During the “Endocrinolympiads” day, April 5, a child psychiatrist recalled the physical consequences of prepubertal or premenarchal anorexia nervosa.
- In France, the incidence of early-onset anorexia nervosa is estimated between 1.1 and 7.5/100,000. Boys are more affected than girls.
- “In young patients, we observe more severe and rapid weight loss, more total aphagia (the inability to swallow) and more fluid restriction,” according to child psychiatrist Coline Stordeur.
- This rare disorder has consequences on weight and then stature growth, pubertal and bone development.
“It’s a rare disease!” These are the first words spoken by Coline Stordeur, child and adolescent psychiatrist at the Robert-Debré Hospital (Paris), when she talks about early-onset anorexia nervosa (AMP) during the “Endocrinolympiads” organized by the French Society of Endocrinology. In fact, the incidence of this disorder is estimated between 1.1 and 7.5/100,000. According to the specialist, this pathology appears in childhood from the age of 6-7 years old or at the very beginning of puberty (before 13 years old). In France, “more boys are affected”.
“More severe and faster weight loss, more aphagia and more fluid restriction”
“Pre-pubertal anorexia nervosa is characterized by insufficient nutritional intake relative to age and height, an intense fear of gaining weight or becoming fat, and an altered perception of the weight or shape of one’s own body. “, indicates the child psychiatrist. The High Authority of Health (HAS) specifies that the existence of an eating disorder (EDB) in the parents or premorbid overweight in the child can cause the appearance of this rare disorder. Mockery, remarks, criticism which can go as far as harassment, difficulty expressing emotions, rigidity and perfectionism are also associated with the occurrence of MPA.
“In young patients, we observe more severe and rapid weight loss, more total aphagia (inability to swallow) and more fluid restriction,” which delay the diagnosis based on clinical examination, analysis of growth curves (weight, height, BMI) and on certain additional examinations, specifies Coline Stordeur. Early onset anorexia nervosa also manifests itself by repeated nausea or abdominal pain, a change in food choices, rigidity around eating with rituals and sometimes, problematic physical activity because it is excessive, even compulsive and/or a academic hyperinvestment.
AMP: consequences on “growth, pubertal and bone development”
If this disorder affects the child’s psychological development, “early onset anorexia nervosa also has a real somatic impact. And for good reason, it has consequences on weight and then stature growth, which sometimes goes unnoticed for a long time, as well as pubertal and bone development”, which can increase the risk of fractures. Depending on the course of the disorder, adult height may be reduced, gonadotropic function may remain disrupted, leading to disorders of sexuality and fertility.
According to the reference center for endocrine diseases of growth and developmentrecovery from AMP would occur in approximately 60% of cases within 5 to 10 years and in the remaining 40% of cases, “the progression would be towards another eating disorder or towards chronicity. However, improvement remains possible at all stages of the disease”. The management of AMP is multidisciplinary. Therefore, the child must be followed by a treating physician, a child psychiatrist, an endocrinologist, a psychologist and a dietitian.
