Eating Disorders in Children and Adolescents
What is an Eating Disorder?
Eating disorders are a group of complex mental disorders that significantly impair physical and mental health as well as social functioning. Eating disorders often pose serious medical risks in addition to having a profound impact on an individual’s thoughts, feelings and behaviors.
What are the Different Types of Eating Disorders?
The following eating disorders are recognized as distinct illnesses, each of which requires specialized treatment: Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), and Avoidant/Restrictive Food Intake Disorder (ARFID).
The hallmark of Anorexia Nervosa (AN) is low body weight, which can occur when an individual loses significant weight or fails to gain weight at their expected rate. In children and adolescents, AN often results in a failure to follow one’s expected growth curve, rather than simply a decrease in total weight over time. AN also involves tremendous mental suffering; individuals are typically intensely preoccupied with fear of gaining weight or becoming overweight. Eating frequently becomes rigid, ritualistic, and highly restrictive, with a tendency to remove more and more items from one’s diet over time. In addition, the individual with AN typically fails to recognize the problem with his or her low body weight and feels intense attachment to low weight as important evidence of his or her success and value as a person.
This diagnosis contains two distinct subtypes – AN restricting subtype and AN binge/purge subtype. The restricting subtype describes AN in which the individual primarily controls body weight through strict dieting. Individuals with this subtype do not routinely binge eat or engage in any type of purging behavior such as vomiting or laxative misuse. The binge/purge subtype describes AN in which the individual does engage in binging and/or purging on a regular basis. Individuals might suffer from different subtypes at different times, and often develop the binge/purge subtype if their illness is prolonged.
Bulimia Nervosa (BN) shares many of the same features as AN, but does not involve low body weight. Like individuals with AN, individuals with BN have a strong preoccupation with their shape and weight due to the same over emphasis on the importance of appearance. Additionally, BN is marked by binge eating, which involves a sense of lost control while eating an abnormal amount of food, as well as behavior that is meant to compensate for this binge eating and prevent weight gain. The compensatory behavior typically involves either vomiting, laxative use, fasting, and/or exercise. BN typically generates intense distress; in turn, this distress often creates a strong desire to receive treatment and work on behavioral change.
Binge Eating Disorder (BED)
BED involves the same binging behaviors seen in BN but does not involve a regular pattern of compensatory behavior. Binging occurs regularly, with the same sense of lost control, and typically involves the experience of intense shame and disgust after eating. These eating episodes are not driven by hunger, and the quantity of food consumed usually leads to marked physical discomfort. BED is the most common eating disorder despite being less frequently discussed. Like BN, BED is often associated with mental anguish for the individuals who find themselves caught in this behavioral pattern.
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is a relatively new diagnosis that refers to a wide range of eating problems that interfere with an individual’s ability to maintain a varied diet and typically a healthy weight as well. ARFID does not, however, apply to those who are purposely restricting their intake due to concerns about their shape or weight. Instead, those with ARFID have sometimes had a traumatic eating experience that led to high anxiety while eating, while others might have long-standing sensory issues that make many foods generally unappealing. Whatever the specific concerns are about food or eating, an individual is diagnosed with ARFID when the difficulty becomes severe enough to cause significantly low body weight, medical issues, or major disruptions to life.
What is the Cause of Eating Disorders in Children and Adolescents?
Research has clarified that genetics play some part in making an individual vulnerable to the development of an eating disorder. Additionally, individuals with eating disorders are more likely to have suffered traumatic experiences, pointing to a possible link between trauma and development of these symptoms. Furthermore, we know that eating disorders are more prevalent in cultures where thinness is highly valued and considered the beauty ideal. However, no single causal factor has been identified by research – eating disorders seem to occur as a result of a complex interplay between genetic and environmental risk factors that we do not yet fully understand. Fortunately, understanding why the disorder initially developed is not necessary in order to successfully treat the disorder. The best treatments available actually focus on interrupting the behaviors and beliefs that keep the eating disorder going in the present moment.
How Do We Diagnose Eating Disorders in Children and Adolescents?
Accurately diagnosing a child or adolescent with an eating disorder is best achieved by an interdisciplinary team that partners closely with the young person’s family and/or caregivers. Given the shame and secrecy that often mark these disorders, observations from the adults who live with the young person are often immensely valuable, particularly since adults usually guide food preparation and mealtimes. An evaluation will also typically include reviewing growth charts and medical history as well as gathering specific information about eating habits, exercise, food preferences and how each has changed over time. Standardized assessments are often useful during this process. Since other conditions can sometimes impact appetite and eating behavior, the evaluation will also include careful screening for other disorders such as anxiety and depression.