Original article
How Do Children with Eating Disorders Differ from Adolescents with Eating Disorders at Initial Evaluation?

https://doi.org/10.1016/j.jadohealth.2006.05.013Get rights and content

Abstract

Purpose

To compare the clinical presentation of children with eating disorders (ED) to that of adolescents with ED.

Methods

Demographic, medical, and psychiatric data of all 959 in- and outpatients (85 males, 874 females) 8–19 years of age diagnosed with ED that presented to an academic center between 1997 and 2005 were examined via retrospective record review. Young patients (n = 109) were defined as aged < 13 years at presentation, and older patients (n = 850) ≥ 13 years and < 20 years.

Results

Compared with older adolescents (mean 15.6 years, SD 1.4), younger patients (mean 11.6 years, SD 1.2) were more likely to be male (χ2 = 9.25, p < .005) or diagnosed with eating disorder not otherwise specified (EDNOS) (χ2 = 5.09, p ≤ .05), and less likely to be diagnosed with bulimia nervosa (BN) (χ2 = 13.45, p ≤ .001). There were no significant differences in anorexia nervosa (AN) diagnoses between groups. Young patients were less likely to report purging (χ2 = 26.21, p < .001), binge eating2 = 26.53, p < .001), diet pill (χ2 = 13.31, p < .001) or laxative use (χ2 = 6.82, p < .001) when compared with older teens. Young patients weighed less in percentage ideal body weight (p < .05), had a shorter duration of disease (p < .001), and had lost weight more rapidly than older adolescent patients (p ≤ .001).

Conclusions

There are important diagnostic and gender differences in younger patients. Young ED patients presented at a lower percentage of ideal body weight and had lost weight more rapidly, which may put them at higher risk for future growth sequelae than their older counterparts.

Section snippets

Subject Selection

We identified all patients aged 8–19 years evaluated in a treatment program for children and adolescents with ED at an academic medical center from January 1997 through August 2005. Charts were identified by searching medical records and clinical databases for all patients aged 8–19 years, diagnosed with AN, BN, or EDNOS. Diagnoses were made using DSM-IV criteria at presentation by a child psychiatrist expert in the assessment of children and adolescents with ED, and record review substantiated

Results

A total of 959 patients were analyzed: 109 (11.4%) patients under 13 years of age and 850 (88.6%) patients aged 13–19 years at presentation to our program. The mean age of the younger patient subset was 11.6 years (SD 1.2); the mean age of the older adolescent subset was 15.6 years (SD 1.4). Most of the young patients were prepubertal: 76.1% of young females (n = 91) were premenarchal, compared with 7.0% of older females (n = 773). SMR of breast/genitourinary and pubic hair was documented in

Discussion

This study is the first to describe a large sample of young children with different types of ED, and to compare them with older teens on multiple measures. Series of young patients with ED to date have focused on smaller samples of patients with AN, with “young” typically defined as prepubertal at time of onset. This literature suggests that children and young adolescents with ED are more likely to be given a diagnosis of EDNOS than AN or BN, due to the difficulty of younger patients meeting

Acknowledgments

Dr. Lock’s participation was supported by NIH grant K24 074467. Data collection was supported in part by the Pediatric Research Fund at Stanford University School of Medicine.

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