Prevalent, Yet Often Unrecognized

Eating disorders in children and adolescents tend to be underdiagnosed although they are highly prevalent, and rates of treatment and full recovery are low.  Most of these diagnoses are exhibited by females, but pediatric eating disorders have been increasing in prevalence, particularly among boys, younger children, and minority groups. Among children and adolescents, the lifetime prevalence of eating disorders is about 13%: 0.8–1.7% with anorexia, 0.8–2.6% with bulimia, 2.3–3% with binge-eating disorder, and the remainder with other specified eating disorders (Lock, 2015).  The onset of some eating disorders tend to peak during the teen years, such as anorexia (ages 13-18) (Campbell & Peebles, 2014). These eating disorders are distinct from feeding disorders, such as pica, ARFID, and rumination disorder, which are also prevalent in children but will not be discussed in this article.

How Does this Happen?

The exact causes of eating disorders are unknown, although they appear to include an overlay of various factors including biological, psychological, environmental, and sociocultural influences.  Eating disorders do include a genetic susceptibility, and psychological factors that contribute to their development may include other underlying mental disorders (depression, anxiety, personality disorders) or trauma.  Sociocultural factors including diet culture, thin idealization, and social media can also increase the risk of developing eating disorders.  In fact, dieting behaviors are highly prevalent and a risk factor for developing an eating disorder in children and adolescents.  In a 2011 study on adolescents, approximately 50% of girls and 25% of boys reported dieting within the past year (Neumark-Sztainer, 2011).

How Do I Know?

Both childhood and adolescence include a series of developmental changes and milestones which could disguise the signs of an eating disorder. For instance, weight loss or gain may appear to be appropriate changes during adolescence as individuals undergo puberty.  However, adolescence, in particular, entails a significant period of cognitive and physical changes that increase the vulnerability of eating disorder development.  Thereby, both parents and healthcare professionals should be wary of the warning signs that a child may be exhibiting symptoms.

According to Ekern (2014), for adolescents, the following signs should be taken into consideration as potential eating disorder symptoms:

• Weight loss or weight gain

• Being overweight or obese

• Unexplained growth stunting/pubertal delay

• Trouble gaining weight

• Restrictive or abnormal eating behaviors/patterns

• Recurrent vomiting or other compensatory behaviors (laxatives, diet pills)

• Excessive exercise

• Body image concerns

• Chronic illness (i.e. diabetes), which could increase eating disorder susceptibility

For younger children, eating disorders may present with atypical signs:

• Failure to thrive/make expected height or weight gain

• Being overweight or obese

• Fear of getting “fat” related to seeing peers teased or bullies

• Aversion or particularity with certain foods

• Anxiety or OCD-like symptoms

Why You Should Seek Help

Regardless of the child or adolescent’s type of eating disorder, symptoms, or weight, they are prone to various physical and mental health complications that could turn fatal.

Cardiovascular concerns

Malnutrition, eating patterns, and compensatory behaviors of eating disorders can affect the cardiovascular system, leading to electrolyte imbalances, bradycardia, arrhythmias, changes in heart rate, low or high blood pressure, cardiomyopathy, and other serious heart complications. These cardiac abnormalities are not just linked to lower-weight individuals, but can be seen in patients with normal weights who exhibit atypical anorexia or bulimia.

Gastrointestinal complications

 These may occur as the result of nutritional deficiencies, vomiting, binging, and other compensatory behaviors.  Malnutrition may lead to gastroparesis, constipation, and high fat/cholesterol levels in the blood, as well as abdominal bloating and nausea. Vomiting can lead to esophageal issues (ruptures, reflux, and inflammation) and hematemesis. Binge eating may lead to pancreatitis, gastric dilation or possible rupture. 

Endocrine issues

Anorexia can suppress gonadotropic and sex hormones, which will affect growth, puberty, and menstrual functioning. Insulin and thyroid hormone levels can also be affected from eating disorder behaviors, as well as leptin, which helps with energy regulation and menstrual function.  Poor nutrition from any of the disorders can also affect bone density.

Renal and hematological issues

 Eating disorder patients can become dehydrated or face renal insufficiency due to severe fluid restriction or vomiting.  Problems with urination may also occur.  The individual’s bone marrow may also be affected, leading to lowered production of immune system cells, such as white blood cells.

Neurologic and psychiatric concerns

  Since the brain is undergoing significant changes and development during childhood and adolescence, malnutrition, low body weight, and cortisol changes can drastically affect the brain’s cognitive and structural development; this could affect neuropsychological functioning.  Moreover, psychiatric comorbidities are common in eating disorders, including mood (depressive, bipolar), anxiety (general anxiety, OCD), PTSD, substance abuse, and personality disorders, as well as self-harm behaviors.

Although eating disorders may go unrecognized in some children and adolescents, their symptoms and associated complications can have drastic long-term effects on the individual’s physical and mental functioning.  Fortunately, help is available in both diagnosing and treating such disorders.  A psychotherapist is crucial in clearly assessing the behavioral, cognitive, and emotional signs of eating disorders, and creating a treatment plan best suited for the child or adolescent’s recovery.