Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap

Freizinger, Melissa; Recto, Michelle; Jhe, Grace; Lin, Jessica

doi:10.3390/children9060837

Cited by 11 publications

(12 citation statements)

References 77 publications

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“…Hospitalisation was also common across groups, with ~ 40% of non-underweight adolescents in studies reviewed requiring a medical admission. These results correlate with findings of other recent reviews that compare AN and AAN [11,34].…”

Section: Medical Instability In An and Aan Presentationssupporting

confidence: 92%

“…A recent review, by Freizinger and colleagues, exploring assessment and treatment in adolescent AAN, in comparison to AN concluded that malnutrition related to rapid or significant weight loss, in the absence of underweight, poses similar risks to health as typical presentations of AN [34]. Similarly, a recent Delphi study exploring research priorities in AAN, identified medical complications arising from the disorder as a high priority [35].…”

Section: Medical Complications In Aanmentioning

confidence: 99%

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Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta-analysis

et al. 2023

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This review investigates the relationship between weight and risk of medical instability (specifically bradycardia, hypotension, hypothermia, and hypophosphatemia) in adolescents with typical and atypical anorexia nervosa. Atypical anorexia nervosa, listed as an example under the DSM-5 category of Other Specified Feeding and Eating Disorders (OSFED), describes patients who are not clinically underweight but otherwise meet criteria for anorexia nervosa. There is a lack of empirical evidence exploring medical complications in adolescents presenting with atypical anorexia nervosa. The small number of studies that do exist in this area indicate that medical instability exists across a range of weights, with weight loss being associated with increased medical risk, independent of underweight. The aim of this review was to collate and analyse results from available studies and identify indicators of medical risk in these two groups of adolescents with restrictive eating disorders. Studies were identified by systematic electronic search of medical databases, including PubMed and EMBASE. All studies investigated the relationship between weight and medical instability and included adolescents diagnosed with anorexia nervosa or atypical anorexia nervosa. One randomised controlled trial, five cohort studies and three chart reviews were included, with a total sample size of 2331 participants. Between 29 and 42% of participants presented with medical instability requiring hospitalisation, in the absence of underweight. Underweight adolescents were significantly more likely to have lower blood pressures (p < 0.0001) and bradycardia was significantly associated with greater weight loss (p < 0.05). There were no statistically significant associations found between degree of underweight and heart rate, temperature, or rate of weight loss (p = 0.31, p = 0.46 and p = 0.16, respectively). Adolescents that were less than 70% median body mass index were significantly more likely to have hypophosphatemia (p < 0.05). The findings of this review support the hypothesis that medical instability can occur across a range of weights in adolescent eating disorders, with rapid weight loss being an important indicator of increasing medical risk. Results were limited by the small number of existing studies that contained data for statistical analysis. Rapid weight loss should be considered as an important indicator of medical instability in adolescents presenting with both typical and atypical anorexia nervosa.

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Section: Medical Instability In An and Aan Presentationssupporting

confidence: 92%

Section: Medical Complications In Aanmentioning

confidence: 99%

Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta-analysis

et al. 2023

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“…For example, a useful clinical clue in the diagnosis of atypical AN derives from the frequent presence of previous obesity or overweight. The subsequent initiation of a diet, linked to reinforcements derived both from a better perception of the own body image and from environmental stimuli (e.g., positive reinforcement from the family), can subsequently lead to the onset and maintenance of this disorder [ 14 ]. However, culturally, the idea that ‘anorexic thinking’ in itself constitutes a psychiatric problem still seems to be uncommon.…”

Section: Atypical Anorexia Nervosamentioning

confidence: 99%

“…In addition, the possibility of developing comorbidities appears to be the same as in subjects with “typical” AN: specifically, the most prevalent comorbidities are depressive symptoms, obsessive-compulsive disorder and suicidal ideation/self-harm [ 15 ]. As with the classic forms of AN, family-based treatment is the first-line therapy in atypical forms [ 14 ]. It is also well known that the psychopharmacological approach in cases of AN has mixed results: mainly, however, it appears to have a minimal effect both in terms of improving anorexic symptoms and weight recovery [ 16 ].…”

Section: Atypical Anorexia Nervosamentioning

confidence: 99%

Pitfalls and Risks of “New Eating Disorders”: Let the Expert Speak!

Salatto¹,

Riccio²,

Garotti³

et al. 2023

Nutrients

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Since the post-pandemic period, there has been an increase in the incidence of eating disorders (EADs) and a lowering of the age of onset. In addition to the ‘classic’ forms, there has also been an increase in new forms of EADs. This article proposes a brief review of the literature concerning mainly two of these new disorders: atypical anorexia and avoidant/restrictive food intake disorder. In addition, a brief overview is proposed of the most frequently raised questions that clinicians may face when dealing with EADs. The answers are provided by doctors from the Federico II University of Naples, who additionally offer the most common red flags on the topic derived from long clinical experience. This article is proposed to be a brief operational guide for all clinicians working in the pediatric area in order to provide diagnostic clues and useful elements to refer patients to specialists for a correct and multidisciplinary treatment.

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“…Adolescents diagnosed with AAN demonstrate higher rates of suicidality compared to peers without eating disorders [4] but exhibit similar rates of self-harm and suicidality compared to peers with AN [5]. Research suggests that adolescents with AAN may display more severe eating disorder psychopathology [5][6][7][8] and comparable levels of poor selfesteem [5] compared to adolescents with AN. While preliminary case-report data exist on the adoption of nutritional guidelines for these patients [9], further comprehensive data are imperative for a more thorough understanding.…”

Section: Introduction 1classification and Definitionmentioning

confidence: 99%

Nutritional Assessment of Children and Adolescents with Atypical Anorexia Nervosa: A Preliminary Longitudinal Investigation Using the 24-h Dietary Recall

Valeriani,

Pruccoli,

Chiavarino

et al. 2024

Children

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Background: Atypical Anorexia Nervosa (AAN) is a Feeding and Eating Disorder characterized by fear of gaining weight and body image disturbance, in the absence of significantly low body weight. AAN may present specific clinical and psychopathological features. Nonetheless, the literature lacks data concerning the nutritional characteristics and body composition of children and adolescents with AAN and their variation over time. Methods: Case series, including 17 children and adolescents with AAN. All the patients were assessed at the first evaluation (T0) with a standardized dietary assessment (24 h Dietary Recall, 24 hDR). Nutritional data were compared with European dietary reference values (DRVs). Body composition parameters (weight, fat mass, fat-free mass) and their changes over time at two (T1) and six (T2) months were collected as well, using a Bioelectrical impedance analysis (Wunder WBA300 with four poles and foot contact; impedance frequency 50 kHz 500 μA; impedance measurement range 200~1000 Ω/0.1 Ω). Results: The included individuals presented eating behaviors oriented towards significantly low daily energy intake (p < 0.001) compared with DRVs set by the European Food Safety Authority (EFSA) (with low carbohydrates and fats), and increased proteins (p < 0.001). A longer latency before observation (illness duration before observation) correlated with a negative change in weight. Body composition parameters were described, with no significant changes across the six-month outpatient assessment. Discussion: This is the first research to systematically assess the body composition and nutritional features of a group of individuals with AAN in the developmental age. Further research should assess the effect of targeted treatment interventions on body composition and nutritional features.

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Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap

Cited by 11 publications

References 77 publications

Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta-analysis

Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta-analysis

Pitfalls and Risks of “New Eating Disorders”: Let the Expert Speak!

Nutritional Assessment of Children and Adolescents with Atypical Anorexia Nervosa: A Preliminary Longitudinal Investigation Using the 24-h Dietary Recall

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