Eating Disorders In Children and Adults Explained

Have you ever wondered if you or someone close to you may be suffering from an eating disorder? Maybe your experience doesn’t match what you have read in the past about some of the more frequently talked about eating disorders. Possibly you have struggled off and on your whole life with eating and never quite understood why.

There are many people who ask themselves, “Is this really an eating disorder?” without fully understanding the signs and symptoms of disordered eating. If you are questioning some of your ideas, feelings, or behaviors around eating, this simple breakdown of the most common kinds of eating disorders might be helpful for you. Although these eating disorders are not commonly talked about, they do occur quite often but are not always recognized at first and can be overlooked.

Eating Disorders in Children

All eating issues that children struggle with are not an indications of an eating disorder, but sometimes they are, so understanding the signs and symptoms of eating disorders can be helpful for parents, caregivers, and maybe even the child them self if they are old enough to ask for help.

Some of these disorders are developed during early childhood and last through adulthood, while some are seen most often in children, but can also be developed in adulthood as well.

Pica

Pica is probably a diagnosis many people have heard of generally associated with expectant mothers, but it is actually an eating disorder that is most often seen in children. Although it is not known how often Pica occurs in normal developing children, it is known that adults who suffer from intellectual disabilities tend to have an increase in prevalence based on the severity of their disability.

Pica: Things You Should Know

Diagnostic Criteria

• It is the persistent eating of nonfood and non nutritive substances for at least a month or more.

• The eating of nonfood and non nutritive substances is inappropriate for the developmental level of the individual.

• The eating behavior is not part of a culturally supported or socially normative practice.

• Minimum age of 2 is suggested to exclude normal mouth of objects by infants.

Typical Substances Ingested with Pica (vary with age and availability)

• Paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal or coal, ash, clay, starch, or ice.

What Might Happen if Left Untreated?

• Medical emergencies such as intestinal obstruction, weight loss, or poisoning.

• Fatalities depending on the substance ingested.

• Pica can impair physical functioning, but is rarely the main cause of impairment in social functioning.

• Deficiencies in vitamins and minerals and intestine obstruction or infections (from eating things such as dirt).

Known Risk Factors of Pica

• Neglect, lack of supervision or developmental delays.

Rumination Disorder

Rumination disorder may not be a name that is familiar to most people, but the symptoms of the disorder might be. Have you ever noticed that babies or children will chew their food and spit it out or chew it, spit it out, and chew it again without a medical reason for doing so? Rumination disorder is based on the regurgitation of food.

Rumination Disorder: Things You Should Know

Diagnostic Criteria

• Repeated regurgitation of food over a period of at least one month (may be re-chewed, re-swallowed, or spit out). Occurring a couple times a week, typically daily.

• Repeated regurgitation is not due to an associated gastrointestinal or other medical condition such as gastroesophageal reflux.

• Eating disturbance does not take place exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

Who and Why?

• Rumination disorder can be developed in infancy, childhood, adolescence, or adulthood.

• In infancy the age of onset is usually between 3 and 12 months.

• Infants may appear to be gaining satisfaction from the behavior (arching back and straining while holding their head back and making sucking noises with their tongue).

• Infants and older individuals with intellectual or neurodevelopmental disorders might use the regurgitation and rumination behaviors for self-soothing or self-stimulating functions.

What Might Happen if Left Untreated?

• Infants may be irritable and hungry between episodes of regurgitation, experience weight loss, or fail to make weight gains.

• Malnutrition may occur in infants, children, and adults. The malnutrition can be fatal.

• Some adolescents and adults may avoid eating before or while being around others in settings such as work, school, or other social settings because of their behavior.

Known Risk Factors of Rumination Disorder

• In children, psychological problems like lack of stimulation, neglect, stressful life situations, and parent-child relationship problems may be factors for infants and young children.

Avoidant/Restrictive Food Intake Disorder

If you have any experience feeding young children, you might know that they can sometimes appear to go through a stage where they will only eat certain foods and nothing else.Avoidant/Restrictive Food Intake Disorder occurs mostly in children, so parents and caregivers might have noticed the symptoms of this disorder in children they know without thinking they were related to an eating disorder

Avoidant/Restrictive Food Intake Disorder: Things You Should Know

Diagnostic Criteria

• An eating or feeding disturbance from a lack of interest in eating or food where avoiding is based on the sensory characteristics of food or concerns about aversive consequences of eating leading to the persistent failure to meet appropriate nutritional or energy needs associated with one or more of the following:

1. Significant weight loss or failure to achieve expected weight gain or faltering growth in children, such as no increase in their height.

2. Significant nutritional deficiency. This is based on clinical assessments (such as physical examination and laboratory testing).

3. Dependence on enteral feeding or oral nutritional supplements.

4. Marked interference with psychosocial functioning like the inability to participate in normal social activities such as eating with others.

• The disturbance is not better explained by the lack of available food or by an associated culturally sanctioned practice (religious fasting, normal dieting, developmentally normal behavior like picky eating in toddlers, or reduced eating in older adults).

Who and Why?

• Food avoidance or restriction associated with insufficient intake or lack of interest in eating commonly is developed infancy or childhood and may continue into adulthood. Avoidance related to adverse consequences can begin at any age.

• For some individuals food avoidance or restriction is based on sensory characteristics of the quality of the food such as extreme sensitivity to appearance, color, smell, texture, temperature, and taste. This can also include the refusal to eat certain brands of food or tolerate the smell of food eaten by others.

• Food avoidance or restriction may also represent a response that is conditioned by a negative response after food intake or an adverse experience such as choking.

• Sometimes parent-child interaction can contribute to the child’s feeding problem due to improper food presentation or misinterpreting the child’s behavior as an act of regression or rejection.

• Triggers for presentation vary and include physical, social, and emotional difficulties.

What are the Symptoms of Avoidant/Restrictive Food Intake Disorder?

• Very young infants may appear too sleepy, distressed, or agitated to feed. They may be hard to console during feeding or appear apathetic or withdrawn.

• Infants and young children may not engage with the primary caregiver during feeding or communicate hunger.

• For older children and adolescents, food avoidance or restriction may be associated with more generalized emotional difficulties that do not meet the criteria for anxiety, bipolar, or depressive disorder.

• In children there tends to be a long delay between onset and clinical presentation.

What Might Happen if Left Untreated?

• No matter what the age is, family functions may be affected due to stress at meal times and in other eating contexts that involve friends and relatives.

Known Risk Factors of Avoidant/Restrictive Food Intake Disorder

• The risk for avoidant or restrictive eating or the behaviors associated with it are increased by having an anxiety disorder, autism spectrum disorder, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder.

• The risk increases if there is familial anxiety and a higher increase may appear in children who have mothers with eating disorders.

• History of gastrointestinal conditions such as gastroesophageal reflux disease can be associated with feeding and eating behaviors characteristic of avoidant/restrictive food intake disorder.

Eating Disorders Seen in Adults

Some of the more well-known eating disorders areanorexia nervosa, bulimia nervosa, and binge eating disorder. When many of us hear these words we already have an idea of what we believe the disorders look like, but actually these disorders can look very different depending on varying factors for individuals.

A simple breakdown of these three disorders might be helpful in recognizing the signs and symptoms in ourselves or people we know. These are not exclusive to adults only, but the diagnostic criteria varies for adults and children, so the disorders may look different for adults than they do for children.

Anorexia Nervosa: Things You Should Know
Diagnostic Criteria

• Restriction of energy intake that is relative to requirements that lead to significantly low body weight in the context of age, sex, developmental trajectory, and physical health (for children and adolescents, less than minimally expected; growing in height but failing to gain weight).

• Fear that is intense around gaining weight (fear is not alleviated by losing weight) or persistent behavior that interferes with weight gain even when at significantly low weight.

• Undue influence of body weight or shape on self-evaluation, disturbance in the way one’s body weight or shape is experienced, or a consistent lack of recognition of the seriousness of the current low body weight.

• Specify whether the behavior is in full or partial remission, if there is binge eating and purging behavior in the last 3 months, and determine the severity based on the Body Mass Index (BMI) (for children and adolescents use the BMI percentile).

What is it Really Like?

• Individuals with distorted experiences about their body weight and shape may use techniques to evaluate their size such as frequent weighing, obsessive measuring of body parts, and persistent use of mirrors to check body parts.

• Often these individuals are aware that they are thin, but they do not recognize the serious medical implications of being malnourished.

• Generally family members bring individuals in for professional attention after noticing the weight loss or failure to gain weight.

• The semi-starvation and purging behavior can be life-threatening and affect most major organ systems.

• Many individuals with anorexia nervosa have depressed moods, social withdrawal, irritability, insomnia, and diminished interest in sex. They are also concerned about eating in public, are preoccupied with thoughts about food, and collect recipes or hoard food.

Interesting Facts

• Anorexia nervosa commonly begins during adolescence or young adulthood, rarely before puberty or after the age of 40 years old.

• Onset of the disorder is often associated with a stressful event.

• Some individuals fully recover after one single episode while others experience a chronic course over years.

• Although the prevalence of anorexia nervosa appears to be lower for Latinos, African Americans, and Asians in the United States when compared to other groups, therapists should still be aware that anorexia nervosa spans across culturally and socially diverse populations.

Known Risk Factors

• Anxiety or obsessional traits in childhood are at an increased risk.

• Culture (cultures that value thinness).

• Having a first-degree biological relative with the disorder increases the risk.

• Suicide risk is elevated.

Bulimia Nervosa: Things You Should Know

Diagnostic Criteria

• Recurrent episodes of binge eating with:
  • Eating in a discrete period of time, amount of food larger than most individuals would eat in the same period with the same circumstances.
  • Sense of lack of control over eating during the episode.

• Recurrent inappropriate compensatory behaviors to prevent weight gain such as vomiting or excessive exercise (occurring in inappropriate times and places or interfering with important activities).

• Binge eating and inappropriate compensatory behaviors that occur at least once a week for 3 months.

• Self evaluation influenced by body shape and weight.

What Might Happen if Left Untreated?

• Menstrual irregularities and amenorrhea in females and rare, but potentially fatal outcomes like esophageal tears, gastric rupture, and cardiac arrhythmias.

Who and Why?

• Bulimia nervosa usually begins in adolescence or young adulthood.

• More common in females than males.

• Usually begins during or after a period of dieting to lose weight.

• Experiencing several stressful life events before the onset of bulimia nervosa.

Known Risk Factors

• Weight concerns, low self-esteem, depressive symptoms, social-anxiety disorder, and overanxious disorder in childhood are associated with an increased risk.

• Internalization of a thin body.

• Experience of childhood sexual or physical abuse.

• Childhood obesity and early pubertal maturation.

• Suicide risk is elevated.

Binge-Eating Disorder: Things You Should Know
Diagnostic Criteria

• Recurrent episodes of binge eating characterized by:
  • Eating in a discrete period of time, amount of food larger than most individuals would eat in the same period with the same circumstances.
  • Sense of lack of control over eating during the episode.

• Episodes associated with three or more:

1. Eating more rapidly than normal.
2. Eating until uncomfortably full.
3. Eating large amounts of food when not hungry.
4. Eating alone because of embarrassment (how much food is being eaten).
5. Feeling disgusted with oneself, depressed, and guilty afterward.

• Marked distress about binge eating.

• Occurs at least once a week for 3 weeks.

Who and Why?

• Prevalent in women from all ethnic backgrounds.

• Seen more in individuals seeking weight loss treatments than in general populations.

• Occurs in normal weight and overweight individuals.

• Triggers: interpersonal stress, dietary restraint; negative feelings related to body weight, body shape, and food; and boredom.

Known Risk Factors

• Binge eating disorder seems to run in families, which may show additive genetic influences.

Self-Reflection

After reading some of these breakdowns of the most common kinds of eating disorders you think you may need to have a more in depth conversation around symptoms you or your child may be experiencing, please reach out to one of our counselors; many are equipped to support you as you begin this journey to understanding your behaviors.