Diagnosis

Pediatric patients will often not fit diagnostic criteria for adults (such as those listed in the DSM IV). The American Academy of Pediatrics therefore defines anorexia nervosa using the following criteria:

• Intense fear of becoming fat or gaining weight, even though underweight.

• Refusal to maintain body weight at or above a minimally normal weight for age and height (ie, weight loss leading to maintenance of body weight 85% of that expected, or failure to make expected weight gain during period of growth, leading to body weight 85% of that expected).

• Disturbed body image, undue influence of shape or weight on self-evaluation, or denial of the seriousness of the current low body weight.

• Amenorrhea or absence of at least 3 consecutive menstrual cycles (those with periods only inducible after estrogen therapy are considered amenorrheic).

source: American Academy of Pediatrics, "Policy Statement: Committee on Adolescence."Pediatrics Vol. 111 No. 1, January 2003

Anorexia fall into two distinct sub-types:

1. Restricting Anorexia (AN): no regular bingeing or purging (self-induced vomiting or use of laxatives and diuretics).

2. Binge eating/purging Anorexia (AN B/P): regular bingeing and purging in a patient who also meets the above criteria for anorexia nervosa

Treatment

At the Kartini Clinic we have a strong belief that childhood anorexia nervosa is a neurobiological brain disorder with a strong heritability component. It is not caused by parents and children do not choose to have it. Boys, as well as girls, can acquire it and it strikes wonderful children and fine families, just as do diabetes or cancer. Yet it is a chronic disease with profound psychological ramifications, one that takes the work of an entire specialized team to get into remission and one whose treatment is not quickly over.

Ill children cannot and should not be in charge of their medical care, even very bright children with much to offer in the way of suggestions. We do not ask children with leukemia whether or not they need medicine nor what they think their dose should be, and we do not ask this of our patients. The state of the art and science in the treatment of childhood eating disorders today is that prompt adequate weight restoration and control of brain nutrition is the only thing known get a child into remission and keep them from a lifetime of suffering and disability. If this does not seem the correct approach to you, then our team would not be the one for you.