Although eating disorders are typically associated with teenagers and young adults, a disturbing number of cases have been appearing in young children as early as age 6 or 7. In a new study, researchers have discovered that young children who are difficult or picky eaters may have lurking psychological issues that increase their risk for full-blown eating disorders.
The researchers, from the University of Montreal in Canada and the CHU Sainte-Justine children’s hospital, presented their findings this week at the Eating Disorders Association of Canada conference in Vancouver.
Led by Dr. Dominique Meilleur, a clinical psychologist, the research questions how eating disorders develop and are diagnosed, as she explains: “Many researchers believe that bulimia only appears at adolescence, but our studies indicate that the problem can arise much earlier. It is possible that it is currently under-diagnosed due to a lack of awareness and investigation.”
In the United States, up to 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified (EDNOS). For various reasons, many cases are likely not to be reported, and thus, many eating disorders go undiagnosed. In addition, many individuals struggle with body dissatisfaction and sub-clinical disordered eating attitudes and behaviors, and the best-known contributor to the development of anorexia nervosa and bulimia nervosa is body dissatisfaction.
By age 6, girls especially start to express concerns about their own weight or shape. Past research indicates that 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming too fat.
As with many other psychiatric and behavioral conditions, researchers are increasingly finding that eating disorders arise as a result of interactions between genetic, biological, behavioral, psychological and social factors. Additionally, eating disorders often present with comorbidities such as depression, substance abuse or anxiety disorders.
Being mocked or bullied served as trigger to eating problems
In the new investigation, Dr. Meilleur and colleagues studied the psychological, sociodemographic and physiological characteristics of 215 children between the ages of 8 and 12 with eating problems. Children were excluded from the study if they had physical issues that could cause eating problems, such as diabetes or cystic fibrosis. The children in the study often suffered from anxiety, mood disorders and attention deficiency, the researchers noted.
The team found that 95% of the children had restrictive eating behaviors, 69.4% were afraid of putting on weight and 46.6% described themselves as ‘fat.’ “These behaviors reflect the clinical presentations we observe in adolescents and support findings that body image is a preoccupation for some children as early as elementary school,” says Dr. Meilleur.
Additionally, the study revealed that around 15.5% of the children occasionally made themselves vomit and 13.3% had other bulimic behaviors (such as excessive exercising or use of laxatives/diuretics). “These results are very concerning,” adds Dr. Meilleur, “but they may help clinicians reach a diagnosis earlier by enabling them to investigate these aspects.”
Of the children included in the analysis, 52% had been hospitalized at least once as a results of their eating problem, and 48% had been treated as outpatients. Psychiatric issues were also present in the families of 36.3% of the children, the researchers note.
“Many factors are associated with the development and persistence of eating disorders,” says Dr. Meilleur. “For some children, bullying can initiate or reinforce body image preoccupations and possibly lead to a change in eating behavior.” Among the children in this study, 22.7% reported being mocked or insulted for their appearance, which they identified as a trigger for modifying their eating behaviors.
Eating disorders are not just a ‘girl problem’
Although eating disorders are typically ascribed to females, the study found that boys in the same age group were similar to the girls in most cases, with the exception being a link with social isolation, which the researchers say was greater and lengthier for boys.
According to the NIMH, some boys with eating disorders display symptoms similar to those seen in females, while others may have muscle dysmorphia – an extreme concern with becoming more muscular.
Unlike girls with eating disorders who typically want to lose weight, some boys with muscle dysmorphia want to gain weight or bulk up, leading to steroid use in some cases. The organization notes that males are less likely to be diagnosed with what is often considered a female disorder and says “more research is needed to understand the unique features of these disorders among males.”
“The profound similarity between boys and girls supports, in our opinion, the hypothesis that common psychological and physical factors linked, amongst other things, to the developmental period, are involved in the development of an eating disorder,” Dr. Meilleur concludes.
Recognizing the signs
It is important that parents learn to distinguish the difference between a clinical eating disorder and other highly prevalent forms of eating dysfunction in infants and small children, the team says. These might include selective eating disorder or picky eating syndrome, whose origins stem from sensory integration disturbances which lead to an aversion to certain tastes and textures in the mouth (research has shown that for some taste buds, vegetables take on a distinctly metallic taste.)
And although parents are clearly not the cause of their child’s eating disorder, they are largely responsible for educating their child about what healthy eating is, and for shaping a child’s healthy eating lifestyle. Parents who are themselves preoccupied with body image and weight gain, who are fearful or rigid about their own approach to food and cooking and/or who do not prepare family meals on a regular basis in the effort to foster a healthy eating lifestyle in their children could possibly increase the risk of childhood eating disorders in those instances where there is a genetic propensity for the onset of an eating disorder.
If you believe a problem exists, with your child, be certain to seek out expert professional help. When children are young, parents may want to consider consultation with a therapist or nutritionist first, before bringing in the child. There is a tremendous amount of good that can come of parents making changes within the family system; in some instances, that alone might be enough to adjust whatever might be troubling your child.