Eating disorders seen in the child and adolescent population include anorexia nervosa, bulimia nervosa, binge-eating disorder, avoidant/ restrictive food intake disorder, pica, and rumination disorder.
Anorexia nervosa is associated with the restriction of food intake. DSM-5 criteria include the restriction of energy leading to a significantly low weight (for age, sex, developmental level, and health condition). Criteria also include the fear of gaining weight, behavior that prevents weight gain, and disturbance in self-image. Subtypes of anorexia include restricting type and binge eating-purging type.
Bulimia nervosa refers to recurrent binge eating and compensatory behaviors. DSM-5 criteria include binge eating with a sense of loss of control over food consumption along with compensatory behaviors (vomiting, laxatives, diuretics, fasting, exercise) to prevent weight gain, both occurring on average once a week for 3 months. Self-image is overly dependent on body and weight.
Binge Eating Disorder
Binge Eating Disorder refers to recurrent binging without the compensatory behaviors seen in bulimia nervosa.
Avoidant/Restrictive Food Intake Disorder
Avoidant/ restrictive food intake disorder is an eating or feeding disorder manifested as the lack of interest in food, avoidance of sensations associated with eating, or avoidance of consequences of eating. Associated signs include weight loss or failure to grow, nutritional deficiencies, and dependence on enteral or oral supplements. It is not due to a medical or another mental disorder.
Pica is the persistent eating of nonfood substances for at least one month.
Rumination disorder involves the repetitive regurgitation, re-chewing, or re-swallowing of food for at least 1 month.
More information about the diagnosis of eating disorders in children and adolescents may be found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
When is it time to screen?
Youth with eating disorders are often secretive because certain aspects of their eating patterns help relieve their anxiety. What they will admit to doing is often just the tip of the iceberg of what they are actually doing. Doctors should have a very low threshold for additional screening and/or referral to a mental health clinician.
How is it diagnosed or measured?
The diagnosis should be made by a doctor or mental health professional familiar with the criteria. Denial of symptoms is very common and may hinder the evaluation process. Screening measures are available and include the following:
The Eating Attitudes Test (EAT) is a 26-item self-report measure. A score of 20 or higher indicates an eating disorder such as anorexia nervosa, although serious binge eating problems may score lower. The links below allow individuals to take the test on-line and get their results.
When is it time to seek help?
Any clearly abnormal eating behavior or an elevated score on a screening tool signals a need to refer to a specialist. These problems typically do not remit quickly on their own.
A thorough medical workup is usually needed to determine if any secondary metabolic or nutritional deficits have developed. Psychotherapy is usually the most effective treatment. Eating disorders are unique and complicated disorders that are best treated by clinicians with experience and/or advanced training. Hospitalization may be indicated for serious abnormalities of heart rate (bradycardia), blood pressure (orthostatic hypotension), body temperature (hypothermia), electrolyte abnormalities, and severe malnutrition.
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National Eating Disorders Association: http://www.nationaleatingdisorders.org/
- Updated March 13, 2019