In:
Psychiatry and Psychobiology, Cambridge University Press (CUP), Vol. 3, No. 2 ( 1988), p. 87-98
Abstract:
Our study involved a statistical comparison of two groups of patients with ano rexia nervosa (according to DSM-III criteria) - below the age of 13, above the age of 13 - who were examine at a child and adolescent psychiatry clinic. It showed the following resuits. 1) Anorexia nervosa is not very frequent among children who are less than 13 years of age, in comparison with) adolescents; indeed the younger group comprises 14 patients over a period of 7.5 years, whereas the older group includes 37 patients over a period of 2.5 years. 2) The proportion of boys is higher in the younger group (below 13) since we find 5 boys and 9 girls, boys repre senting 35% of this group; the predominance of girls over boys is more clear at puberty since we have one boy; for 36 girls, with boys representing only 3% of the older group. 3) Growth delays are marked in young anorexic patients. In our series, only boys were affected by it (3). The age of onset was 10 years for the first one and 11.5 for the other 2. Two patients had reached their final height which was normal. The third patient had a height below - 2 SD at age 23. One can question the absence of growth delay in our younger female series. In our opinion, the reason is that our anorexic girls were older than 10 year. of age at the time of onset of the illness. Their growth was then well-advanced and they were likely to have started their puberty. In contrast, those boys with growth arrest were all prepubertal at the time of onset of the anorexia, disorder. 4) The clinical symptomatology is more spectacular in the younger group: – a premorbid State characterized by eating problems during early childhood; – a rapid weight loss. Weight is often below 25% of the previous one but thinness is pronounced, as there is little fat tissue before puberty. In the young group, the weight loss is generally between 15 and 20%; – in 3 cases out of 14, hydration refusal was associated with food refusal; this particulur symptom was not observed in the older group. These last two observations challenge the appropriateness of DSM-III criteria for anorexia nervosa in young children. 5) In contrast, there was no significant difference between the 2 groups regarding: the frequency of psychiatric disorders among parents and siblings: 17,8% in parents of group I, primarily affective disorders (16%). Eating disorders was the most often diagnosed pathology among our patients’ siblings; the position of the anorexic patient within the sibling System, the social status of parents, the situation of the parental home; physical hyperactivity, occurrence of induced vomiting, use of laxatives and Somatic complaints; prevalence of depression as an associated diagnosis; it is fairly high in both groups since we find 86% with depression in the younger group (12 out of 14) and 60% in the older group (22 cases out of 37); severity of psychosocial stress; the level of adjustment and of academic and social functioning during the past year. Among the various adjustment problems observed in many of our anorexic patients, we find social relationship problems as well as cognitive distortions which lead to poor academie achievement in spite of adequate intellectual potential and overinvolvement in scholl work. 6) Our conclusions concerning the outcome of anorexia are incomplete because of a lack of precision in some of the data collected, the relatively brief duration of follow-up (patients front group I generally benefited front a more regular and prolonged follow-up - an average of 4 years - than patients front groupe 2 - average of 2 years) and because of the sampling weaknesses of the younger group. Weight returned to normal in 78.5% of the cases of group 1 and 54% of the cases of group 2. We noted that it is relatively easy to produce weight gains in anorexic patients. Eating behavior was adequate in 1 subject of group 1 (64%) and 19 subjects of group 2 (51%). Appearance or reappearance of menses are observed in 6 girls out of 9 in group 1 (66.6%) and 20 girls out of 36 in group 2 (55.5%). An evaluation of our subjects mental status (only 12 out of 14 subjects were involved since 2 did not respond to our questions) shows that one female patient presents with chronic anorexia nervosa, involving recurrent episodes of major depression; another female patient had a delusional episode of depression; a third one can be considered as being schizophrenic. Six subjects suffer from chronic anxiety with lack of self-confidence and social phobia for one of them. The last three function adequately in all areas. As we can see, anorexia nervosa is a serious illness with an uncertain prognosis. However, there did not seem to be any difference between the two groups with regard to the evolution of the disease (front a behavioral standpoint). However, we should stress that except for 2 cases, anorexic patients below the age of 13 had been affected by the disorder right before puberty or soon after its beginning.
Type of Medium:
Online Resource
ISSN:
0767-399X
,
2633-0903
DOI:
10.1017/S0767399X00001863
Language:
English
Publisher:
Cambridge University Press (CUP)
Publication Date:
1988
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