Abstract
ObjectiveEpidemiological studies suggest that the incidence of anorexia nervosa (AN) is increasing in younger populations, with some evidence that clinical differences occur according to age of onset (AOO), which may impact prognostic outcomes. The current study sought to compare eating disorder (ED) symptomatology, psychological distress and psychosocial function between early onset (EO), typical onset (TO) and later onset (LO) AN in a large sample of treatment-seeking patients with a diagnosis of AN.MethodsParticipants included 249 individuals with a diagnosis of AN who were assessed at an outpatient ED service. The sample was divided into three groups based on AOO; those with an AOO ≤14 years (N = 58) were termed ‘EO-AN’, those with an AOO between 15 and 18 years (N = 113) were termed ‘TO-AN’ and those with an AOO of > 18 years (N = 78) were termed ‘LO-AN’. Comparisons were made between AOO groups on assessments of ED symptomatology, psychological distress and psychosocial function.ResultsEO-AN patients reported a significantly longer illness duration than both TO-AN and LO-AN groups. After controlling for effect of illness duration, the EO-AN group demonstrated significantly higher ED symptomatology and dysmorphic concern compared to the LO-AN group. The EO-AN group demonstrated significantly decreased cognitive flexibility compared to both the TO-AN and LO-AN groups.DiscussionThese findings suggest that clinical differences do occur according to AOO in AN whereby EO-AN may represent a more severe form of illness that is not attributable to increased illness duration. Treatment strategies which specifically address patients with EO-AN may improve long term health outcomes and recovery.
Highlights
Anorexia nervosa (AN) is a severe illness that has an approximate lifetime prevalence of 1.7% [1], is associated with significant psychiatric comorbidity [2], and demonstrates the highest mortality rate of any psychiatric disorder [3]
Other studies have found no difference in severity of weight loss between early onset (EO)- and later onset (LO)-anorexia nervosa (AN) [21], fewer cases of extremely low weight in those with EO-AN compared to LO-AN [22], and a positive association between low body mass index (BMI) and increased age of onset (AOO) [23]
Investigations into psychological distress in the current study found no significant differences between the three AOO groups in measures of depression, anxiety and stress
Summary
Anorexia nervosa (AN) is a severe illness that has an approximate lifetime prevalence of 1.7% [1], is associated with significant psychiatric comorbidity [2], and demonstrates the highest mortality rate of any psychiatric disorder [3]. AOO has been demonstrated as a clinically significant feature in various psychiatric illnesses including affective disorders [11, 12], psychotic disorders [13] and anxiety disorders [14, 15] and may have important prognostic implications [16]. Evidence for increased ED severity and poorer prognostic outcomes in EO-AN (as compared to LO-AN) have been demonstrated including; more rapid weight loss [17, 18], poorer long-term outcomes of low body weight and psychiatric comorbidity [19], and a longer duration of illness [20]. Other studies have found no difference in severity of weight loss between EO- and LO-AN [21], fewer cases of extremely low weight in those with EO-AN compared to LO-AN [22], and a positive association between low body mass index (BMI) and increased AOO [23]. Whereas one study reported better self-esteem in those with EO-AN [24], others have reported that individuals with EO-AN demonstrate higher maturity fear, impulsivity and asceticism (interpreted as greater character fragility) than those with LO-AN [25]
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