Detection and importance of laxative use in adolescents with anorexia nervosa

Objective: The frequency of laxative use in adolescents with anorexia nervo sa is poorly described. This study of adolescents with anorexia nervosa exa mined self-report and biochemical screening methods for the detection of la xative use, the pattern of laxative use in this population over lime, and t he associated medical complications and psychopathology. Method: Forty-thre e consecutive patients with anorexia nervosa were studied. Initial assessme nt encompassed psychiatric history, medical examination, and administration of the Eating Disorders Examination, Child Behavior Checklist, and Youth S elf-Report. Biochemical investigations, including random urinary laxative s creening, were performed at assessment and follow-up. Results: The frequenc y of laxative use from self-report alone was 12%; combined with urine scree ning it was 19%. The frequency of laxative use increased to 32% with prospe ctive follow-up. Medical complications were associated with laxative use at follow-up. Laxative use was associated with longer duration of disease and with higher scores on the Eating Disorders Examination subscale Eating Con cern. Conclusions: Laxative use is common among adolescents with anorexia n ervosa, and the risk of associated medical complications increases over tim e. Biochemical screening will improve detection of laxative use. Longer dur ation of illness and greater Eating Concern scores are associated with incr eased risk of laxative use, and monitoring patients at increased risk is im portant.