Paediatric Drugs

, Volume 3, Issue 2, pp 91–99 | Cite as

Eating Disorders in Children and Adolescents

Epidemiology, Diagnosis and Treatment
Therapy In Practice

Abstract

Eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) are increasingly prevalent among children and adolescents. Whereas AN has a peak age of onset in early to mid-adolescence, BN typically presents during or after late adolescence. There is a spectrum of eating disorders that can be categorised by the criteria in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders into AN, BN and ‘eating disorder not otherwise specified (ED-NOS)’.

The key clinical signs of AN are those of protein calorie malnutrition. In BN, signs of purging are also important. Despite marked physical changes, metabolic decompensation occurs late and when present is an indication for hospital admission. During refeeding, electrolyte disturbances, in particular hypophosphataemia, should be serially monitored. For females with AN, restoration of gonadotropins, oestradiol and resumption of menses is a cardinal indicator of nutritional recovery.

Treatment should address the medical, nutritional and psychological needs of children and adolescents with eating disorders. No single professional can be proficient in all spheres. Children and adolescents with eating disorders are best managed by a ‘team approach’. Treatment may occur in a variety of inpatient, daypatient or outpatient settings. The aims of medical treatment are to promote bodyweight gain and nutritional recovery. Psychiatric goals address the psychosocial precipitants, treat comorbid mood symptoms and assist the patient to develop alternative coping skills.

The crude mortality of AN has decreased to around 6%. For children and adolescents, the morbidity from malnutrition is increased because of the biological changes that are interrupted.

Keywords

Anorexia Nervosa Obsessive Compulsive Disorder Eating Disorder Binge Eating Bulimia Nervosa 

References

  1. 1.
    Thompson J, Thompson C. Body size distortion and self esteem in asymptomatic, normal weight males and females. Int J Eat Disord 1986; 5: 1061CrossRefGoogle Scholar
  2. 2.
    Cohn L, Adler N, Irwin C, et al. Body figure preferences in male and female adolescents. J Abnorm Psychol 1987; 96: 276–9PubMedCrossRefGoogle Scholar
  3. 3.
    Eisele J, Hertsgaard D, Light H. Factors relating to eating disorders in young adolescent girls. Adolescence 1986; 21: 283–90PubMedGoogle Scholar
  4. 4.
    Maloney M, Ruedisueli G. The epidemiology of eating problems in non-referred children and adolescents. Child Adolesc Psychiatr Clin North Am 1993; 2: 1Google Scholar
  5. 5.
    Paxton SJ, Wertheim EH, Gibbons K, et al. Body image satisfaction, dieting beliefs and weight loss behaviours in adolescent girls and boys. J Youth Adolesc 1991; 20: 361CrossRefGoogle Scholar
  6. 6.
    Marchi M, Cohen P. Early childhood eating behaviours and adolescent eating disorders. J Am Acad Child Adolesc Psychiatry 1990; 29: 112–7PubMedCrossRefGoogle Scholar
  7. 7.
    Bruch H. The golden cage: the enigma of anorexia nervosa. Vancouver (WA): Vintage Books, 1978Google Scholar
  8. 8.
    Orbach S. Hunger strike: the anorectic’s struggle as a metaphor for our age. New York (NY): Anon Books, 1986Google Scholar
  9. 9.
    Maloney M, Maguire J, Turns M, et al. Dieting behaviour and eating attitudes in children: peer pressure or imitation of parental behaviour [abstract]. Annual meeting of the International Conference on Eating Disorder; 1990; New York (NY), 1:29Google Scholar
  10. 10.
    Killen JD, Hayward C, Litt I, et al. Is puberty a risk factor for eating disorders? Am J Dis Child 1992; 146: 323–5PubMedGoogle Scholar
  11. 11.
    Alexander N, Kohn MR, Clarke S. Changing faces of anorexia nervosa [monograph no. 7]. In: Bashir M, Bennett D, editors. Deeper dimensions: culture, youth and mental health. Sydney (NSW): Transcultural Health Centre, 2000: 119–22Google Scholar
  12. 12.
    Crago M, Shisslak CM, Estes LS. Eating disturbances among American minority groups: a review. Int J Eat Disord 1996; 19: 239–48PubMedCrossRefGoogle Scholar
  13. 13.
    Lucas AR, Beard CM, O’Fallon WM, et al. 50-year trends in the incidence of anorexia nervosa in Rochester, Minn: a population based study. Am J Psychiatry 1991; 148: 917–22PubMedGoogle Scholar
  14. 14.
    Wade T, Heath AC, Abraham S, et al. Assessing the prevalence of eating disorders in an Australian twin population. Aust NZ J Psychiatry 1996; 30: 845–51CrossRefGoogle Scholar
  15. 15.
    de Azevedo MH, Ferreira CP. Anorexia nervosa and bulimia: a prevalence study. Acta Psychiatr Scand 1992; 86: 432–6PubMedCrossRefGoogle Scholar
  16. 16.
    Hoek HW The incidence and prevalence of anorexia nervosa and bulimia nervosa in primary care. Psychol Med 1991; 21: 455–60PubMedCrossRefGoogle Scholar
  17. 17.
    Morande G, Celande J, Casas JJ. Prevalence of eating disorders in a Spanish school age population. J Adolesc Health 1999; 24: 212–9PubMedCrossRefGoogle Scholar
  18. 18.
    Kreipe RE. Eating disorders among children and adolescents. Pediatr Rev 1995; 16:370–9PubMedCrossRefGoogle Scholar
  19. 19.
    Wakeling A. Epidemiology of anorexia nervosa. Psychiatry Res 1996; 62: 3–9PubMedCrossRefGoogle Scholar
  20. 20.
    Neumarker KJ. Mortality and sudden death in anorexia nervosa. Int J Eat Disord 1997; 21: 205–12PubMedCrossRefGoogle Scholar
  21. 21.
    Sullivan PF. Mortality in anorexia nervosa. Am J Psychiatry 1995; 152: 1073–4PubMedGoogle Scholar
  22. 22.
    Keel PK, Mitchell JE, Miller KB, et al. Long-term outcome of bulimia nervosa. Arch Gen Psychiatry 1999; 56: 63–9PubMedCrossRefGoogle Scholar
  23. 23.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV. 4th Ed. Washington, DC: American Psychiatric Press, 1994Google Scholar
  24. 24.
    Golden N, Sacker IM. An overview of the etiology, diagnosis and management of anorexia nervosa. Clin Pediatr 1984; 23: 209–14CrossRefGoogle Scholar
  25. 25.
    Strober M, Freeman R, Morrell W. The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord 1997; 22: 339–60PubMedCrossRefGoogle Scholar
  26. 26.
    Ogren FP, Huerter JV, Pearson PH, et al. Transient salivary gland hypertrophy in bulimics. Laryngoscope 1987; 97: 951–3PubMedCrossRefGoogle Scholar
  27. 27.
    Fisher M, Golden NH, Katzman DK, et al. Eating disorders in adolescents: a background paper. J Adolesc Health 1995; 16: 420–37PubMedCrossRefGoogle Scholar
  28. 28.
    Klibanski A, Biller BMK, Schoenfeld DA, et al. The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa. J Clin Endocrinol Metab 1995; 80: 898–904PubMedCrossRefGoogle Scholar
  29. 29.
    Fluoxetine in the treatment of bulimia nervosa: a multicentre, placebo-controlled, double-blind trial. Fluoxetine Bulimia Nervosa Collaborative Study Group. Arch Gen Psychiatry 1992; 49: 139–47Google Scholar
  30. 30.
    Agras WS, Rossiter EM, Arnow B, et al. Pharmacologic and cognitive-behavioural treatment for bulimia nervosa: a controlled comparison. Am J Psychiatry 1992; 149: 82–7PubMedGoogle Scholar
  31. 31.
    Ferguson CP, La Via MC, Crossan PJ, et al. Are selective serotonin reuptake inhibitors effective in under-weight anorexia nervosa? Int J Eating Disord 1999; 25: 11–7CrossRefGoogle Scholar
  32. 32.
    Attia E, Haiman C, Walsh BT, et al. Does fluoxetine augment the inpatient treatment of anorexia nervosa? Am J Psychiatry 1998; 155: 548–51PubMedGoogle Scholar
  33. 33.
    Solanto MV, Jacobson MS, Heller L, et al. Rate of weight gain of inpatients with anorexia nervosa under two behavioural contracts. Pediatrics 1994; 93: 989–91PubMedGoogle Scholar
  34. 34.
    Kohn MR, Golden NH, Shenker IR. Cardiac arrest and delirium: presentations of the refeeding syndrome in severely malnourished adolescents with anorexia nervosa. J Adolesc Health 1998; 22: 239–43PubMedCrossRefGoogle Scholar
  35. 35.
    Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry 1998; 173: 11–53PubMedCrossRefGoogle Scholar
  36. 36.
    Crisp Ah, Callender JS, Halek C, et al. Long term mortality in anorexia nervosa: a 20 year follow up of the St. George and Aberdeen cohorts. Br J Psychiatry 1992; 161: 104–7Google Scholar
  37. 37.
    Deter HC, Herzog W. Anorexia nervosa in a long term perspective: results of the Heidelberg-Mannheim study. Psychosom Med 1994; 56: 20–7PubMedGoogle Scholar
  38. 38.
    Moller-Madsen S, Nystrup J, Nielsen S. Mortality in anorexia nervosa in Denmark during the period 1970–1987. Acta Psychiatr Scand 1996; 94: 454–9PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Department of Adolescent MedicineThe New Children’s HospitalParramattaAustralia
  2. 2.Division of Adolescent MedicineSchneider Children’s HospitalNew Hyde ParkUSA

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