Abstract
Teen-age onset has been a characteristic trait of anorexia nervosa from the early descriptions and onward. Early onset may be defined by using an age limit or by using menarche as a biological age limit. A review of the literature indicates that there are relatively more boys among patients with an extremely early onset. When patients are recruited exclusively from clinics for children or from clinics for adults, various selection biases will result, having great importance for the interpretation of the findings. Results from a Swedish long-term study are presented showing outcome in patients with different age at onset. The general trend is that early onset is predicting a better outcome, but the long-term course is far from favorable in many early onset cases. There is a risk of intractable sequelae, e.g., short stature, if anorexia patients with an early onset are allowed to run a long or chronic course of illness.
Similar content being viewed by others
References
Askevold, F. (1980). Anorexia nervosa hos yngre kvinner. En klinisk studie av tilstanden, behandlingen og forlöpet. (Diss.). Rigshospitalet, Oslo.
Blitzer, J. E., Rollins, N., and Blackwell, A. (1961). Children who starve themselves: Anorexia nervosa.Psychosom. Med. 23: 369–383.
Bryant-Waugh, R., Knibbs, J., Fosson, A., Kaminski, Z., and Lask, B. (1988). Long term follow up of patients with early onset anorexia nervosa.Arch. Dis. Child. 63: 5–9.
Cantwell, D. P., Sturzenberger, S., Burroughs, J., Salkin, B., and Green, J. K. (1977). Anorexia nervosa. An affective disorder?Arch. Gen. Psychiat. 34: 1087–1093.
Casper, R. C. (1983). On the emergence of bulimia nervosa as a syndrome.Int. J. Eat. Disord. 2: 3–16.
Crisp, A. H., and Burns, T. (1983). The clinical presentation of anorexia nervosa in the male.Int. J. Eat. Disord. 2: 5–10.
Crisp, A. H., Burns, T., and Bhat, A. V. (1986). Primary anorexia nervosa in the male and female: A comparison of clinical features and prognosis.Br. J. Med. Psychol. 59: 123–132.
Crisp, A. H., Hsu, L. K. G., Harding, B., and Hartshorn, J. (1980). Clinical features of anorexia nervosa: A study of a consecutive series of 102 female patients.J. Psychosom. Res. 24: 179–191.
Dally, P. (1969). Anorexia nervosa. W. Heinemann Medical Books, London.
Dally, P., Gomez, J., and Isaacs, A. J. (1979).Anorexia Nervosa. W. Heinemann Medical Books, London.
Fichter, M. M. (1985).Magersucht und Bulimia. Springer-Verlag, Berlin.
Fosson, A., Knibbs, J., Bryant-Waugh, R., and Lask, B. (1987). Early onset anorexia nervosa.Arch. Dis. Child. 62: 114–118.
Garfinkel, P. E., and Garner, D. M. (1982).Anorexia Nervosa: A Multidimensional Perspective. Brunner/Mazel, New York.
Gillberg, C., Rastam, M., and Gillberg, I. C. (1994). Anorexia nervosa: Who sees the patients and who do the patients see?Acta Paediatr. 83: 967–971.
Gillberg, I. C., Rastam, M., and Gillberg, C. (1995). Anorexia nervosa outcome: Six year controlled longitudinal study of 51 cases including a population cohort.J. Am. Acad. Child. Adolesc. Psychiat. 33: 729–739.
Halmi, K. A., Casper, R. C., Eckert, E. D., Goldberg, S. C., and Davis, J. M. (1979). Unique features associated with age of onset of anorexia nervosa.Psychiat. Res. 1: 209–215.
Hawley, R. M. (1985). The outcome of anorexia nervosa in younger subjects.Br. J. Psychiat. 146: 657–660.
Higgs, J. F., Goodyer, I. M., and Birch, J. (1989). Anorexia nervosa and food avoidance emotional disorder.Arch. Dis. Child 64: 346–351.
Hsu, L. K., Crisp, A. H., and Harding, B. (1979). Outcome of anorexia nervosa.Lancet 1: 61–65.
Jacobs, B. W., and Isaacs, S. (1986). Pre-pubertal anorexia nervosa: A retrospective controlled study.J. Child Psychol. Psychiat. 27: 237–250.
Johnson-Sabine, E., Wood, K., Patton, G., Mann, A., and Wakeling, A. (1988). Abnormal eating attitudes in London schoolgirls—A prospective epidemiological study: Factors associated with abnormal response on screening questionnaires.Psychol. Med. 18: 615–622.
Lask, B., and Bryant-Waugh, R. (eds.) (1993).Childhood Onset Anorexia Nervosa and Related Eating Disorders. Lawrence Erlbaum Associates, Hove (UK), Hillsdale (USA).
Mester, H. (1981).Anorexia Nervosa. Springer-Verlag, Berlin.
Nussbaum, M., Shenker, I. R., Baird, D., and Saravay, S. (1985). Follow-up investigation in patients with anorexia nervosa.J. Pediatr. 106: 835–840.
Patton, G. C., Johnson-Sabine, E., Wood, K., Mann, A. H., and Wakeling, A. (1990). Abnormal eating attitudes in London schoolgirls—A prospective epidemiological study: Outcome at twelve month follow-up.Psychol. Med. 20: 383–394.
Rastam, M., Gillberg, C., and Garton, M. (1989). Anorexia nervosa in a Swedish urban region. A population-based study.Br. J. Psychiat. 155: 642–646.
Ratnasuriya, R. H., Eisler, I., Szmukler, G. I., and Russell, G. F. (1991). Anorexia nervosa: Outcome and prognostic factors after 20 years.Br. J. Psychiat. 158: 495–502.
Russell, G. F. M. (1985). Premenarchal anorexia nervosa and it sequelae.J. Psychiatr. Res. 19: 363–369.
Russell, G. F. M. (1995). Anorexia nervosa through time. In Szmukler, G. I., Dare, C., and Treasure, J. (eds.),Handbook of Eating Disorders. Theory, Treatment and Research. John Wiley & Sons, Chichester.
Steinhausen, H. C., and Glanville, K. (1983). A long-term follow-up of adolescent anorexia nervosa.Acta Psychiatr. Scand. 68: 1–10.
Steinhausen, H. C., and Seidel, R. (1993). Outcome in adolescent eating disorders.Int. J. Eat. Disord. 14: 487–496.
Sturzenberger, S., Cantwell, D. P., Burroughs, J., Salkin, B., and Green J. K. (1977). A follow-up study of adolescent psychiatric inpatients with anorexia nervosa. I. The assessment of outcome.J. Am. Acad. Child Psychiat. 16: 703–715.
Szmukler, G. I., and Russell, G. F. M. (1986). Outcome and prognosis of anorexia nervosa. In Brownell, K. D., and Foreyt, J. É (eds.),Handbook of Eating Disorders. Basic Books, New York.
Theander, S. (1970). Anorexia nervosa: A psychiatric investigation of 94 female patients.Acta Psychiatr. Scand. Suppl. 214: 1–194.
Theander, S. (1985). Outcome and prognosis in anorexia nervosa and bulimia: Some results of previous investigations compared with those of a Swedish long-term study.J. Psychiatr. Res. 19: 493–508.
Theander, S. (1992). Chronicity in anorexia nervosa: Results from the Swedish long-term study. InThe Course of Eating Disorders. Herzog, W., Deter, H.-C., and Vandereycken, W. (eds.), Springer-Verlag, Heidelberg, Berlin.
Tolstrup, K., Brinch, M., Isager, T., Nielsen, S., Nystrup, J., Severin, B., and Olesen, N. S. (1985). Long-term outcome of 151 cases of anorexia nervosa.Acta Psychiatr. Scand. 71: 380–387.
Walford, G., and McCune, N. (1991). Long-term outcome in early-onset anorexia nervosa.Br. J. Psychiatr. 159: 383–389.
Warren, W. (1968). A study of anorexia nervosa in young girls.J. Child Psychol. Psychiat. 9: 27–40.
Additional information
Newly retired from a position as Associate Professor and Head of the Anorexia Nervosa Unit at the University of Lund, Sweden. Received M.D. from University of Lund. Research interests are course and outcome of anorexia nervosa.
Rights and permissions
About this article
Cite this article
Theander, S. Anorexia nervosa with an early onset: Selection, gender, outcome, and results of a long-term follow-up study. J Youth Adolescence 25, 419–429 (1996). https://doi.org/10.1007/BF01537539
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01537539