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Adverse Childhood Experiences (ACEs) have a wide range of negative outcomes including physical and mental health difficulties. Research shows the impact of ACEs are greater for those who face four or more traumatic events in their childhood, with strong associations between ACEs and sexual risk-taking, offending behaviour, and reduced education. It is likely those are at-risk of certain trauma, like sexual abuse, are more likely to have had other traumas as well. The current project screened through family assessments of young people involved in CSATS (Child Sexual Abuse Therapeutic Service) to look for all ACEs experienced by the cohort, as other factors could be contributing to difficulties for this group of young people. The CSATS cohort experiences more traumas during childhood than the general population, indicating a higher risk of physical and mental health difficulties. It was also found that the highest levels of trauma were between young people and their caregiver (parental substance use, mental health, separation, and domestic violence), indicating a lack of support from home. We also found higher levels of neurodiversity than in the general population. These results show a need to consider possible trauma during assessment and intervention while working with young people who have experienced sexual abuse to work with them in a more effective way. These results should be interpreted with caution due to possibility of underestimation of difficulties, however, is a good starting point to considering different ways we can work with the population served by CSATS.

AimsAnorexia Nervosa (AN) mimics a state of starvation as a result of extreme calorific restriction, often with associated extreme exercise or purging behaviours. The physiological demands are known to lead to a number of health complications and contribute to a significantly increased mortality compared to the general population. Although males account for 10% of the AN population, they are often underrepresented in research. There is a particular gap in evidence for males under 18 despite the unique physiological requirements of adolescence including growth, puberty and achieving peak bone mass.This review aims to bring together current research on physical health complications in male adolescent anorexia and help understand the knowledge gaps which exist.MethodA scoping literature review was undertaken between January and March 2020. A single researcher searched OvidSP, psychinfo, relevant grey literature and undertook hand searches of key reference lists. Following PRISMA-SCR protocol, abstracts and articles were screened against inclusion/exclusion criteria to identify relevant papers. Papers were then subjected to critical appraisal and findings summarised using a narrative approach. Key data for blood pressure, pulse and body temperature were pooled and analysed in the context of wider findings.ResultData from 219 patients were included from 20 studies. 13 of these studies were case studies or case series, 5 were cross sectional and 2 were cohort studies. Cardiovascular compromise including bradycardia (61%) and hypotension (30.3%) were common and a single episode of cardiac arrest was documented in the literature. Bone density was reduced (Z score ≤1) in 36.7% of cases. A wide variety of single episodes of physical morbidity were also documented including pneumothorax, liver dysfunction, growth retardation and thyroid dysfunction.ConclusionThis scoping review highlights the physiological compromise experienced by some male adolescents with AN. Guidelines for the identification, assessment and management of physical health complications - including MARSIPAN by the Royal College of Psychiatrists - continues to use data heavily drawn from female-biased populations. Given the evidence summarised, there is concern that in the absence of specific guidance, adolescent males may be at high risk of negative outcomes including acute cardiovascular compromise, osteoporosis and reduced linear growth.

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