Atypical eating disorders in young children

Abstract

Eating disorders are considered rare in young children. However, we have admitted 8 prepubertal patients with atypical eating disorders. The 6 girls and 2 boys were 5‐11 years old and had markedly abnormal eating behaviors for periods of 2 months to 10 years. Weights varied from 82% to 108% of desirable body weight. All patients refused to eat normal amounts or types of food and struggled with family and staff about eating and weight gain. Several displayed ritualistic, obsessive behaviors during meals. None had a distorted body image or fear of fatness, and none had anorexia nervosa or bulimia nervosa. Observed symptoms ranged from phobic food aversion with little weight loss or depression to very restrictive diets with bizarre eating behaviors, low weight, and significant depressive symptoms. A wide range of critical familial psychosocial problems was identified. All patients gained weight and demonstrated some improvement in eating behaviors in hospital. However, most children had significant associated psychopathology, which required treatment after discharge. Eating disorders may be more common in children than now believed, may be associated with major family conflict, and may not manifest distorted body image or fear of fatness as cardinal symptoms.

Strict versus lenient weight criterion in anorexia nervosa

“…They experience numerous somatic complaints (Shisslak et al, 1989), have a past history of ED symptoms, and have had previous treatment (Clinton & Glant, 1992;Hall & Hay, 1991). They have been found to engage in as great a variety of abnormal ED behaviours (Jaffe & Singer, 1989;Williamson et al, 1992), albeit less frequently than their full-syndrome counterparts Shisslak et al, 1998). Less body image distortion has been found in individuals with partial syndrome disorders (Shisslak et al, 1989).…”

The spectrum of eating disturbances

“…The characteristics of individuals with partial syndrome EDs have been the focus of various studies. Some of the characteristics which have been reported are: older age at onset (Mitchell, Pyle, Hatsukami, & Eckert, 1986;Shisslak, Crago, & Yates, 1989), numerous somatic complaints but little evidence of body image distortion (Shisslak et al, 1989), a past history of ED symptoms and/or treatment (Clinton & Glant, 1992;Hall & Hay, 1991), and engagement in a variety of abnormal behaviors (Jaffe & Singer, 1989;Williamson et al, 1992). In several recent large-scale epidemiological studies involving a total of more than 26,000 subjects, most of whom were interviewed individually, those with partial syndrome EDs tended to be young women of normal weight who wanted to weigh less and were experiencing considerable psychological distress (Kishchuk, Gagnon, Belisle, & Laurendeau, 1992), were engaging in most of the problem eating behaviors associated with full syndrome EDs (Whitaker, 1992), and differed from full syndrome EDs only in frequency of compensatory behaviors such as dieting, fasting, use of laxatives or diuretics, and self-induced vomiting (Garfinkel et al, 1994), and levels of severity (Kendler et al, 1991).…”

Comparative study of children and adolescents referred for eating disorder treatment at a specialist tertiary setting

“…6 The tendency to group children and adolescents together may also have trivialized important developmental differences. 7 Biological, social, and cognitive processes en route to adulthood conceivably influence clinical presentation of EDs.…”