Vol 11, N°1 Child and Adolescent Psychiatry
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Anorexia nervosa: an increasing problem in children and adolescents Katherine A. Halmi, MD norexia nervosa developing in early adoles- cence  was  well  documented  in  the  case  of  Princess Margaret of Hungary, who lived and died in the 13th cen- tury.1 She was the daughter of King Bela IV, who had her enter a Dominican convent during her early childhood. Her history comes from a complete copy of depositions by witnesses who gave evidence in the process of her beatification, which began less than 5 years after her death. Her eating behaviors were indistinguishable from those  of  young  anorexia  nervosa  patients  of  today. Although there is documentation of fasting female saints in the middle ages,2 the fasting did not appear to occur during childhood. Obtaining the precise information to answer the question as to whether anorexia nervosa is an increasing problem in children and adolescents requires population-based interview data ascertaining the prevalence of anorexia nervosa, with age-of-onset distribution for different time cohorts. This  data  is  simply  not  available. Studies  of changing  rates  of  anorexia  nervosa  published  in  the recent literature are limited to specific populations, have small sample sizes, or are based on questionnaires rather than personal interviews. Age of onset is presented as a mean statistic, rather than the number of cases with a specific age of onset. Table I summarizes the more recent published rates of anorexia nervosa. It should be noted that the studies from England3 and Brazil4 reported the greatest incidence and prevalence in females from age 10 through 19 or 10 through 13, respectively. In Singapore,5 there was an increase in adolescents with anorexia ner- vosa admitted to a clinic over the years 1994 to 2002. Another study conducted in New South Wales,Australia6 concluded that there was an increasing prevalence of Brief  report Copyright © 2009 LLS SAS.  All rights reserved Keywords:  anorexia nervosa; body image; dieting; perfectionism; biological vulnerability Author affiliations: Professor of Psychiatry, Weill Cornell Medical College, White Plains, New York, USA   Address for correspondence: Katherine A. Halmi, MD, Professor of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA, (e-mail: kah29@cornell.edu) Information from eating disorder clinics across five conti- nents  suggests  that  anorexia  nervosa  is  becoming  an increasing problem in children and young adolescents. There is some indication that anxiety disorders in childhood may  be  a  major  risk  factor  for  the  development  of anorexia nervosa. Early recognition and family treatment for this disorder are essential to prevent chronic impair- ment.       © 2009, LLS SAS Dialogues Clin Neurosci.  2009;11:100-103. A