Younger patients with eating disorders are at particular risk because of their development stage.

1. Strober M., Freeman R., and Morrell W. The Long-Term, Course of Severe Anorexia Nervosa in Adolescents: Survival Analysis of Recovery, Relapse, and Outcome Predictors Over 10-15 Years in a Prospective Study. International Journal of Eating Disorders. 1997; 22:339-60.
   • "The course of anorexia nervosa is protracted" 76% of their sample, followed for 10-15 years after initial admission, eventually met criteria for full recovery, but time to recovery ranged from 57-74 months. An additional 10% met criteria for partial recovery.
     
     
2. Society for Adolescent Medicine. Eating Disorders in Adolescents: Position Paper of the Society for Adolescent Medicine. J Adolescent Health. 1995; 16:476-480.
   • "Diagnostic criteria for eating disorders such as DSM-IV may not be entirely applicable to adolescents. The wide variability in the rate, timing, and magnitude of both height and weight gain during normal puberty, the absence of menstrual periods in early puberty along with the unpredictability of menses soon after menarche, and the lack of psychological awareness regarding abstract concepts (such as self-concept or motivation to lose weight) owing to normative cognitive development, limit the application of these formal diagnostic criteria to adolescents."
     
   • "...pubertal delay, growth retardation, or the impairment of bone mineral acquisition may occur at sub clinical levels of eating disorders."
     
   • "The use of strict criteria may preclude the recognition of eating disorders in their early stages and subclinical form... abnormal eating habits may result in significant impairment in health even in the absence of fulfillment of formal criteria for an eating disorder."
   • "Because of the potentially irreversible effects of an eating disorder on physical and emotional growth and development in adolescents, because of the risk of death, and because of the evidence suggesting improved outcome with early treatment, the threshold for intervention in adolescents should be lower than in adults."
     
     
3. American Psychiatric Association. Treatment Recommendations for Patients with Eating Disorders. Am J Psychiatry. 2006; 163(7 suppl):1-54.
   • "To avert potentially irreversible effects on physical growth and development, many children and adolescents require inpatient medical treatment, even when weight loss, although rapid, has not been as severe as that suggesting a need for hospitalization in adult patients."
     
     
4. Fisher M, Golden NH, Katzman DK, et al. Eating Disorders in Adolescents. J Adolescent Health. 1995; 16:420-437.
   • Weight loss, one of the diagnostic criteria for AN in an older adolescent or adult with a stable pre-morbid weight and height, is not necessarily present in younger adolescents with the disorder. Because growth is a dynamic process, severe nutritional deficits can occur in the absence of weight loss in early adolescence.
   • "Young adolescents who have lost a higher proportion of their body weight sooner, and whose growth may therefore be retarded, should be admitted earlier."
   • "Growth retardation and short stature are known complications of AN and are most severe when the disorder develops before the pubertal growth spurt."
     
     
5. Rome ES, Ammerman S, Rosen DS, at al. Children and Adolescents with Eating Disorders: The State of the Art. Pediatrics. 2003; 111:e98-e108.
   • "Disordered eating which does not meet the strict Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic threshold for AN [anorexia nervosa] or BN [bulimia nervosa] still represents a serious risk to health and well-being. The diagnosis of ED-NOS [eating disorder not otherwise specified] should never be considered a low-grade disorder or undeserving of aggressive treatment. Rather, disordered eating and ED-NOS represent an opportunity to intervene in a potentially life-threatening pathologic process at an early stage that may be more amenable to treatment."
   • "Failure to meet the strict criteria for AN or BN should never deter the clinician from offering early and comprehensive intervention. This is especially true in younger patients in whom earlier intervention is associated with a better long-term prognosis."
   • "To avert potentially irreversible effects on physical growth and development, many children and adolescents require inpatient medical treatment even when weight loss, although rapid, has not been as severe as that suggesting a need for hospitalization in adult patients."
     
     
6. Committee on Adolescence, American Academy of Pediatrics. Policy Statement: Identifying and Treating Eating Disorders. Pediatrics. 2003; 111:204-211.
   • "Early detection and management of an eating disorder may prevent the physical and psychological consequences of malnutrition that allow of progression to a later stage."