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NEDA TOOLKIT for Parents Eating disorders among children and adolescents From the Finnish Medical Society Duodecim Brief Summary Bibliographic Source Finnish Medical Society Duodecim. Eating disorders among children and adolescents. In: EBM Guidelines. Evidence- Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2007 Mar 28 [Various]. Major Recommendations The levels of evidence [A-D] supporting the recommendations are defined at the end of the “Major Recommendations” field. Objectives Remember that eating disorders are very common among adolescent girls, and especially bulimic disorders are encountered in boys as well. One must remember to look for signs of an eating disorder; patients seldom report it themselves. The diagnosis and planning of treatment are the responsibility of special personnel. Basic Rules An eating disorder refers to states in which food and nourishment have an instrumental and manipulative role: food has become a way to regulate the appearance of the body. The spectrum of eating disorders is vast. The most common disorders are anorexia nervosa and bulimia nervosa. In addition, incomplete clinical pictures and simple binge eating have become more general. Recently the international trend has been to put more emphasis on early reaction to the symptoms. Even small children can have different kinds of eating disorders that relate to difficulties in the relationships between the child and his/her caretaker. Aetiology Currently, eating disorders are considered to be multifarious. Genetic and sociocultural factors and also individual dynamics all affect eating disorders. The typical age of onset is adolescence, when the body changes and grows. Anorexia nervosa typically emerges between 14 and 16 years of age or around the age of 18 years. Bulimia appears typically at the age of 19 to 20 years. Eating disorders are 10 to 15 times more common among girls than boys. Every 150th girl between the ages of 14 and 16 years suffers from anorexia nervosa. There is no epidemiologic data on the occurrence of bulimia, but it is considered to be more common than anorexia nervosa. Diagnostic Criteria for Anorexia Nervosa The patient does not want to maintain his/her normal body weight. The patient’s weight is at least 15% below that expected for age and height. The patient’s body image is distorted. The patient is afraid of gaining weight. There is no other sickness that would explain the loss of weight. Diagnostic Criteria of Bulimia Nervosa Desire to be thin, phobic fear of gaining weight. Persistent preoccupation with eating and an irresistible urge or compulsive need to eat. Episodes of binge eating (at least twice a week); control over eating is lost. After the episode of binge eating, the person attempts to eliminate the ingested food (e.g., by self-induced vomiting and by abuse of purgatives and diuretics). Page | 32