Eating Disorders in Children and Teenagers

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) there are seven types of eating disorders: anorexia, bulimia, binge-eating, pica, avoidant/restrictive food intake disorder, rumination disorder and eating disorder not elsewhere classified.

  • Anorexia Nervosa (AN) – severe low body weight, intense fear of gaining weight, distorted body image and persistent behaviour that interferes with weight gain
  • Bulimia Nervosa (BN) – intake of large amounts of food followed by purging
  • Binge Eating Disorder (BED) – intake of very large amounts of food with no purging
  • Pica – craving and eating things not considered food e.g. dirt, ice, soap, hair
  • Avoidant/Restrictive Food Intake disorder (ARFID) – no interest in food, poor diet due to sensory issues or food refusal related to fear of choking, vomiting
  • Rumination Disorder (RD) – regurgitation of food that has been chewed and swallowed. Food is then rechewed and re-swallowed or spit out.
  • Eating Disorder Not Elsewhere Classified (EDNEC) – dysregulated eating that does not fit all diagnostic criteria of AN, BN, BED. For example, orthorexia, night eating syndrome, purging disorder

It is important to understand that eating disorders are not solely confined to food issues but are usually due to a range of psychological conditions that cause unhealthy eating habits to develop e.g. obsession with food, delusions, anxiety, fixation with body image, substance/alcohol use. Untreated eating disorders can lead to some very serious medical problems and research is finding that an eating disorder rarely exists in isolation but is usually accompanied with other mental disorders/illnesses e.g. depression, anxiety, substance abuse.

Eating Disorders and Self Harm
Approximately one quarter of children/teenagers with eating disorders self-harm. Self harm is often thought of as ways to escape, avoid or regulate aversive emotional states (Buckholdt et al., 2015). Unfortunately, as both behaviours appear effective in regulating emotion in the moment, it is very difficult to stop.

Eating Disorders and Mood Disorders
Research shows that approximately 44 percent of teenagers with bipolar disorder, also have an eating disorder. Similarly, as many as half of all children/teenagers diagnosed with binge eating disorder, also have a history of depression.

Eating Disorders and Substance Abuse
The most used substances in teenagers and young adults with eating disorders are marijuana, alcohol, caffeine pills, sedatives, heroin and cocaine. Up to 50 percent of kids with eating disorder also abuse alcohol and/or drugs. Eating disorders and substance abuse share a number of common risk factors including brain chemistry, low self-esteem, family history, depression, anxiety and social pressures.

Causes of Eating Disorders

  • Genetics
  • Brain structure and biology – researchers have found some brain messengers, namely serotonin and dopamine may play role in development of an eating disorder
  • Personality traits e.g. perfectionism, impulsivity, neuroticism
  • Cultural ideals
  • Exposure to social media promoting thinness and ideal body image
  • Bullying

Of interest, eating disorders appear to be almost non-existent in cultures that have not been exposed to western influences and social media.

Eating Disorders in Children
Most children with eating disorders have more atypical eating disorder symptoms compared to teenagers and adults. Common reasons for food problems include a fear of getting fat, fear of stomachache, vomiting, choking, aversion to taste, smell and texture of foods. In addition, many children can have pre-morbid anxiety symptoms which can exacerbate their fears whilst others may develop OCD like behaviours which can further restrict food intake and obsessions. Children often present in behaviorally regressed states displaying:

  • Severe tantrums
  • Physical aggression
  • Screaming
  • Excess movement

The most common eating disorders in children are anorexia nervosa (AN), avoidant/restrictive food intake disorder (ARFID) and eating disorder not elsewhere classified (EDNEC).

Treatment of children is primarily behavioural and focuses on rewards and consequences related to ensuring adequate nutritional intake and management of maladaptive behaviours. Medical monitoring of a paediatrician and ongoing follow up with a dietician and child psychologist is essential. Due to issues of frequent episodes of behavioral regression, treatment of children is usually long-term.

Eating Disorders in Teenagers
It is estimated that 35 percent of teenage girls have an eating disorder, that equates to 7 in 25 girls, and of all children/teenagers with an eating disorder, 10 per cent are male, this rises to 35 percent with males who binge eat. The most common eating disorders in teenagers are anorexia nervosa, bulimia nervosa and binge eating disorder.

Anorexia Nervosa

This is the most well-known eating disorder and usually develops during adolescence and young adulthood, although research is showing that children as young as 7 to 8 years old have anorexia nervosa.

Signs and symptoms

  • Excessive exercise
  • Fear of being fat and sees self as fat in mirror
  • Dieting despite being very thin
  • Rapid weight loss
  • Anxiety, depression, a need to be perfect
  • Periods usually stop in teenage girls
  • Health Problems
  • Anorexia is very harmful to the body and overtime the child/teenager may experience:
  • Brittle hair and nails
  • Dehydration and malnutrition
  • Electrolyte disturbance
  • Thin, brittle bones
  • Episodes of fainting, confusion, difficulty concentrating
  • Anemia
  • Possible multiple organ failure
  • Treatment

Treatment for anorexia is very specialized and sometimes hospitalization and/or artificial feeling may be required. Long-term treatment involves dealing with psychological issues: behavioural therapy, psychotherapy, support groups, family counselling and medication such as an antidepressant.

Bulimia Nervosa

Bulimia tends to develop during adolescence and young adulthood. In bulimia, unusually large amounts of food are eaten. The food is usually of high fat and sugar content. After eating, the food is then purged to relieve abdominal discomfort and get rid of the excessive calories consumed.

Signs and symptoms
Abusing laxatives
Bingeing on large amounts of food then vomiting afterward
Excessive exercise
Mood swings, anxiety, sadness
Sees self as fat or not thin enough
Preoccupation with food, eating in secret
Increased risk of using drugs and alcohol
Disappearing to the bathroom after eating
Health Problems
Inflamed sore throat
Swollen salivary glands
Worn teeth enamel and tooth decay
Dehydration
Hormonal problems
Abdominal problems e.g. acid reflux
Electrolyte imbalance leading to potential stroke, heart attack
Treatment

Treatment aims to break the binge-purge cycle and may include nutritional counselling, therapy, behaviour modification therapy and possibly an antidepressant medication.

Binge Eating

Whilst similar to bulimia, there is no vomiting after eating a very large meal. Binge eating is usually indicative of a child/teenager who is struggling with managing his/her emotions and is usually due to lots of stressors in life e.g. bullying, abuse, abandonment, etc.

Signs and Symptoms

Eating large amount of food rapidly and in secret despite not feeling hungry
Lack of control during binging episodes
Rapid weight gain
Feelings of anger, shame, guilt, disgust
Health Problems
Obesity
Immobility
Social isolation
Diabetes
Dental problems
Breathing difficulties
Treatment

A child/teenager who has binge eating disorder requires intensive counselling, which may include behavioural therapy and psychotherapy. Nutritional counselling, plus a supervised weight loss plan and exercise program is also an essential part of the treatment plan.

What Can a Parent(s) Do?

The most important thing a parent can do is to talk with and listen to your child/teenager’s concerns, fears, etc. Sit close, make eye contact, look at the body language, offer a caring touch or hug. Hear what is being said, or not being said (silence can speak volumes), be non-judgemental and open minded, do not invalidate or laugh, be responsive not reactive. Avoid comments like “you are too thin,” “you need to eat more,” “You are thin enough”.

Your child/teenager needs you to believe him/her, be kind, supportive and understanding, offer reassurance and show love. The child/teenager needs to know that you will be there, that you will help him/her and that you will do whatever it takes to help him/her manage the symptoms of the eating disorder (and other mental disorder), improve health and well being and recover.

Once you have spoken with your child/teenager, the next step is to schedule an appointment with a doctor for an assessment and physical examination. Medical monitoring by a pediatrician and psychiatric support is essential as is consultation and ongoing follow up with a nutritionist, counsellor/psychologist. Consider Family Based Therapy which helps parents take charge of nutrition decisions, gain skills in meal support and supervision and management of food avoidant behaviors and anxiety. Other tasks include following up with the school, talk with child/teenager’s siblings and any family/friends who play an active role in your child/teenager’s life and most importantly implement and adhere to the treatment plan

.
Buckholdt, K.E., Parra, G.R., Anestis, M.D., Lavender, J.M., Jobe-Shilelds, L.E., Tull, M.T., & Gratz, K.L. (2015). Emotion Regulation Difficulties and Maladaptive Behaviors: Examination of deliberate self-harm, disordered eating, and substance misuse in two samples. Cognitive Therapy and Research, 39, 140-152.

In my next Blog #26
I Will Discuss Mental Illness and the Holidays

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