Eating Disorder Facts
Anorexia Nervosa, Bulimia Nervosa, and Related Disorders
Who gets these types of eating disorders?
Anyone can develop an eating disorder. How eating disorders evolve is still poorly understood. Risk factors, such as perfectionism, difficulty managing emotions, a focus on achievement and a history of dieting have been identified, but researchers are still working to understand why some individuals with such experiences and traits develop an eating disorder and some do not. There are some things we do know. Individuals with eating disorders come from all types of families. Parents do not cause eating disorders. However, they are critical in helping children and teenagers in recovering from these illnesses. Eating disorders are also not necessarily a result of trauma. Some individuals with eating disorders have a history of such experiences, but many do not. Any gender, all socioeconomic classes, and all ethnic groups can develop an eating disorder. In fact, research indicates that one fourth to one half of new cases of Anorexia that happen before puberty occur in boys.
How we think about these eating disorders
Eating disorders are complex biopsychosocial disorders which require medical, psychological and nutritional intervention.
Common symptoms and behaviors
- The individual typically experiences significant body image disturbance or distortion.
- The individual overemphasizes the importance of weight/appearance on self-worth and identity. In general, there is a belief that being thin or losing weight will result in a positive outcome (e.g., increased success, increased peer acceptance) or that gaining weight or being fat will result in a negative outcome (e.g., failure, peer rejection).
- These thought patterns are associated with behaviors intended to decrease weight or prevent weight gain and are not behaviors that would be recommended by a medical professional. These behaviors may or may not logically be expected to result in weight loss, particularly in children and adolescents who may have a misunderstanding of what results are realistic for a given behavior.
- Eating disorders are often associated with significant symptoms of depression and/or anxiety. These concerns may warrant a separate diagnosis or may be a result of malnutrition, even in those who appear to be of normal weight.
- Eating disorder behaviors are maladaptive coping strategies. They are ways to manage negative situations and emotions that are effective in the short-term and damaging in the long run. Therefore, engaging in these behaviors often makes sense to the individual when parents and other adults are baffled.
Avoidant/Restrictive Food Intake Disorder (ARFID)
Who gets ARFID?
ARFID primarily develops in those with anxious temperaments or strong sensory symptoms. These factors can make kids more at risk of having negative experiences with food and eating and/or reacting more strongly to negative experiences when they occur. Associating fear or discomfort with eating creates a barrier to children eating enough or an appropriate variety of foods.
In addition, ARFID can develop because of brain differences that lead some people to find eating less interesting and less satisfying. In this situation, it is easy to eat less than the body needs.
How we think about ARFID
How we understand ARFID depends on what subtype a child/teen is experiencing. Sometimes we think about avoiding food as a way to decrease uncomfortable sensory experiences or anxiety. In other situations, we understand ARFID to result from a child being disinterested in food or eating. In most cases, how the body adapts to malnutrition can also create barriers to improving nutrition.
Common symptoms and behaviors
- Eating a small number of foods or sometimes not eating any foods in a certain food group (e.g., fruits).
- Eating a good variety of foods, but in small quantities that do not meet the body’s nutritional needs.
- A sudden decrease in the amounts or types of food after a traumatic experience related to food or eating (e.g., a choking incident).
- Depending on nutritional supplements to meet nutritional needs for growth and health.
- Avoiding social situations because of the foods available in those situations.
Impact of malnutrition on cognition and emotions
Malnutrition impacts all organ systems, including the brain. This impact can be present despite an individual being a normal weight or overweight since it depends upon balanced and complete nutrition as well as overall caloric intake.
Other effects of malnutrition
Concentration, focus and memory can be impacted, leading to additional stress as the child or adolescent and those around them recognize that these abilities are weaker than before. ADHD should never be diagnosed when an individual is malnourished or if their nutritional status has not been determined by a medical professional.
- Emotions are greatly impacted as well. Malnutrition can cause symptoms of overall emotion dysregulation, including irritability, anxiety, rigidity, depression, sadness and behavioral outbursts.
- Obsessive-compulsive symptoms are often heightened by poor nutrition and sometimes resolve when nutrition is improved.
- We carefully monitor symptoms of inattention, anxiety and depression within the context of nutritional status. We maintain a cautious approach to diagnosing additional mental health concerns, given the potential impact of malnutrition.
Eating disorder resources
Families may find the following resources helpful:
Get help for an eating disorder
There is help and hope for families affected by an eating disorder. Find out more about the services we offer for children and adolescents with eating disorders at Children's Mercy.