Early-onset anorexia nervosa: a scoping review and management guidelines

Anaël Ayrolles^{1

2

3}, Julia Clarke^{4

5}, Nathalie Godart^{6

7

8}, Céline André-Carletti⁹, Clémentine Barbe¹⁰, Anne Bargiacchi¹¹, Corinne Blanchet^{12

13

8}, Florence Bergametti¹¹, Valérie Bertrand¹⁴, Emmanuelle Caldagues¹⁵, Marylene Caquard¹⁵, Danielle Castellotti¹⁶, Richard Delorme^{11

17

18}, Laurence Dreno¹⁰, Dominique Feneon Landou¹⁹, Priscille Gerardin²⁰, Selim Guessoum^{13

8}, Ludovic Gicquel²¹, Juliane Léger²², Stéphanie Legras²³, Lucile Noel¹¹, Anne Fjellestad-Paulsen^{11

22}, Hélène Poncet-Kalifa¹¹, Flora Bat-Pitault^{24

25}, Coline Stordeur¹¹

Affiliations

¹ Child and Adolescent Psychiatry Department, Reference Centre for Rare Disease - Early-Onset Anorexia Nervosa (EOAN), Robert Debré University Hospital, APHP, Paris, France. anael.ayrolles@aphp.fr.
² Université Paris Centre, Paris, France. anael.ayrolles@aphp.fr.
³ Human Genetics & Cognitive Functions, CNRS UMR3571, Institut Pasteur, Paris, France. anael.ayrolles@aphp.fr.
⁴ Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France.
⁵ Université Paris Cité and GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 75014 , Université Paris Cité, Paris, France.
⁶ UFR Simone Veil, UVSQ, University Paris-Saclay, Montigny-le-Bretonneux, France.
⁷ Fondation de Santé des Etudiants de France, Paris, France.
⁸ Inserm U1018, Team DevPsy, CESP, Paris Saclay University, Paris, France.
⁹ Psychologist, Paris, France.
¹⁰ Child Psychiatry Department, Nantes University Hospital, Nantes, France.
¹¹ Child and Adolescent Psychiatry Department, Reference Centre for Rare Disease - Early-Onset Anorexia Nervosa (EOAN), Robert Debré University Hospital, APHP, Paris, France.
¹² APHP, Cochin Hospital, Maison de Solenn, Maison des Adolescents, Paris, France.
¹³ Department of Clinical Psychology, Psychopathology, Psychoanalysis - ED 261 (PCPP), Paris Cité University, Boulogne-Billancourt, France.
¹⁴ Department of Pediatrics, Le Havre Hospital, Le Havre, France.
¹⁵ Adolescent Medicine Department, Nantes University Hospital, Nantes, France.
¹⁶ Fédération Nationale des Associations liées aux Troubles des Conduites Alimentaires (FNA- TCA), Saint-Marc Jaumegarde, France.
¹⁷ Université Paris Centre, Paris, France.
¹⁸ Human Genetics & Cognitive Functions, CNRS UMR3571, Institut Pasteur, Paris, France.
¹⁹ Child and Adolescent Psychiatry Department, Clermont-Ferrand University Hospital, Clermont- Ferrand, France.
²⁰ Child and Adolescent Psychiatric Department, Univ Rouen Normandie, CRFDP, CHU Rouen, CH du Rouvray, Rouen, 76000, France.
²¹ Child and Adolescent Psychiatry Department, Centre of Competence for Rare Diseases EOAN, Unité de Recherche Clinique, Université de Poitiers, Poitiers, F-86000, France.
²² Pediatric Endocrinology-Diabetology Department, Reference Centre for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Robert Debré University Hospital, APHP, Paris, France.
²³ Child and Adolescent Psychiatry Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France.
²⁴ Child and Adolescent Psychiatry Unit, Centre of Competence for Rare Diseases EOAN, Salvator Hospital, APHM, Aix-Marseille University, Marseille, France.
²⁵ Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France.

PMID: 39558193
PMCID: PMC11572092
DOI: 10.1186/s40337-024-01130-9

Early-onset anorexia nervosa: a scoping review and management guidelines

Anaël Ayrolles et al. J Eat Disord. 2024.

. 2024 Nov 18;12(1):182.

doi: 10.1186/s40337-024-01130-9.

Authors

Affiliations

¹ Child and Adolescent Psychiatry Department, Reference Centre for Rare Disease - Early-Onset Anorexia Nervosa (EOAN), Robert Debré University Hospital, APHP, Paris, France. anael.ayrolles@aphp.fr.
² Université Paris Centre, Paris, France. anael.ayrolles@aphp.fr.
³ Human Genetics & Cognitive Functions, CNRS UMR3571, Institut Pasteur, Paris, France. anael.ayrolles@aphp.fr.
⁴ Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France.
⁵ Université Paris Cité and GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 75014 , Université Paris Cité, Paris, France.
⁶ UFR Simone Veil, UVSQ, University Paris-Saclay, Montigny-le-Bretonneux, France.
⁷ Fondation de Santé des Etudiants de France, Paris, France.
⁸ Inserm U1018, Team DevPsy, CESP, Paris Saclay University, Paris, France.
⁹ Psychologist, Paris, France.
¹⁰ Child Psychiatry Department, Nantes University Hospital, Nantes, France.
¹¹ Child and Adolescent Psychiatry Department, Reference Centre for Rare Disease - Early-Onset Anorexia Nervosa (EOAN), Robert Debré University Hospital, APHP, Paris, France.
¹² APHP, Cochin Hospital, Maison de Solenn, Maison des Adolescents, Paris, France.
¹³ Department of Clinical Psychology, Psychopathology, Psychoanalysis - ED 261 (PCPP), Paris Cité University, Boulogne-Billancourt, France.
¹⁴ Department of Pediatrics, Le Havre Hospital, Le Havre, France.
¹⁵ Adolescent Medicine Department, Nantes University Hospital, Nantes, France.
¹⁶ Fédération Nationale des Associations liées aux Troubles des Conduites Alimentaires (FNA- TCA), Saint-Marc Jaumegarde, France.
¹⁷ Université Paris Centre, Paris, France.
¹⁸ Human Genetics & Cognitive Functions, CNRS UMR3571, Institut Pasteur, Paris, France.
¹⁹ Child and Adolescent Psychiatry Department, Clermont-Ferrand University Hospital, Clermont- Ferrand, France.
²⁰ Child and Adolescent Psychiatric Department, Univ Rouen Normandie, CRFDP, CHU Rouen, CH du Rouvray, Rouen, 76000, France.
²¹ Child and Adolescent Psychiatry Department, Centre of Competence for Rare Diseases EOAN, Unité de Recherche Clinique, Université de Poitiers, Poitiers, F-86000, France.
²² Pediatric Endocrinology-Diabetology Department, Reference Centre for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Robert Debré University Hospital, APHP, Paris, France.
²³ Child and Adolescent Psychiatry Department, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France.
²⁴ Child and Adolescent Psychiatry Unit, Centre of Competence for Rare Diseases EOAN, Salvator Hospital, APHM, Aix-Marseille University, Marseille, France.
²⁵ Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France.

PMID: 39558193
PMCID: PMC11572092
DOI: 10.1186/s40337-024-01130-9

Abstract

Background: Anorexia nervosa (AN) is a serious multifactorial eating disorder characterized by insufficient nutritional intake to maintain a minimum normal weight for one's age and height, a fear of gaining weight and a distorted body image. It affects mainly adolescents, but a decreased age at diagnosis has been reported, leading to the definition of a rare form of AN called early-onset or prepubertal anorexia nervosa (EOAN; ORPHA 525738), with reported epidemiological and clinical specificity. Current knowledge and specific treatments for this particular condition remain scarce. We aim to summarize the literature review and synthesize actual knowledge on EOAN for preliminary guidelines to harmonize the diagnosis, treatment and follow-up.

Methods: A scoping literature review was performed from 2010-2021 using PubMed, Web of Science, PsycInfo and Cochrane via the following search terms: (anorexia nervosa) AND (early-onset OR premenarchal OR prepubertal OR childhood). International guidelines were screened for additional hits. Data extraction was limited to findings relevant to the key topic questions: epidemiology and clinical specificities section, diagnosis and initial evaluation section, treatment section, and follow-up and prognosis section.

Results: A total of 1257 titles were retrieved via the initial search strategy. Finally, 42 records were included in the present article (30 articles and 11 international guidelines and 1 literature review). We identified 15 articles relevant for the epidemiology and clinical specificities section, 11 for the diagnosis and initial evaluation section, 3 for the treatment section, and 1 for the follow-up and prognosis section. Despite the growing literature on the epidemiological and clinical features of EOAN, knowledge of specific treatments and prognoses remains scarce in the absence of extensive standardized data collection and few age-specific clinical research protocols. Current international guidelines generally extrapolate strategies proposed for adolescents and young adults to children with a low level of evidence.

Conclusions: Continuing research efforts in this specific younger population is needed to validate child-specific care strategies, enabling the establishment of age-appropriate recommendations with a higher level of evidence targeting specific determinants and clinical specificities of EOAN.

Keywords: Childhood; Diagnosis; Early-onset anorexia nervosa; Management; Recommendation.

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Conflict of interest statement

Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

**Fig. 1**
Flow chart of the literature review

**Fig. 2**
Initial paraclinical assessment, somatic and psychiatric examination in early-onset anorexia nervosa

See this image and copyright information in PMC

References

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Early-onset anorexia nervosa: a scoping review and management guidelines

Affiliations

Early-onset anorexia nervosa: a scoping review and management guidelines

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources

Molecular Biology Databases