Abstract
Purpose
Childhood-onset anorexia nervosa (AN) may be under-recognised and under-treated due to atypical presentations. The aims of this study are: (1) describe features of AN in patients ≤ 18 years in an Asian population; and (2) compare childhood-onset and adolescent-onset AN.
Methods
This study involved a retrospective chart review of patients ≤ 18 years in a Asian population who were treated for anorexia nervosa at the Eating Disorders Service at Singapore General Hospital between Jan 2003 and Dec 2014 (n = 435). Childhood-onset AN was defined as onset < 13 years, while adolescent-onset AN was defined as onset between 13 and 18 years.
Results
Patients were predominantly female (95.4%) and Chinese (83%). The childhood-onset group (8.3%) had mean age of onset 11.5 ± 1.0 years, compared to 15.2 ± 1.6 years for the adolescent-onset group. The childhood and adolescent-onset groups were similar in socio-demographic variables, as well as gender distribution, AN subtype, number of psychiatric comorbidities, family history of psychiatric illness, body image issues and excessive exercise. The childhood-onset group had significantly longer duration of illness prior to presentation (4.75 vs 2.62 years), greater frequency of comorbid obsessive–compulsive disorder (19.4% vs 5.3%) and were more likely to report teasing as a trigger for AN (58.3% vs 31.6%). The childhood-onset group had significantly longer duration of inpatient stay (5.97 vs 3.22 weeks), as well as a greater number of total admissions (2.78 vs 1.37).
Conclusion
Our results suggest that cultural factors may impact the development or identification of AN in an Asian context. Possible delay in diagnosis of childhood-onset AN may lead to a more unfavorable clinical course.
Level of evidence
Level V, descriptive study.
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Acknowledgements
The authors would like to thank Kelly Ann Zainal for assistance with data collection and statistical analysis.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Ethical approval was obtained from the SGH Institutional Review Board (2015/2591).
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Kwok, C., Kwok, V., Lee, H.Y. et al. Clinical and socio-demographic features in childhood vs adolescent-onset anorexia nervosa in an Asian population. Eat Weight Disord 25, 821–826 (2020). https://doi.org/10.1007/s40519-019-00694-9
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DOI: https://doi.org/10.1007/s40519-019-00694-9