Linear growth and final height characteristics in adolescent females with anorexia nervosa.

OBJECTIVE: Growth retardation is an established complication of anorexia nervosa (AN). However, findings concerning final height of AN patients are inconsistent. The aim of this study was to assess these phenomena in female adolescent inpatients with AN. METHODS: We retrospectively studied all 211 female adolescent AN patients hospitalized in an inpatient eating disorders department from 1/1/1987 to 31/12/99. Height and weight were assessed at admission and thereafter routinely during hospitalization and follow-up. Final height was measured in 69 patients 2-10 years after discharge. Pre-morbid height data was available in 29 patients. RESULTS: Patients' height standard deviation scores (SDS) on admission (-0.285±1.0) and discharge (-0.271±1.02) were significantly (p<0.001) lower than expected in normal adolescents. Patients admitted at age ≤13 years, or less than 1 year after menarche, were more severely growth-impaired than patients admitted at an older age, (p = 0.03). Final height SDS, available for 69 patients, was -0.258±1.04, significantly lower than expected in a normal population (p = 0.04), and was more severely compromised in patients who were admitted less than 1 year from their menarche. In a subgroup of 29 patients with complete growth data (pre-morbid, admission, discharge, and final adult height), the pre-morbid height SDS was not significantly different from the expected (-0.11±1.1), whereas heights at the other time points were significantly (p = 0.001) lower (-0.56±1.2, -0.52±1.2, and -0.6±1.2, respectively). CONCLUSIONS: Our findings suggest that whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.

Compulsory treatment of anorexia nervosa.

Compulsory treatment in anorexia is a controversial subject brought to the fore of public awareness with each new case reported in the media. The attitudes towards involuntary hospitalization for anorexia swing like a pendulum from recognizing the necessity for compulsory treatment in life-threatening situations to advocating the patient's rights for autonomy over his/her body and thus the right to refuse treatment. In view of the fact that the existing legislation in Israel (Law of Patient's Rights, 1996; Law of Guardianship 1962; and the Law for the Treatment of the Mentally Ill, 1991) does not provide an adequate solution to emergency situations in which anorexia is life threatening, the authors suggest that the Law for the Treatment of the Mentally Ill (1996), which enables compulsory treatment, can be interpreted to include life-endangering conditions.