[What Are the Individual, Family, and Social Characteristics Differentiating Prepubertal from Pubertal Anorexia Nervosa?]

Analysis of feeding and eating disorders in 191 children according to psychiatric or gastroenterological recruitment: The PEDIAFED cohort study

OBJECTIVE

The DSM-5 classification introduced new Feeding and Eating Disorders (FED) diagnostic categories, notably Avoidant and Restrictive Food Intake Disorder (ARFID), which, like other FED, can present psychiatric and gastrointestinal symptoms. However, paediatric clinical research that focuses on children below the age of 12 years remains scarce. The aim of this study was first to investigate the clinical features of FED in a cohort of children, second to compare them according to their recruitment (gastroenterology or psychiatry unit).

METHOD

This non-interventional retrospective cohort study analysed 191 patients in a French paediatric tertiary care centre (gastroenterology n = 100, psychiatry n = 91). The main outcome variables were clinical data (type of FED, BMI, nutritional support, chronic diseases, psychiatric comorbidities, sensory, sleep, language disorders, gastrointestinal complaints, adverse life events, family history). The outcome was defined by a Clinical Global Impression of Change-score.

RESULTS

FED diagnoses were ARFID (n = 100), Unspecified FED (UFED, n = 57), anorexia nervosa (AN, n = 33) and one pica/rumination. Mean follow-up was 3.28 years (SD 1.91). ARFID was associated with selective and sensory disorders (p < 0.001); they had more anxiety disorders than patients with UFED (p < 0.001). Patients with UFED had more chewing difficulties, language disorder (p < 0.001), and more FED related to chronic disease (p < 0.05) than patients with ARFID and AN. Patients with AN were female, underweight, referred exclusively to the psychiatrist, and had more depression than patients with ARFID and UFED (p < 0.001). The gastroenterology cohort included more UFED, while the psychiatry cohort included more psychiatric comorbidities (p < 0.001). A worse clinical outcome was associated with ARFID, a younger age at onset (p < 0.001), selective/sensory disorders and nutritional support (p < 0.05).

CONCLUSION

ARFID and UFED children were diagnosed either by gastroenterologists or psychiatrists. Due to frequently associated somatic and psychiatric comorbidities, children with FED should benefit from a multidisciplinary assessment and care.

A glance into psychiatric comorbidity in adolescents with anorexia nervosa

BACKGROUND

Eating disorders display several psychiatric comorbidities. The aim of this study was to describe these comorbidities in a group of adolescent patients with anorexia nervosa or OSFED (Other Specified Feedind or Eating Disorder). We have evaluated the comorbidity both with a clinical interview (categorical comorbidities) and with a self-report interview (dimensional comorbidities) in order to compare the two profiles.

METHODS

The study was carried out at the Division of Child and Adolescent Psychiatry (eating disorder service for developmental age) of the Luigi Vanvitelli University of Campania (ex Second University of Naples). Data were collected retrospectively from chart review, routinely gathered during the clinical assessment.

RESULTS

Seventy-two subjects constituted the sample, 62 (86.1%) were female and 10 (13.9%) male. The most frequent categorical comorbidities were social anxiety disorder (SS: 38; 52.8%), Depression disorder (SS: 30; 41.7%) and generalized anxiety disorder (SS: 14; 19.4%). The mean scores at dimensional questionnaires were 15.5 (SD: 10.7) for the depression (Children Depression Inventory) and 34.8 (SD: 28.3) for social anxiety (Liebowitz Social Anxiety Scale).

CONCLUSIONS

Data analysis showed that social anxiety and depression were the most common categorical comorbidities in young patients with eating disorders. However, comparing the data from the clinical interview with those of the self-interviews revealed that patients well recognize social anxiety symptoms, but tend to deny depressive ones.