CHARACTERISTICS AND OUTCOMES OF ATYPICAL ANOREXIA NERVOSA IN ADOLESCENTS AND CHILDREN: A SYSTEMATIC REVIEW

Abstract

Sawsan Hassan Abdalla Hashim*, Sara Ghazi Alenezi, Ohoud Salman Alenazi, Saad Abdullah Saad Almutairi, Mohammed Muthyib Almuawi and Kholoud Obeid H Al Bathaly

Objectives: To summarize current research on the characteristics and outcomes of atypical anorexia nervosa (AAN) in children and adolescents.

Methods: A total of 299 pertinent publications were found after a comprehensive search across four databases. 34 full-text publications were examined after duplicates were eliminated using Rayyan QCRI and relevance was checked; four studies finally satisfied the requirements for inclusion.

Results: We included six studies with a total of 2059 participants and the majority 1791 (87%) were females. Adolescents with AAN, particularly those with a history of being overweight or obese, experience delayed diagnosis and treatment due to significant weight loss masking disordered eating patterns. Regardless of initial weight, rapid and extensive weight loss correlates with poor health outcomes, including deteriorating medical and nutritional status. Bone health is a significant concern, with low bone mineral density (BMD) linked to pre-illness BMI, placing adolescents with AAN at physical risk even without low body weight. Psychologically, adolescents with AAN exhibit more purging, body shape concerns, self-harm, and drug overdoses, along with higher hospitalization rates compared to those with traditional anorexia nervosa, highlighting the severity of their condition.

Conclusion: sAN is a prevalent but poorly identified illness in adolescents and children. Earlier recognition due to weight loss patterns and psychological symptoms in higher-weight individuals can definitely help provide better results. These identified strategies will go a long way in improving treatment-including the use of FBT-and enhancing clinicians' awareness for decreasing health compromise. Future research needs to be directed at long-term outcomes and towards developing standardized diagnostic tools so that timely and accurate identification of AAN is done across diverse populations. Keywords: Atypical anorexia nervosa; Eating disorders; Children; Adolescents; Systematic review