Emotional Disorders in Children with Eating Disorders

A study out of Duke University found that picky eating can coincide with more serious childhood problems such eating disorders, anxiety and depression [1]. Researchers from this study found that 20% of the children, aged 2-4, are picky eaters and nearly 18% are moderately picky while 3% are severely selective eaters [1].

When the lead researcher, Dr Nancy Zucker looked at the children in both the moderate and severely selective range, she found these children are twice as likely to peers to have increased symptoms of general anxiety [1]. The researchers also found that some of these children also have heightened senses to taste, smell, and textures of certain foods and feel overwhelmed.

Connection Between Eating Disorders and Emotional Disorders

Eating disorders in children can start at a young age and be coupled with emotional disturbances and disorders. The Individuals with Disabilities Education Act (IDEA) defines emotional disturbance as a “condition exhibiting one or more of the following over a long period of time and to a marked degree that it affects the child’s educational performance [2].”

• Inability to learn that cannot be explained intellectually, sensory, or health factors
• An inability to build or maintain satisfactory interpersonal relationships with peers and teachers
• Inappropriate types of behavior or feelings under normal circumstances
• A general pervasive mood of unhappiness or depression
• A tendency to develop physical symptoms or fears associated with personal or school problems

Defining Eating Disorders in Children

To better understand emotional disorders in children with eating disorders also means defining eating disorders. Eating disorders are defined into three categories, anorexia nervosa, bulimia nervosa, and binge eating disorders. Childhood Anorexia can be defined as children who are preoccupied with body weight and shape and typically have a distorted view of self.

Children struggling with anorexia may eat a significantly reduced amount of food and have a strong desire to lose weight. Food choices can be seen as selectively picky, or avoidant [6]. Emotional symptoms of those with anorexia include irritability, social withdrawal, lack of mood or emotional responses, inability to understand the seriousness of the anorexia, fear of eating in public and/or obsession with food and exercise or play behavior [3].

Childhood Bulimia can be defined as those who engage in frequent binging followed with vomiting to void the food just eaten. Binging is defined as eating larger than normal amounts of food in a short amount of time. Typically binging is done is secret and can be up to four times the amount that a peer would eat.

Often binges can be odd combinations of food [6]. Emotional symptoms can include feelings of guilt, shame, poor self-esteem, highly critical judgement of self [3, 6]. Emotional symptoms are highly linked to low self-esteem and body image. Often there are feelings of being out of control with food.

Childhood Binge Eating Disorder is similar to that of Bulimia Nervosa, without the purging. There is typically frequent episodes of out of control eating, but no vomiting. Emotional disturbances include feelings to guilt, shame, distress, embarrassed, coupled with anxiety, and depression [3, 7].

How Emotional Disorders Arise

Emotional Disorders in children with eating disorders can be displayed in behaviors such as hyperactivity with short attention spans or impulsivity; aggression or self-injurious behavior; withdrawal from peers or adults; immaturity through inappropriate crying, temper tantrums, and poor coping skills; and potential learning difficulties [2]. Emotional disorders in those with eating disorders can include a wide range of mental health conditions, such as anxiety, bipolar disorder, conduct disorder, and obsessive-compulsive disorder.

Anxiety disorders can be excessive, persistent, seemingly uncontrollable and overwhelming, especially for a child. When coupled with an eating disorder, especially anorexia where the person is malnourished or underweight, anxiety becomes a physiological response. According to the Health and Human Services, every 13th child of 100, aged 9-17, may have an anxiety disorder [5].

This includes unrealistic phobias, general anxiety, panic disorders, and obsessive-compulsive disorders. Depression can also occur at any age and every 2 in 100 children may have major depression, and as many as 8 in 100 teens may have clinical depression according to the National Institutes of Health [5]. Depression symptoms include children showing signs of sadness, crying, or stating worthlessness or low self-esteem. Children may also display decreased motivation, changes in appetite or sleep and physical complaints. Children showing signs of depression may also be self-critical/judgmental.

Bipolar disorder is a manic-depressive illness [2] which can cause dramatic mood swings from significantly energetic and upbeat to irritable, sad, hopeless, and continued cycle of ups and downs. Often there is a normal or flat mood typically seen in between the cycles. Bipolar in children can appear as excessive talking, or talking nonstop, needing little sleep and showing unusual poor judgement.

Children at end of manic phase can show periods of severe depression [5]. Conduct disorders are a behaviors and emotional difficulties where they have problems following rules and behaving in a socially acceptable way. It can include aggression to others or animals, destruction of property, lying, or stealing, and truancy [2, 5]. Obsessive-Compulsive disorder is a type of anxiety disorder but is characterized as recurrent, unwanted thoughts and/or repetitive behaviors. The repetitive behaviors such as handwashing, counting, checking, or cleaning are used to provide relief from thoughts.

Eating Disorders in children with eating disorders also include looking at personality. Personality characteristics can heavily tie into children with eating disorders and emotional disorders. Anorexic children tend to be perfectionistic, conflict avoidance, people pleasing, immature emotionally, excessively dependent, potentially socially anxious, fear spontaneity, and are typically reluctant to take risks [4].

Those with Bulimia and Binge Eating Disorders tend to show more unstable moods, thought patterns, and behaviors. Typically they are fearful of being alone, seek constant attention, show impulsive behavior, as well as secretive behavior [4]. Typically with all eating disorders the child has significant difficulty with self-soothing, empathizing with others, is hypersensitive to criticism or defeat, can have cycles of depression with anxiety, and difficulty communicating with loved ones.

In conclusion, Emotional Disorders in Children with Eating Disorders can be complex and often confused with other mental health disorders. It is important for caregiver and parents who are struggling with multiple concerns, to have your child assessed by both a physician and therapist who specialize in eating disorders.

About the Author: Libby Lyons, MSW, LCSW, CEDS is a specialist in the eating disorder field. Libby has been treating eating disorders for 10 years within the St. Louis area, and enjoys working with individuals of all ages.

References:

[1] Venosa, A. (2015, August 03). Why Picky Eaters Are More Likely To Be Depressed. Retrieved January, 2017, from http://www.medicaldaily.com/picky-eating-and-emotional-distress-kids-selective-eating-disorder-may-increase-their-345704
[2] (n.d.). Retrieved January, 2017, from http://www.parentcenterhub.org/repository/emotionaldisturbance/
[3]  NAMI. (n.d.). Retrieved January, 2017, from https://www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders
[4]  (n.d.). Retrieved January, 2017, from https://www.psychology.com/resources/child_behavior.php
[5]  Eating Disorders. (n.d.). Retrieved January, 2017, from https://www.adaa.org/understanding-anxiety/related-illnesses/eating-disorders

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Reviewed By: Jacquelyn Ekern, MS, LPC on February 25, 2017.
Published on EatingDisorderHope.com