Eating Disorders in Children and Adolescents

Eating disorders in children and adolescents can cause serious changes in eating habits that can lead to major, even life threatening health problems. The three main types of eating disorders are:

Anorexia, a condition in which a child refuses to eat adequate calories out of an intense and irrational fear of becoming fat

Bulimia, a condition in which a child grossly overeats (binging) and then purges the food by vomiting or using laxatives to prevent weight gain

Binge eating, a condition in which a child may gorge rapidly on food, but without purging

In children and teens, eating disorders can overlap. For example, some children alternate between periods of anorexia and bulimia.

Eating disorders typically develop during adolescence or early adulthood. However, they can start in childhood, too. Females are much more vulnerable. 

What causes eating disorders in children and teens?
Although the exact cause is unknown, it is felt that a combination of biological, behavioral, and social factors contribute to eating disorders.   For instance, young people may be influenced by cultural images that favor bodies too underweight to be healthy. Also, many children and teens with eating disorders struggle with one or more of the following problems:  Low self-esteem; fear of becoming overweight/poor body image; feelings of helplessness and loss of control, and family problems.

To cope with these issues, children and teens may adopt harmful eating habits. In fact, eating disorders often go hand-in-hand with other psychiatric problems such as anxiety and depressive disorders and substance abuse.  In addition, it may be more prevalent in homes where there is child abuse.

Eating disorders can be dangerous!
Eating disorders in children and teens can lead to a host of serious physical problems and even death. Eating disorders are not cured via sheer willpower. The child will need treatment to help restore normal weight and eating habits. Treatment also addresses underlying psychological issues.  The best results in treatment occur when eating disorders are treated at the earliest stages.

Anorexia in children and teens
Children and teens with anorexia have a distorted body image. People with anorexia view themselves as heavy, even when they are dangerously skinny. They are obsessed with being thin and refuse to maintain even a minimally normal weight.  Research indicates that 1 out of 25 girls and women will have anorexia during their lifetime.  Most often, they deny that they have an eating disorder

Symptoms of anorexia include:

Anxiety, depression, perfectionism, or being highly self-critical
Dieting even when one is thin or emaciated
Excessive or compulsive exercising
Intense fear of becoming fat, even though one is underweight 
Menstruation that becomes infrequent or stops 
Rapid weight loss, which the person may try to conceal with loose clothing
Strange eating habits, such as avoiding meals, eating in secret, monitoring every bite of food, or eating only certain foods in small amounts

Anorexia can lead to several serious health problems, including damage to major organs, especially the brain, heart and kidneys; irregular heartbeat and lowered blood pressure, pulse, body temperature, and breathing rates

Anorexia is fatal in about one out of every 10 cases. The most common causes of death include cardiac arrest, electrolyte imbalance, and suicide.

Treating anorexia
The first aim of treatment is to bring the young person back to normal weight and eating habits. Hospitalization, sometimes for weeks, may be necessary. In cases of extreme or life-threatening malnutrition, tube or intravenous feeding may be required.

Long-term treatment addresses psychological issues. Treatments include: antidepressant medication, behavioral therapy, psychotherapy and support groups

Bulimia in children and teens
Like children and teens with anorexia, bulimic young people also fear weight gain and feel extremely unhappy with their bodies.

They will repeatedly eat too much food in a short amount of time. Often the child or teen senses a loss of control. Feeling disgusted and ashamed after overeating, young people with bulimia try to prevent weight gain by inducing vomiting or using laxatives, diet pills, diuretics, or enemas. After purging the food, they feel relieved.

Symptoms of bulimia include:

Abusing drugs and alcohol
Abusing laxatives and other treatments to prevent weight gain
Bingeing on large amounts of food
Eating in secret or having unusual eating habits
Excessive exercise
Mood swings
Overemphasis on physical appearance
Regularly spending time in the bathroom after eating
Sadness or anxiety
Scarring on knuckles from using fingers to induce vomiting
Unusual interest in food
Vomiting after eating

Complications can be serious.  Stomach acids from chronic vomiting can cause damage to tooth enamel, inflammation of the esophagus and swelling of the salivary glands in the cheeks

Treating bulimia
Treatment aims to break the binge-and-purge cycle. Treatments may include antidepressants medication, behavior modification, individual, family, or group therapy and nutritional counseling.

Binge eating in children and teens
Binge eating is similar to bulimia. It includes chronic, out-of-control eating of large amounts in a short time, even to the point of discomfort. However, binge eaters do not purge the food through vomiting or other means. As a result, they tend to become overweight or obese.

Binge eaters may be struggling to handle their emotions. Anger, worry, stress, sadness, or boredom may trigger a binge. Often, binge eaters are upset about overeating and may become depressed.  Binge eaters are at risk for a variety of health problems, including heart disease, high blood pressure, high cholesterol and type 2 diabetes.

Treating binge eating
Treatments include the following: behavioral therapy, medications, including antidepressants, and psychotherapy.

In general, the treatment of eating disorders may involve various treatment modalities and mental health/health professionals to insure the health, psychological well-being and safety of the child or teen.  Treatment teams often include psychologists, psychiatrists, nutritionists, and medical doctors.  At times, hospitalization may be necessary.  

At OHEL, we are here to help.
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