Anorexia Nervosa

Eating disorders in mid-childhood are diverse and can be carried over from feeding difficulties during infancy or early childhood, or may signal fears of fatness and early struggles to control one’s weight. In addition, some children develop fears of choking and dying after they have experienced a traumatic event or witnessed someone else choking, and they avoid any foods that they fear would get stuck in their throat. In order to help affected children to overcome their fears, it is important to understand the factors that are troubling to them: is it the fear of being “fat,” the fear of eating new foods, or the fear of choking? In addition, the family needs to provide an environment in which these children can learn to regulate eating in accord with hunger and fullness and deal with their emotions more effectively.

Eating disorders in mid-childhood are diverse and can be carried over from feeding difficulties during infancy or early childhood, or may signal fears of fatness and early struggles to control one’s weight. In addition, some children develop fears of choking and dying after they have experienced a traumatic event or witnessed someone else choking, and they avoid any foods that they fear would get stuck in their throat. In order to help affected children to overcome their fears, it is important to understand the factors that are troubling to them: is it the fear of being “fat,” the fear of eating new foods, or the fear of choking? In addition, the family needs to provide an environment in which these children can learn to regulate eating in accord with hunger and fullness and deal
with their emotions more effectively.

Children diagnosed with anorexia nervosa are often intensely afraid of gaining weight, attempt to lose weight, and exhibit a significant disturbance in the perception of the shape or size of their body . Prepubertal children have less body mass and may enter a state of starvation rather quickly. In their effort to diet and lose weight, children also fail to drink adequately and may not maintain their hydration. In addition, when children eat inadequately for months and years, they stunt their linear growth, though they may not appear as malnourished because of their compromised height. However, there is a prolonged delay of puberty and failure of catch-up growth affecting breast development. Interestingly, whereas studies of anorexia nervosa in adolescents and adults consistently have shown that the ratio of girls to boys is generally 9:1, early-onset anorexia nervosa in children has been reported to occur in 19% to 30% of boys.

Although twin and family studies have demonstrated that there is a high heritability to anorexia nervosa, several other risk factors have been identified. Sharpe and colleagues identified a significant correlation between anxious attachment and eating concerns. Other studies have identified affective lability and maternal preoccupation with diets as risk factors of eating disturbances in children. Whereas the psychobiological challenges of puberty have been seen as triggering factors for anorexia nervosa during the adolescent years, prepubertal children have been shown to experience more stressful life events, which act as alternative precipitating factors to puberty in triggering anorexia nervosa. Some studies have described premorbid depressive symptoms that usher in anorexia nervosa, and several studies have reported on the high comorbidity of anorexia nervosa and depression. Many children experience depression as their nutritional state deteriorates.

Treatment

The initial goal of treatment is the restoration of physical health. Some children may require hospitalization for refeeding and weight restoration. Early discharge with low discharge weight has been shown to confer high risk for relapse and a poor prognosis. A large variety of outpatient approaches to individual, family, and group therapy are used in the treatment of anorexia nervosa. A study by Russell and colleagues, which compared family therapy that encouraged the family to take charge of the patient’s eating with individual therapy that emphasized support, education, and problem solving, found that family therapy was superior for younger patients, whereas individual therapy had a better outcome for older adolescents. Generally, outcome studies of anorexia nervosa have reported good results in 50% to 67% of patients. Some studies have reported that onset at <11 years of age is associated with poor outcome, whereas other studies found that the older the age of onset, the poorer the outcome.

References

  • Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
  • Chatoor I. Feeding disorders in infants and toddlers: diagnosis and treatment. Child Adolesc Psychiatr Clin N Am. 2002;11(2):163-183.

 

 

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