AACAP: With Anorexia, Obsessions and Compulsions Have Limits

SAN DIEGO, Oct. 27 -- Although anorexia nervosa patients commonly have obsessions and compulsions, that doesn't necessarily translate into full-blown obsessive-compulsive disorder, according to a Polish team.

In a study of 120 adolescent patients with anorexia, 51.8% had obsessions related to food and body-image and 36.8% had other compulsions, but none met the criteria for obsessive-compulsive disorder, said Tomasz Wolanczyk, M.D., Ph.D., of the Medical University of Warsaw.

"Clinicians should be very careful diagnosing OCD," he said in a poster presentation at the American Academy of Child and Adolescent Psychiatry meeting here. "If the diagnosis is comorbid OCD, it may lead to pharmacotherapy."

Previous studies have reported that 6% to 33% of patients with anorexia have comorbid OCD. However, most of these studies have based the diagnosis of OCD on clinical impression instead of diagnostic tests as well, Dr. Wolanczyk said.

The investigators reported that the most frequent obsessive compulsive symptoms were:

• Hatred of dirt and contamination (69%).
• Worry about being clean enough (68%).
• Repetition (62%).
• Fussiness about hands (57%).
• Doing things in an exact manner (57%).

The researchers pointed out that their findings were consistent with the "severity and content" of obsessive-compulsive symptoms in Polish adolescents without anorexia, with the exception of food obsessions.

The study included a homogenous population of 120 female patients (average age 14.8, range 10.9 to 20.0) who met the Diagnostic and Statistical Manual of Mental Disorders-III-R criteria for anorexia nervosa at the time of admission to a psychiatric department. They were assessed by two child psychiatrists using the self-report Leyton Obsessional Inventory-Child Version and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. DSM-IV criteria were used to diagnose OCD.

Most patients were in their initial episode of anorexia without a long prior duration of illness (average 11.21 months). The mean body fat percentage was 12.36% and body mass index at admittance 14.62 (range 10.65 to 20.0). The decrease in body weight since anorexia onset was 25.8%.

In these patients, the mean interference score of the Leyton Obsessional Inventory-Child Version was 6.91 (range 0 to 35) and the mean number of positive responses was 8.29 (range 0 to 20). While three patients scored 25 or more points on the interference portion of the Leyton Obsessional Inventory-Child Version, none had 15 or more positive responses or 10 or fewer points on the interference score.

The researchers found that exercising was associated with more severe obsessive compulsive symptoms. They reported the following positive correlations with excessive physical exercise (more than three hours a day):

• Interference score on the Leyton Obsessional Inventory-Child Version (P=0.006).
• Positive responses on the Leyton Obsessional Inventory-Child Version (P=0.047).
• School-related interference score on the Leyton Obsessional Inventory-Child Version (P=0.01).

The lack of correlation between anorexia and OCD was unexpected, said Maria Valen?a, M.D., a psychiatrist in private practice in Indianapolis, who was not involved in the study.

"You can't have a cookie-cutter treatment," she said. "You have to be nuanced."