Family Physician Consultation Patterns Indicate High Risk for Early-Onset Anorexia Nervosa Introduction Early-onset anorexia nervosa is characterized by deter- mined food avoidance, marked weight loss, morbid preoccupation with weight and shape, fear of fatness, and denial of any problem. It has a poor prognosis, with high morbidity (Bryant-Waugh & Lask, 1995; Eis- ler et al., 2000; Patton, 1988). Failure to recognize the disorder and make an appropriate diagnosis predicts poor outcome both in adults (Hsu, 1990) and in chil- dren (Bryant-Waugh, Knibbs, Fosson, Kaminski, & Lask, 1988). Consequently, earlier diagnosis and treat- ment have been suggested as means to reduce mortal- ity and morbidity (e.g., Hall, Slim, Hawker, & Salmond, 1984; Ogg, Millar, Pusztai, & Thorn, 1997; Rome et al., 2003). However, early identification has proven problematic in early-onset cases. For example, in a study of the differential diagnosis of two case studies of children with classical features of anorexia nervosa (Bryant-Waugh, Lask, Shafran, & Fosson, 1992), only 2% of family physicians considered the diagnosis in both cases. Methods are needed to facilitate earlier diagnosis of eating disorders in primary care. It has been suggested that the nature of family physician consultations might provide a crucial indicator (Ogg et al., 1997), but this hypothesis has never been tested in early-onset anorexia nervosa. The purpose of the current study was to ascertain whether there are specific patterns in the frequency and content of family physician consultations before a diagnosis of early-onset anorexia nervosa. Three groups were studied, that is, subjects with early-onset anorexia nervosa, clinical case controls (emotional disorders), and nonclinical case controls. It was hypothesized that the two clinical groups (subjects with anorexia nervosa and case controls) would have a higher overall number of consultations before diagnosis compared with the nonclinical group; that the anorexia nervosa group would have a higher number of consultations regarding eating, and shape and weight concerns; and that the emo- tional disorder group would have a greater number of consultations for psychological problems. Bryan Lask, FRCPCH, FRCPsych, MPhil, MBBS, FAED 1,2 * Rachel Bryant-Waugh, MSc, DPhil 3 Fiona Wright, MA, MSc 1 Mari Campbell, BSc 1 Kate Willoughby, BSc 1,2 Glenn Waller, DPhil 1,4 ABSTRACT Objective: There is often a delay in the recognition of early-onset anorexia nervosa. The current study aimed to determine whether there are specific patterns in the frequency and content of family physician consultations that might predict its onset. Method: Lifetime number and type of family physician consultations were recorded for three groups: (a) an index group comprising 19 girls with anorexia nervosa, onset under 14; (b) a clinical control group comprising 19 girls with an emotional disorder; and (c) a noncli- nical group comprising 19 girls with no history of mental health problems. Results: Both clinical groups had an elevated number of consultations, parti- cularly in the 5 years before diagnosis. The index group had a significantly higher number of eating, weight, and shape consultations (especially in the year before diagnosis), whereas the clin- ical control group had a greater number of psychological consultations. Conclusion: A single consultation about eating behaviour or weight and shape concerns is a strong predictor of the subsequent emergence of anorexia nervosa. ª 2005 by Wiley Periodicals, Inc. Keywords: anorexia nervosa; early onset; family physician (Int J Eat Disord 2005; 38:269–272) Accepted 11 August 2004 *Correspondence to: Bryan Lask, FRCPH, Department of Mental Health, St. George’s Hospital Medical School, London SW17 0RE, United Kingdom.E-mail:b:lask@sghms.ac.uk 1 Department of Mental Health, St. George’s Hospital Medical School, London, United Kingdom 2 Eating Disorder Service, Huntercombe Hospitals, United Kingdom 3 Hampshire Partnership Trust Eating Disorder Service and Mental Health Group, School of Medicine, University of Southampton, Southampton, United Kingdom 4 Eating Disorders Service, South West London and St. George’s Mental Health NHS Trust, London, United Kingdom Published online 6 October 2005 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.20163 ª 2005 Wiley Periodicals, Inc. Int J Eat Disord 38:3 269–272 2005 269 BRIEF REPORT