小児科領域における摂食障害について : 初診時の食行動からみた検討

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The aim of this study is to characterize the clinical manifestations of relatively early onset of eating disorders in children. Twenty four cases (6 boys, 18 girls) visited firstly the department of pediatrics of Saitama Medical School Hospital or Children's Hospital at Yorii with abnormal eating behavior and weight loss at 7 to 15 years of age. The diagnostic criteria for anorexia nervosa (AN) of committee on AN (Ministry of Health and Welfare, 1990) is met in 10 cases, the criteria for bulimia nervosa (BN) (DSM-III-R, 1987) in 2 cases and both criteria of AN and BN in 2 cases. Other 10 are suspected or atypical AN. They are classified into 4 types by eating behaviors at the initial visit, and describe their clinical manifestations and prognosis. 1. Voluntary dieting type (1 boy, 7 girls, 12.6±L1.3 years of age at the onset). They restrict food intake voluntarily to have lean figure, and manifest strong fear of becoming fat and abnormal eating behaviors. Three of them have good prognosis, but other 5 have abnomal eating behavior and/or maladjustment in school life. 2. Appetite loss type (1 boy, 6 girls, 12.3±l.2 years of age at the onset). They complain of anorexia and eat less amount. It is suggested from their background of onset that they have latent desire to reduce their body weight. Most of them complain of headache. abdominal pain, nausea or other symptoms, but their prognosis was much better than that of other types. 3. Eating refusal type (2 boys, 3 girls, 10.2±2.5 years of age at the onset). They refuse to eat stubbornly without desire for lean figure or dislike their body shape. Their mean age at the onset is youngest among 4 types, and 3 girls start eating disorder at the premenarche. Although abnormal eating behavior improve early, adjustment to school life is poor in 4 cases. 4. Binge eating and vomiting type (2 boys, 2 girls, 13.5±O.5 years of age at the ontet). Their emaciation is not so severe but binge eating and vomiting are evident with desire for lean figure. Their mean age at the onset is oldest among 4 types. All of them have pubertal onset, and manifest school refusal and/or abnormal social behavior. The short-term prognosis (24.5±13.3 months' duration) of 24 cases is good in 10 cases (42%). Their abnormal eating behaviors improve early, their outcomes are good in physical status and in social adjustment. The poor prognosis is related to the loss of weight more than - 15% of standard body weight in 2 cases (8%), continued abnormal eating behaviors in 7 cases (29%), social maladjustment in 10 cases (42%) and to males.
日本心身医学会の論文
1993-12-01

小児科領域における摂食障害について : 初診時の食行動からみた検討

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