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01-08-2012 | Original Contribution

Somatic problems and self-injurious behaviour 18 years after teenage-onset anorexia nervosa

Authors: Elisabet Wentz, I. Carina Gillberg, Henrik Anckarsäter, Christopher Gillberg, Maria Råstam

Published in: European Child & Adolescent Psychiatry | Issue 8/2012

Abstract

The aim of this study was to study long-term outcome of physical health and self-injurious behaviour (SIB) in anorexia nervosa (AN). Fifty-one adolescent-onset AN cases, originally recruited after community screening, and 51 matched controls (COMP) were interviewed regarding somatic problems and SIB and physically examined 18 years after AN onset, at mean age 32 years. Six individuals had an eating disorder (ED). No one had died. The AN group weighed less than the COMP group. The frequency of somatic problems did not differ between groups. Dental enamel lesions and shorter than expected stature occurred only in the AN group. Dysdiadochokinesis was overrepresented in the AN group and age of AN onset was lower among those with the neurological deficit. Severe SIB occurred only in the AN group, predominantly during adolescence. To conclude, somatic problems were common in both groups. Most individuals in the AN group had recovered from their ED, but weight revealed a persistent restricted eating behaviour.

Steinhausen HC (2002) The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159(8):1284–1293PubMedCrossRef

Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68(7):724–731PubMedCrossRef

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association, Washington, DC

Herpertz-Dahlmann B, Muller B, Herpertz S, Heussen N, Hebebrand J, Remschmidt H (2001) Prospective 10-year follow-up in adolescent anorexia nervosa—course, outcome, psychiatric comorbidity, and psychosocial adaptation. J Child Psychol Psychiatry 42(5):603–612PubMedCrossRef

Wentz E, Gillberg IC, Anckarsater H, Gillberg C, Rastam M (2009) Adolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiatry 194(2):168–174PubMedCrossRef

Nilsson K, Hägglöf B (2005) Long-term follow-up of adolescent onset anorexia nervosa in Northern Sweden. Eur Eat Disorders Rev 13:89–100CrossRef

Deter HC, Herzog W (1994) Anorexia nervosa in a long-term perspective: results of the Heidelberg-Mannheim Study. Psychosom Med 56(1):20–27PubMed

Zipfel S, Lowe B, Reas DL, Deter HC, Herzog W (2000) Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet 355(9205):721–722PubMedCrossRef

Papadopoulos FC, Ekbom A, Brandt L, Ekselius L (2009) Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry 194(1):10–17PubMedCrossRef

10.

Michels KB, Ekbom A (2004) Caloric restriction and incidence of breast cancer. JAMA 291(10):1226–1230PubMedCrossRef

11.

Mellemkjaer L, Emborg C, Gridley G, Munk-Jorgensen P, Johansen C, Tjonneland A et al (2001) Anorexia nervosa and cancer risk. Cancer Causes Control 12(2):173–177PubMedCrossRef

12.

Paul T, Schroeter K, Dahme B, Nutzinger DO (2002) Self-injurious behavior in women with eating disorders. Am J Psychiatry 159(3):408–411PubMedCrossRef

13.

Herpertz S (1995) Self-injurious behaviour. Psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatr Scand 91(1):57–68PubMedCrossRef

14.

Welch SL, Fairburn CG (1996) Impulsivity or comorbidity in bulimia nervosa. A controlled study of deliberate self-harm and alcohol and drug misuse in a community sample. Br J Psychiatry 169(4):451–458PubMedCrossRef

15.

Garfinkel PE, Moldofsky H, Garner DM (1980) The heterogeneity of anorexia nervosa. Bulimia as a distinct subgroup. Arch Gen Psychiatry 37(9):1036–1040PubMedCrossRef

16.

Nagata T, Kawarada Y, Kiriike N, Iketani T (2000) Multi-impulsivity of Japanese patients with eating disorders: primary and secondary impulsivity. Psychiatry Res 94(3):239–250PubMedCrossRef

17.

Wentz E, Gillberg IC, Anckarsater H, Gillberg C, Rastam M (2009) Reproduction and offspring status 18 years after teenage-onset anorexia nervosa—a controlled community-based study. Int J Eat Disord 42(6):483–491PubMedCrossRef

18.

Rastam M, Gillberg C, Wentz E (2003) Outcome of teenage-onset anorexia nervosa in a Swedish community-based sample. Eur Child Adolesc Psychiatry 12(Suppl 1):I78–I90PubMed

19.

Wentz E, Gillberg IC, Gillberg C, Rastam M (2000) Ten-year follow-up of adolescent-onset anorexia nervosa: physical health and neurodevelopment. Dev Med Child Neurol 42(5):328–333PubMedCrossRef

20.

Wentz E, Mellstrom D, Gillberg C, Sundh V, Gillberg IC, Rastam M (2003) Bone density 11 years after anorexia nervosa onset in a controlled study of 39 cases. Int J Eat Disord 34(3):314–318PubMedCrossRef

21.

Wentz E, Mellstrom D, Gillberg IC, Gillberg C, Rastam M (2007) Brief report: decreased bone mineral density as a long-term complication of teenage-onset anorexia nervosa. Eur Eat Disord Rev 15(4):290–295PubMedCrossRef

22.

Rastam M, Gillberg C, Garton M (1989) Anorexia nervosa in a Swedish urban region. A population-based study. Br J Psychiatry 155:642–646PubMed

23.

Gillberg C, Rastam M, Gillberg IC (1994) Anorexia nervosa: who sees the patients and who do the patients see? Acta Paediatr 83(9):967–971PubMedCrossRef

24.

Rastam M (1992) Anorexia nervosa in 51 Swedish adolescents: premorbid problems and comorbidity. J Am Acad Child Adolesc Psychiatry 31(5):819–829PubMedCrossRef

25.

Morgan HG, Hayward AE (1988) Clinical assessment of anorexia nervosa. The Morgan-Russell outcome assessment schedule. Br J Psychiatry 152:367–371PubMedCrossRef

26.

First MB, Spitzer RL, Gibbon M, Williams JBW(1997) Structured clinical interview for DSM-IV axis I disorders-patient edition (SCID-I/P, version 2.0, 4/97 revision). Biometrics Research Department, New York

27.

First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin L (1997) Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Association, Washington DC

28.

Gillberg IC, Rastam M, Wentz E, Gillberg C (2007) Cognitive and executive functions in anorexia nervosa ten years after onset of eating disorder. J Clin Exp Neuropsychol 29(2):170–178PubMedCrossRef

29.

Gillberg C, Rastam M, Wentz E (2001) The Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI): a preliminary study of a new structured clinical interview. Autism 5(1):57–66PubMedCrossRef

30.

Ratnasuriya RH, Eisler I, Szmukler GI, Russell GF (1991) Anorexia nervosa: outcome and prognostic factors after 20 years. Br J Psychiatry 158:495–502PubMedCrossRef

31.

Cloninger CR, Svrakic DM, Przybeck TR (1993) A psychobiological model of temperament and character. Arch Gen Psychiatry 50(12):975–990PubMedCrossRef

32.

Gillberg IC, Billstedt E, Wentz E, Anckarsater H, Rastam M, Gillberg C (2010) Attention, executive functions, and mentalizing in anorexia nervosa eighteen years after onset of eating disorder. J Clin Exp Neuropsychol 32(4):358–365PubMedCrossRef

33.

Ahren-Moonga J, Holmgren S, von Knorring L, Af Klinteberg B et al (2008) Personality traits and self-injurious behaviour in patients with eating disorders. Eur Eat Disord Rev 16(4):268–275PubMedCrossRef

34.

Touwen BI (1979) Examination of the child with minor neurological dysfunction. Clinics in developmental medicine. SIMP, London

35.

Gillberg C, Rastam M, Gillberg IC (1994) Anorexia nervosa: physical health and neurodevelopment at 16 and 21 years. Dev Med Child Neurol 36(7):567–575PubMedCrossRef

36.

Body-Mass-Index für Erwachsene (http://www.mybmi.de/main.php). Accessed 26 Aug 2010

37.

Strober M, Freeman R, Morrell W (1997) The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord 22(4):339–360PubMedCrossRef

38.

Frey J, Hebebrand J, Muller B, Ziegler A, Blum WF, Remschmidt H et al (2000) Reduced body fat in long-term followed-up female patients with anorexia nervosa. J Psychiatr Res 34(1):83–88PubMedCrossRef

39.

WHO (1992) International classification of diseases. 10th revised edn. Geneva

40.

Baxter-Jones AD, Faulkner RA, Forwood MR, Mirwald RL, Bailey DA (2011) Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res 26(8):1729–1739

41.

Nussbaum M, Baird D, Sonnenblick M, Cowan K, Shenker IR (1985) Short stature in anorexia nervosa patients. J Adolesc Health Care 6(6):453–455PubMedCrossRef

42.

Prabhakaran R, Misra M, Miller KK, Kruczek K, Sundaralingam S, Herzog DB et al (2008) Determinants of height in adolescent girls with anorexia nervosa. Pediatrics 121(6):e1517–e1523PubMedCrossRef

43.

Morgan J, Scholtz S, Lacey H, Conway G (2008) The prevalence of eating disorders in women with facial hirsutism: an epidemiological cohort study. Int J Eat Disord 41(5):427–431PubMedCrossRef

44.

Unluhizarci K, Kaltsas G, Kelestimur F (2012) Non polycystic ovary syndrome-related endocrine disorders associated with hirsutism. Eur J Clin Invest 42(1):86–94PubMedCrossRef

45.

Sirinathsinghji DJ, Mills IH (1983) Effect of human pituitary luteinizing hormone administration on plasma levels of dehydroepiandrosterone, androstenediol and their sulphates and testosterone in women with secondary amenorrhoea. J Endocrinol 98(2):201–210PubMedCrossRef

46.

Bradlow HL, Boyar RM, O’Connor J, Zumoff B, Hellman L (1976) Hypothyroid-like alterations in testosterone metabolism in anorexia nervosa. J Clin Endocrinol Metab 43(3):571–574PubMedCrossRef

47.

Baranowska B, Zgliczynski S (1979) Enhanced testosterone in female patients with anorexia nervosa: its normalization after weight gain. Acta Endocrinol (Copenh) 90(2):328–335

48.

Edwards O, Rook A (1980) In: Rook A, Savin S (eds) Recent advances in dermatology. Churchill Livingstone, Edinburgh, pp 159–183

49.

Tchanturia K, Morris RG, Anderluh MB, Collier DA, Nikolaou V, Treasure J (2004) Set shifting in anorexia nervosa: an examination before and after weight gain, in full recovery and relationship to childhood and adult OCPD traits. J Psychiatr Res 38(5):545–552PubMedCrossRef

50.

Clark DC (1985) Oral complications of anorexia nervosa and/or bulimia: with a review of the literature. J Oral Med 40(3):134–138PubMed

51.

Lo Russo L, Campisi G, Di Fede O, Di Liberto C, Panzarella V, Lo Muzio L et al (2008) Oral manifestations of eating disorders: a critical review. Oral Dis 14(6):479–484PubMedCrossRef

Title: Somatic problems and self-injurious behaviour 18 years after teenage-onset anorexia nervosa
Authors: Elisabet Wentz
I. Carina Gillberg
Henrik Anckarsäter
Christopher Gillberg
Maria Råstam
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: European Child & Adolescent Psychiatry / Issue 8/2012
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-012-0274-9

At a glance: The STEP trials

Springer Medicine

Somatic problems and self-injurious behaviour 18 years after teenage-onset anorexia nervosa

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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