The continuity of anorexia nervosa from infancy to adult life
LAZARATOU H.

Eating disorders are psychiatric conditions with serious psychological and medical consequences. Anorexia nervosa with onset during adolescence is the most studied clinical syndrome. It is presented with well defined diagnostic criteria in the classification systems ICD-IO and DSM-IV. It is characterized by refusal to maintain adequate body weight due to disturbed body image, which is accompanied by denial of the seriousness of the disorder.

Eating disorders in childhood are defined as those disorders in which there is excessive concern with the control of body weight and shape, accompanied by inadequate, irregular or chaotic food intake. In childhood beside the classical syndrome of anorexia nervosa, selective eating, food avoidance emotional disorder and pervasive refusal syndrome are met. The term of selective eating is applied to those children who have a very restricted range of food, usually carbohydrate based. Food Avoidance Emotional Disorder is used to describe children with an emotional disorder in which food avoidance plays a prominent part. Pervasive Refusal Syndrome is manifested by a profound and pervasive refusal to eat, drink, walk, talk or indulge in any form of self-care. It is a form of post traumatic stress disorder.

Anorexia nervosa of infancy is a new clinical entity which has not found yet its place in the classifications systems. The main findings in this disorder are a failure to eat adequately and, as a consequence, the failure to gain weight appropriately. The possibility that symptoms are due to a general medical condition or another mental disorder has to be ruled out. Psycho dynamically the evaluation of mother-infant relationship usually reveals conscious or unconscious conflicts.

The continuity of anorexia nervosa from infancy to adult life waits empirical testing. There is a different clinical entity in relation to the fragment of age where the onset occurs. Demographics point out that boys are at greater risk of eating disorders in early childhood whereas in adolescence girl become so.

Regarding the continuity of the disorder Lewinshohn et al (2000) found that children with full or partial syndrome of eating disorders were more likely to have eating disorders at follow-up in young adulthood than were comparison groups with major depression, non affective disorders or no psychiatric disorder. Problem eating behaviors such as pickiness were related to the development of anorexia nervosa in adolescence (Marchi and Cohen, 1990). In the same way, risk factors hot the development of anorexia nervosa in adolescence comprise eating conflicts , struggles with food and unpleasant meals in early childhood ( Kotler al, 2001 ). No epidemiological studies have focused specifically on the longitudinal continuity of infants anorexia nervosa. Only selected cases are published that provide data in favor of this continuity.

Psychodynamic theories support the continuity, point out that the same mental processes act both in infancy and in adolescence such processes include, for example, the failure in separation and individuation. Development psychoanalytical approaches point out that adolescent anorexia has its roots at the disturbed early relationship between mother and infant. Finally infantile anorexia nervosa, when the mother was anorectic during her adolescence, is related to mother's unresolved grief.

Key words: Anorexia nervosa, development approache, infancy, childhood.