Anorexia Nervosa is the refusal to eat sufficient food to maintain health, and a fear of weight gain. Bulimia Nervosa is also characterized by a fear of weight gain and an overemphasis on the importance of weight and shape, but is also associated with periods of perceived loss of control with eating and engagement in behaviors meant to compensate for eating (e.g. vomiting, use of laxatives, and over exercise). In each case, the person is consumed with thinking about food and not eating. These disorders usually begin around the time of puberty, with most youth being diagnosed by health care providers around 15 years of age.
What Causes Eating Disorders?
There are still health care providers out there who may come across as blaming and judgmental of parents, but current research is clear that eating disorders are not the parent’s fault. In fact, there does not seem to be one clear cause of an eating disorder: the current literature suggests that eating disorders develop as the result of I) personality traits of either obsessiveness and perfectionism and/or emotional dysregulation and impulsivity (biological or genetic factors), combined with II) a desire for thinness or value placed on diet, healthy eating, or thinness (importance of body related ideals). To summarize, it is believed that there are people who are genetically or biologically at risk of developing an eating disorder, who, if they value and pursue thinness, will be at greater risk of developing an eating disorder. Bullying about weight and appearance is the most common form of bullying.
Pursuit of thinness is believed to be the result of a variety of influences. Our culture’s “thin ideal”, and more recent “fit ideal” has been argued to be a large contributor to the pervasiveness of body dissatisfaction. Over half of women are unhappy with their bodies and appearance. Rates of body dissatisfaction in boys and men have been increasing in recent years, perhaps as a result of the recent media emphasis of the masculine fit ideal. Our relationships with others also influence our beliefs about the importance of weight and appearance. Among youth, bullying and “fat talk” is particularly concerning, as children conclude from these messages that thinness or attractiveness will result in happiness, worth, and likeability. It is of note that over half of individuals diagnosed with an eating disorder report having been teased or bullied about weight as a child.
Eating disorders affect all sorts of families. They are not a choice, they are a serious mental health disorder associated with illogical thinking and immense suffering.
What are the Signs of an Eating Disorder?
Although the above factors are common for a wide range of children, less than three percent will develop an eating disorder. The first outward sign of an eating disorder is dieting, followed by gradually more drastic reductions in nutritional intake. Other signs include:
• Calorie counting
• Eliminating food groups (e.g. meat, dairy, grains)
• Unusual food behaviors such as micro-eating (cutting things in small pieces) or using large amounts of condiments (mustard, hot sauce)
• Weight loss or failure to continue growing
• Using only the same cutlery or dishware
• Feeling cold, particularly in the hands and feet
• Lack of menstruation
• Hair loss
• Interest in cooking or baking, but not eating what they have made
• Obsessive or compulsive exercise, and anxiety or guilt if they miss part of their routine
Over half of individuals struggling with an eating disorder also have an anxiety disorder or struggle with depression.
Treatment of an Eating Disorder
If you think your child has an eating disorder, consult your child’s physician or pediatrician. Both anorexia and bulimia affect the heart, either by starvation or electrolyte abnormalities, which can be fatal. If the physician diagnoses an eating disorder, request a referral to a specialized pediatric eating disorder treatment program. The first line of treatment for an eating disorder in childhood is Family Based Treatment for an Eating Disorder. This treatment approach will provide you as parents with the supports needed to “re-feed” your child. If this approach is not successful, hospitalization may be considered.
Treatment first focuses on normalization of eating and activity level, as, the sooner you make these changes the more likely your child will recover from the eating disorder. Once the behaviors are improved, psychological interventions will be introduced to address the overemphasis on weight and shape, as well as self-worth.
The good news: children and youth who receive treatment for their eating disorder early, while still in their parent’s care, recover more quickly from their eating disorder than those whose treatment does not occur until they are adults. It is believed that this is due to the fact that weight restoration, which can be done more quickly when people are younger, allows the person to face their fears of a healthy body weight more quickly, reducing the number of years the disorder can be entrenched.