Prepubertal anorexia nervosa: clinical characteristics at onset

Objective To describe the clinical characteristics at onset of a group of prepubertal anorexic girls (we included in this study subjects who suffered from anorexia nervosa, restricting type, anorexia nervosa, binge-eating/purging type, eating disorder not otherwise specified, restricting type, eating disorder not otherwise specified, binge-eating/purging type). Methods The sample consists of 21 prepubertal (PreP, all subjects with primary amenorrhea) anorexic girls. This sample has been compared with another sample composed of 21 postpubertal (PostP, all subjects were post-menarche) anorexic girls. The mean age of PreP was 11.5 years (SD: 1.58; range: 9.6-15.10); the mean age of PostP was 16.6 years (SD: 1.07; range: 13.7-17.10). All the girls were referred to the "Eating Disorder Program" at the Scientific Institute "Stella Maris" of the University of Pisa. To evaluate psychopathology and eating symptoms we used the following instruments: Eating Attitudes Test (EAT-26), Eating Disorders Inventory (EDI-2), Child Behaviour Checklist (CBCL), Youth Self Report (YSR), Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS-PL). For the medical conditions we performed standard blood chemistry, ECG, echocardiogram, and abdominal ultrasonography. To analyse data we used the SPSS for Windows (1999, Statsoft Inc) software to perform Student's t-test, chi(2) and Pearson's correlation. Results No significant differences between the two groups were found with regard to the characteristics of eating (Table I) and medical (Table III) symptoms. The only statistically different symptoms between the two groups were suicidal thoughts, that occurred at a significantly higher rate in PostP (Table I: suicidal thoughts are present in 6 PostP and in none of the PreP). Statistical analysis did not detect any significant difference between the two groups with regard to psychiatric comorbidity. Psychopathology (Table II), as observed by the parents through the CBCL, is worse in PreP compared to PostP, while the latter scored worse, although not statistically significant, on the YSR (a self-report questionnaire to be filled-in by the adolescent). Conclusions In our study, by comparing the PreP with the PostP group, no statistically significant differences are found, both in the clinical features of the eating disorder and in the associated psychopathological characteristics. Nevertheless, we may observe that with the progression of pubertal development and probably, with increased illness awareness, there appear more dissatisfaction with one's own body and weight, as well as important depressive symptoms and suicidal thoughts. On the other hand, in the PreP group there is a discrepancy between the evaluation by the parents (CBCL) and self-evaluation by the adolescent (YSR); this could be related to the low awareness of the younger girls' emotional distress associated to the eating disorder.