Late- vs. early-onset anorexia nervosa in Asia: Nosological, aetiological, and therapeutic implications

Abstract

ABSTRACTWhile anorexia nervosa (AN) is typically an illness of adolescent onset, there has been evidence of rising incidence of older-onset cases in recent years. Existing literature on late-onset AN has been plagued with methodological flaws and is inconclusive. We aim to describe their clinical features and examine for differences with early-onset cases. All AN cases presented between 2003 and 2014 to Singapore General Hospital, the largest eating disorder treatment service in Singapore, were identified and their medical records were studied retrospectively. Out of 577 AN cases that presented, only 41 (7.1%) were late onset. Compared to early-onset AN, late-onset cases reported less teasing and more relationship problems as a trigger for the illness. They were also less likely to join the eating disorders treatment program. Post hoc analysis affirmed robustness of the results. The low number of late-onset AN cases suggests that it is either uncommon or patients are not seeking help. The differences in precipitating factors for the illness suggest aetiological differences which could ultimately guide the modification of existing treatment services to better cater to the needs of late-onset cases. Future research should leverage on the knowledge gleaned from current literature and the limitations of prior studies, to better characterize late-onset AN.