J, le Grange D, Forsberg S, Hewell K. Is family therapy useful for treating
children with anorexia nervosa? Results of a case series. J Am Acad Child Adolesc
Psychiatry. 2006;45(11):1323-1328.
9. Theander S. Anorexia nervosa with an early onset: selection, gender, outcome, and
results of a long-term follow-up study. J Youth Adolesc. 1996;25(4):419-429.
10. American Psychiatric Association Task Force on DSM-IV. Diagnostic and
Statistical Manual of Mental Disorders : DSM-IV-TR. 4th rev ed. Washington,
DC: American Psychiatric Association; 2000.
11. Nielsen GB, Lausch B, Thomsen PH. Three cases of severe early-onset eating
disorder: are they cases of anorexia nervosa? Psychopathology. 1997;30(1):49-52.
12. Robins PM, Putnam PH. From the children’s corner: a comparison of childhood
variant disorders of eating and early-onset eating disorders. Eat Disord.
1999;7:149-156.
13. Cooper PJ, Watkins B, Bryant-Waugh R, Lask B. The nosological status of early
onset anorexia nervosa. Psychol Med. 2002;32(5):873-880.
14. Lask B, Bryant-Waugh R, Wright F, Campbell M, Willoughby K, Waller G.
Family physician consultation patterns indicate high risk for early-onset anorexia
nervosa. Int J Eat Disord. 2005;38(3):269-272.
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