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Guest Editorial

New Developments in Child and Adolescent Eating Disorders


Jennifer Couturier MD, FRCPC1

Eating disorders are highly prevalent among mately 70% recover (Strober, Freeman et al
adolescents and have serious long-term conse- 1997; Herpertz-Dahlmann, Muller et al 2001).
quences. Patients with Anorexia Nervosa (AN) The reason for the better prognosis in adoles-
characteristically present with low body weight, cents is unknown, but perhaps it is due to the
intense fear of weight gain, body image distor- support provided by families in securing help for
tion, denial of the seriousness of their illness, the young patient.
and amenorrhea, whereas patients with This special issue of the Journal of the
Bulimia Nervosa (BN) are typically of average Canadian Academy of Child and Adolescent
body weight, and have binge eating and purging Psychiatry on children and adolescents with
behaviours. Recent estimates suggest that the eating disorders contains several important
prevalence of AN is 0.3% and that of BN is 1%, papers covering a wide variety of topics within
although many more adolescents present with this field. The issue begins with a review of the
clinically significant eating disorders that do not available literature on psychotherapeutic inter-
meet full DSM-IV-TR criteria for AN or BN. These ventions for this population. Although the liter-
adolescents receive a diagnosis of Eating ature on treatment for eating disorders in chil-
Disorder Not Otherwise Specified, which is the dren and adolescents is rather scant, there
most commonly diagnosed eating disorder. have recently been some promising findings in
Only one third of those meeting diagnostic cri- the field of family therapy for AN (Lock, Agras
teria for AN actually receive treatment in a et al 2005; Lock, Couturier et al 2006). In addi-
mental health setting, and only 6% of those tion, family therapy for adolescent BN appears
with BN receive such treatment (Hoek 2006). to be gaining some support (le Grange, Crosby
Both AN and BN affect social relationships, et al 2007).
school functioning, and perhaps most impor- Following this review, Bucholz et al present
tantly in young patients, family relationships. a novel paper on what they describe as self-
The medical and psychological conse- silencing in female adolescents with eating dis-
quences of eating disorders may persist orders. The authors have found an association
throughout life if patients remain chronically ill. between social anxiety and body dissatisfac-
The mortality rate from AN is estimated to tion, a link that may be very important clinically
increase by 5% every decade a patient remains in the prevention and treatment of eating disor-
ill (Sullivan 1995; Steinhausen 2002). Although ders. Cairns et al then report their study on
the mortality rate from BN is thought to be meal support training for parents and care-
lower, it has not been well studied. Serious givers. Their study helps clinicians to remember
medical complications occur with both illnesses to focus on parents as a resource at meals
with cardiac complications being most danger- when working with this population. Norris et al
ous. In AN deaths are due to medical complica- then discuss obstacles to conducting psy-
tions in about 50% of cases, whereas about chopharmacology trials in this patient popula-
30% of deaths are from suicide, and the remain- tion. High dropout rates, along with low inci-
ing 20% from unknown causes. Studies in the dence rates have been previously reported in
adult population suggest that only about 50% of the literature as having a negative impact on
patients with AN recover (Steinhausen 2002), research in the field of adult eating disorders
whereas in the adolescent population approxi- (Halmi, Agras et al 2005). Add to these factors
the parental concerns about the side effects of
1University medication, and patient’s concerns about
of Western Ontario, London Health Sciences
Center, London, Ontario weight gain as reported by Norris et al, and
Corresponding email: jennifer.couturier@lhsc.on.ca recruitment for research studies within the

J Can Acad Child Adolesc Psychiatry 16:4 November 2007 151


GUEST EDITORIAL

child and adolescent population becomes even in accessing treatment for their children and
more complex. ensuring that they remain in treatment. Early
The special issue concludes with a review family intervention may prevent long-term mor-
on medication treatments for children and ado- bidity and mortality of eating disorders in the
lescents with eating disorders. Due to the many child and adolescent population, and thus,
obstacles cited by Norris et al, studies on med- research should focus further on involving
ication treatments for children and adolescents families in treatment.
are limited in number. Most of the literature is
restricted to case reports and case series. For References
Halmi, K. A., W. S. Agras, et al (2005). “Predictors of
this reason, most experts in the field agree treatment acceptance and completion in anorexia
that medications should only be recommended nervosa: implications for future study designs.”
for co-morbid conditions that clearly precede Archives of General Psychiatry 62(7): 776-81.
the onset of the eating disorder. However, Herper tz-Dahlmann, B., B. Muller, et al (2001).
“Prospective 10-year follow-up in adolescent anorexia
Selective Serotonin Reuptake Inhibitors show nervosa—course, outcome, psychiatric comorbidity,
promise for adolescent BN, and Atypical and psychosocial adaptation.” Journal of Child
Antipsychotics may be promising for adolescent Psychology and Psychiatry 42(5): 603-12.
Hoek, H. W. (2006). “Incidence, prevalence and mortality
AN. All require further study in child and ado- of anorexia nervosa and other eating disorders.”
lescent populations, but have gathered some Current Opinions in Psychiatry 19(4): 389-94.
evidence base in adults. le Grange, D., R. D. Crosby, et al (2007). “A randomized
controlled comparison of family-based treatment and
Due to the many difficulties in studying this supportive psychotherapy for adolescent bulimia
patient population as identified throughout this nervosa.” Archives of General Psychiatry 64(9):
issue, there is a dearth of literature in the field 1049-56.
Lock, J., W. S. Agras, et al (2005). “A comparison of
of child and adolescent eating disorders. Due short- and long-term family therapy for adolescent
to this lack of information, standardized, evi- anorexia nervosa.” Journal of the American Academy
dence-based practice is not yet available or of Child and Adolescent Psychiatry 44(7): 632-9.
Lock, J., J. Couturier, et al (2006). “Comparison of long-
possible. This may be one of the key reasons term outcomes in adolescents with anorexia nervosa
that treatment approaches for these disorders treated with family therapy.” Journal of the American
tend to differ between centers. Having acknowl- Academy of Child and Adolescent Psychiatry 45(6):
edged this, however, one must pay attention to 666-72.
Steinhausen, H. C. (2002). “The outcome of anorexia
the recent encouraging findings in the literature nervosa in the 20th century.” American Journal of
that suggest that involving families in assess- Psychiatry 159(8): 1284-93.
ment and treatment of young people with Strober, M., R. Freeman, et al (1997). “The long-term
course of severe anorexia nervosa in adolescents:
eating disorders is important, and perhaps crit- survival analysis of recovery, relapse, and outcome
ical. We know that adolescents have a better predictors over 10-15 years in a prospective study.”
prognosis than adults, perhaps due to parental International Journal of Eating Disorders 22(4): 339-
60.
involvement, and that interventions that involve Sullivan, P. F. (1995). “Mortality in anorexia nervosa.”
parents are efficacious. Parents play a key role American Journal of Psychiatry 152(7): 1073-4.

152 J Can Acad Child Adolesc Psychiatry 16:4 November 2007