Anorexia nervosa in Singapore: an eight-year retrospective study

Information regarding the clinical features of patients with anorexia nervosa in Singapore is rare and there have not been any large studies published to date. The aims of this paper were to study the clinical characteristics and features of patients with anorexia nervosa in Singapore, and to compare the clinical features of the early versus the classical later-onset cases.

126 cases presenting to the Child Guidance Clinic and the Eating Disorder Clinic at the Institute of Mental Health between 1994 and 2002 were identified and studied retrospectively. All presented with anorexia nervosa or had a past history of it. Subjects were further classified into early-onset (younger than 14 years) or classical later-onset (14 years and older), and a comparison was done between the two groups.

The large majority were female students with a mean presenting age of 17.6 years. 65.1 percent were of the restricting subtype. 84.1 percent were Chinese, 7.9 percent were Indians and 4.8 percent were Malays. Mean presenting body mass index (BMI) was 15.56. Depression was the most common co-morbid condition affecting 25.4 percent of the sample. The number of new cases increased significantly from six in 1994 to 24 in 2002 (p-value equals 0.002). Commonest precipitating factors were comments from others, school and work stress. 11.1 percent were previously members of trim and fit club in school. 42.7 percent of late-onset cases compared to 16.2 percent of the early-onset were of the binge-purge type (p-value equals to 0.005) and had a higher presenting BMI (15.91 +/- 2.90 versus 14.74 +/- 2.14, p-value equals 0.003).

The clinical characteristics of patients with anorexia nervosa in Singapore are similar to that reported in western literature. The Malay population appears to be under-represented. There was a significant increase in numbers presenting over the last two years. The early-onset cases tend to be of the restrictive-type and had a lower presenting BMI than the later-onset group.