eating disorders » Parents ED

The dangerous epidemic of eating disorders has become common knowledge, but new discoveries are transforming how they are understood and treated. These serious illnesses can be damaging or even fatal, but early sophisticated care by teams of specialists can produce complete cure. Research findings in genetics, temperament, development and brain chemistry inform the newest approaches.

 

Anorexia nervosa is the most recognizable. It generally begins between ages 10 and 17. Signs include absence of menses, weight loss or failure for weight gain to keep up with growth, and increased concern about exercise, diet and body fat. Youngsters generally continue to do well in school and sports and have a characteristic conviction that there is no cause for concern. In fact, inadequate calories take a silent physical toll, especially on heart, brain and bones.

 

Bulimia nervosa is more common but less obvious, since weight is generally in the normal range. It has a somewhat later onset, often in high school but especially during the college years and has become a pervasive mental health problem on college campuses. Bulimics restrict their intake, becoming so hungry they binge. Fearful of weight gain, they induce vomiting, fast, exercise excessively, or abuse laxatives. Sufferers are often ashamed and secretive, delaying recognition and treatment.

 

Binge-eating disorder (BED) is a recently recognized eating disorder. BED is more common in adults but affects some teenagers. Those with BED are usually overweight and despite their distress over this are plagued by binge episodes. Sufferers do not purge but often feel depressed. The associated obesity may cause health problems, especially polycystic ovarian syndrome in adolescent girls. BED is the most common form of eating disorder in African American and Hispanic populations.

 

People with eating disorders who don’t fit into one of these categories are termed Eating Disorder Not Otherwise Specified (EDNOS). They may lack certain typical features or have a milder variant. Their recognition is important, since almost half of these subsyndromal cases become full-blown if not treated.

 

Prevalence: disordered eating is common but worrisome
Current studies show that 50% of young women in the greater New York area experience transient disordered eating at some point in their teens.  Those who also have some depression and/or discomfort with their bodies are most likely to escalate to a sustained eating disorder.

Genetics: vulnerability to eating disorders is inherited  

Research studies have identified the first genetic linkages, on Chromosome 1 for anorexia and on Chromosome 10 for bulimia. Other studies have shown these illnesses are highly heritable – as strongly inherited as schizophrenia, for example. Families may not be aware of relatives with eating disorders per se, but rather depression, anxiety disorders or substance abuse. While genes predispose to eating disorders, stressful life events (teasing, early puberty, illness, etc) catalyze the process.

 

Temperament plays a role in susceptibility to eating disorders. Children who become anorexic have often been sensitive, people-pleasing, harm-avoidant, anxious, disciplined, high-achieving or perfectionistic. Youngsters who become bulimic may be novelty-seeking, impulsive, anxious, moody or low in self esteem. These qualities may reflect a brain chemistry associated with higher risk.

 

Culture: dieting may be dangerous
For vulnerable youngsters, a period of intentional dieting may set off a cascade of changes in appetite, mood and brain chemistry that leads to an eating disorder.  Normal weight children should not restrict calories needed to grow and develop.  Preteen girls in particular experience a surge in height and physical development requiring significant weight gain. At puberty, boys’ body fat falls while girls’ body fat rises, producing the estrogen needed for feminization, menstruation and strong bones.

Many kids with eating disorders are smart, responsible and high achieving. They often seem intellectually more adult than their years. In other ways, however, their brains may not yet have shifted from the thinking centers of childhood to those that handle the more complex demands of teenage life. This can make the developmental demands of adolescence additionally stressful.

 

Families should have healthy eating and exercise habits and attend to medical concerns. However, parents should avoid commenting negatively on their own bodies or that of others, especially their children.  The goal is to have children grow up understanding that body size is not a measure of self-worth or value as a person (“it’s what’s inside that counts”).

Minimize treatable risk factors
Address treatable causes of emotional distress. Children with excessive levels of anxiety, obsessionalism or sadness should be evaluated by an expert. Be proactive. Undue psychological stress takes a toll.

 

Youngsters who have difficulty separating should not leave home for camp, boarding school, distant colleges or study abroad until they are ready. The progression should begin with short intervals and locations accessible to home.  Overachievers or perfectionists may need encouragement to modulate burdening themselves with excessive demands. Girls who find the social demands of larger high schools overwhelming may do better in a single-sex or parochial school, or in activites that help them find like-minded peers. Teens who tend to be impulsive may need more parental involvement and limit-setting until they can develop better judgment and coping skills.

Recognize eating disorder warning signs
There are often clues to a developing problem. Eating attitudes or behaviors may change, with progressive food restriction, vegetarian or veganism, increasing fat phobia, preoccupation with food content, or other changes in mealtime behavior. Body perception often changes, with new discomfort over an unchanged or normal weight body, falling weight goals (“I want to weigh 5 lbs less,” then another 5, then 5 more), complaints about body fatness, and defensiveness about the concerns of others. Exercise may increase or become excessive: getting healthier taken to an extreme.  There may be physical signs like absent menstrual periods or psychological changes like social withdrawal, sadness or irritability. 

Have a low threshold for professional assessment

Parental, peer and teacher concerns, or requests for help from a teenager, should trigger prompt response. All parents hope their children won’t have problems, but dismissing early signs can make matters worse. An assessment by a skilled professional can relieve concerns or allow proactive intervention to keep a minor problem from escalating into a major one.

If an eating disorder develops, early aggressive treatment by experienced specialists greatly improves the likelihood of recovery. Expert care isn’t always easy to find or to identify. Here are some hallmarks of good treatment.

 

Correcting low weight is a crucial first step. Initially, inadequate nutrition is the real problem. Traditional talk therapy aimed at understanding why will NOT lead to improved eating and weight and wastes valuable time. Psychotherapy from eating disorder specialists might be adjunctive and supportive but the best work in therapy will follow weight restoration. Similarly with bulimia, stopping the binge/purge cycle is the initial goal and building confidence and coping skills comes later.

 

Outcome is improved by initial intensity. This can include frequent treatment visits, interruption in sports, even absence from school, and now taking advantage of new medication options. 

 

High dose fluoxetine (prozac) has been shown to be a safe and effective short-term treatment for bulimia but is of no benefit at or for low weight. Exciting studies now show that temporary use of olanzapine may facilitate weight restoration, insight and emotional comfort, sometimes obviating the need for hospitalization in low-weight anorexics.

Parents are pivotal

Treatment should involve a close collaboration between parents and the health care team. This requires time, joint planning, and close communication. Some provides use email between visits. There should be a clear treatment plan, including weight goals and time frames, and a contingency plan in case the situation fails to improve or even worsens. If hospitalization is required, selecting the best program the first time lessens the risk of repeat stays. Caregivers may provide the names of other parents for information and support. Additional resources are available from the website of NEDA www.NationalEatingDisorders.org Be an activist and join today.

 

 

Diane Mickley MD

Director, Wilkins Center

7 Riversville Road

Greenwich, CT 06831

203-531-1909