ABSTRACT

Anorexia nervosa in childhood and early adolescence is less common than in later adolescence, but its occurrence at an early age gains in importance because of its impact on puberty. The first accounts of anorexia nervosa of early onset were more concerned with arbitrary age limits such as onset from 8 to 16 years (Lesser et al., 1960; Blitzer et al., 1961: Tolstrup, 1965). One of the first accounts to time the onset of anorexia nervosa in relation to puberty was that of Warren (1968) who distinguished between ‘pre-pubertal’, pubertal and post-pubertal onset. Puberty, however, is a complex developmental process spanning two to three years (Tanner, 1962), and varying in its timing from child to child. For the purpose of the present account, the onset of anorexia nervosa will be timed in relation to the pubertal process rather than the patient's age.

True pre-pubertal anorexia nervosa: in these children anorexia nervosa commences before the very first signs of puberty. Thus, in girls the illness precedes the appearance of pubic hair and breast growth; and in boys it precedes the first signs of genital growth.

Intra-pubertal anorexia nervosa: this is the commoner early manifestation of anorexia nervosa. The first signs of puberty will have appeared (breast growth in girls and genital enlargement in boys), but puberty will still be incomplete. In girls the illness precedes the first menstrual period so that this early form of anorexia nervosa has been called pre-menarchal (Russell, 1985a).