title: Physical and Psychological Morbidity in Adolescents With Atypical Anorexia Nervosa.
abstract: Adolescents with atypical anorexia nervosa (AN) have lost significant weight but are not underweight. This study aimed to describe the physical and psychological morbidity of adolescents diagnosed with atypical AN, and to compare them with underweight adolescents with AN.
  
  
  
  All first presentations of atypical AN (n = 42) and full-threshold AN (n = 118) to a specialist pediatric eating disorder program between July 2010 and June 2014 were examined. Diagnosis was assessed by using the Eating Disorder Examination and anthropometric measurement. Psychological morbidity measures included eating and weight concerns, bingeing, purging, compulsive exercise, and psychiatric comorbidity.
  
  
  
  Compared with AN, more adolescents with atypical AN were premorbidly overweight or obese (71% vs 12%). They had lost more weight (17.6 kg vs 11.0 kg) over a longer period (13.3 vs 10.2 months). There was no significant difference in the frequency of bradycardia (24% vs 33%;) or orthostatic instability (43% vs 38%). We found no evidence of a difference in frequency of psychiatric comorbidities (38% vs 45%) or suicidal ideation (43% vs 39%). Distress related to eating and body image was more severe in atypical AN.
  
  
  
  Atypical AN considerably affects physical and psychological functioning, despite adolescents presenting within or above the normal weight range. There was little evidence that the morbidity of adolescents with atypical AN was any less severe than that of adolescents with full-threshold AN. The findings support the need for vigilance around weight loss in adolescents, regardless of body size.
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, and Murdoch Childrens Research Institute, Melbourne, Australia; and.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sawyer
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, and Murdoch Childrens Research Institute, Melbourne, Australia; and Department of Nutrition and Food Services, Royal Children's Hospital, Melbourne, Australia;
authors.forename: Melissa
authors.initials: M
authors.lastname: Whitelaw
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Departments of Psychiatry, and Pediatrics, University of California San Francisco, San Francisco, California.
authors.forename: Daniel
authors.initials: D
authors.lastname: Le Grange
authors.affiliation: Centre for Adolescent Health, and.
authors.forename: Michele
authors.initials: M
authors.lastname: Yeo
authors.affiliation: Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, and Murdoch Childrens Research Institute, Melbourne, Australia; and Libby.Hughes@rch.org.au.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000503:physiopathology* / Q000523:psychology*; D015992:Body Mass Index; D001068:Feeding and Eating Disorders / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity; D013851:Thinness / Q000523:psychology; D015431:Weight Loss