Eating Disorders in Pre-Teens By: Jankee Dahya, Amiell Paz & Fernanda Garcia

A Brief Overview

Etiology/Psychopathology: What causes eating disorders? There is no single cause but childhood adversities contribute to greater risk for development of an eating disorder. There is no single cause but childhood adversities contribute to greater risk for development of an eating disorder

Increased Risk Depression (mostly associated BN) Stress and lack of control over their lives. Maladaptive parental behavior: Maternal vs Paternal Verbal abuse, teasing about weight, possessiveness low parental care. May also run in families: If a member has an eating disorder there is a higher risk the child will also develop one. However, there is many reasons why a child could develop and eating disorder but childhood adversities contribute to greater risk for development of an eating disorder. - depression is commonly associated with eating disorders and is an associated psychopathology to Bulimia Nervosa. emotional distress and inability to express that emotion→ not eating gives them a sense of control Maladaptive parental behavior: plays an important role in the development of an eating disorder in children. Maternal vs Paternal Parental: presence of loud arguments between parents and acts of violence. Maternal: use of guilt to control child, educational aspirations, possessiveness, verbal abuse. ( could be a sideaffect of their ED). one study emphasized that Maladaptive paternal behavior was uniquely associated with risk for eating disorders in offspring after the effects of maladaptive maternal behavior. low paternal care, affection,empathy, and high control. as well as unfriendliness, overprotectiveness and seductiveness. youths who experienced three or more kinds of maladaptive paternal behavior were approximately three times as likely as youths who did not experience any maladaptive pateral behaviors to have eating disorders during adolescence or early adulthood ) A family member with an eating disorder can teach unhealthy eating habits.: especially if a parent is very concerned with their weight and complained about their own appearance. Mothers with past or current ED play a significant role in the development of children’s feeding disorders. mothers had a warped sense of child's healthy growth size, many want to slim their babies down. Several studies suggest that early childhood feeding problems may be associated with the development of eating disorders in later childhood, adolescence and early adulthood. the children of mothers with eating disorders showed more negative affect such as sadness, crying and irritability. established three patterns of mother-child relationship in their patients with eating disorders: 1) mother-child relationships that were too close or overprotective and enmeshed; 2) reversal of roles where the child was forced into a ‘caretaker’ role towards the mother and the needs of child were therefore neglected; and 3) mothers showing a frankly distant and emotionally controlled relationship to the child. EX: mothers with current or past ED tend to integrate poor feeding habits to their children. (feeding disorders)

Increase Risk Cont. Childhood maltreatment (general risk factor) Neglect, physical or sexual abuse Kids that are involved in certain sports: Gymnastics, cheerleading, modeling or beauty pageants. girls feel the need to be thin to compete. Usually are in sports that emphasize weight class; wrestling. “Making weight” pressure to stay in their class (1) Child Maltreatment: some sort of parenting failure to provide protection or support. Categorized into neglect, physical abuse, psychological/emotional abuse, and sexual abuse. Neglect is the most common form of maltreatment. In addition, sexually abused children report many of the early risk signs of eating disorders, such as higher levels of weight dissatisfaction and of purging and dieting behavior (656) sexual abuse results into the sensation of body shame. http://dualibra.com/wp-content/uploads/2011/06/CHILD-Psichology.pdf#page=16 (7) one study found that among population samples of school-age youths; that is, youths at risk for disordered eating reported more negative perceptions of their families and parents, and more sexual or physical abuse experiences(3) - kids that are pressured due to involvement in a particular sport. → need to be competitive

Pathophysiology: Anorexia Nervosa Amenorrhea Decrease in Biological Processes Including Breathing, Blood Pressure, Etc. Feeling Cold Feelings of isolation Having Trouble Concentrating Many of the functional changes associated with pre-teen eating disorders have similarities of adult eating disorders. Since there are too many ED’s to cover, we are going to do a general comparison of the symptoms in AN and BN.

Pathophysiology: Bulimia Nervosa Loss of electrolytes (including Potassium, which is very important) Tooth Decay and Erosion Chipmunk Cheeks Stomach Pain Electrolytes in general help maintain a healthy heart .Since vomit is acidic, it can cause deterioration of the teeth Chipmunk Cheeks: condition where frequent purging causes the cheeks to expand.

Diagnosis: Eating Disorder Examination (EDE) Interview Children’s Eating Disorder Examination (cEDE) Children’s Eating Attitudes Test (ChEAT) Questionnaire -There is no clear or effective way in assessing eating disorders, however researchers believe that we can apply what we use to assess adolescent and adult eating disorders can be used for children. -However, there are some age related problems with doing tests such as the Eating Disorder Examination Interview because children may not be able to express their thoughts as well as an adult. (Colton, Olmsted & Rodin, 2007)

Treatment/Intervention: Behavioral/Psychological Treatment Behavior Modification Family Involvement/Therapy Parent Counseling Hospitalization Refeeding Increase caloric intake Cognitive-Behavioral Treatment (CBT) Therapist focus on the meaning of weight, shape and appearance Psychopharmacology The use of antidepressant medication to treat mainly BN Family involvement is essential in the outpatient treatment of all children and adolescents. For young adolescents, family therapy where the parents are asked to take charge of their adolescent’s eating is more effective in restoring weight than individual therapy in the short run, but as long as the parents are involved in collateral sessions, both treatments work equally well in the long run. Family and individual therapy are equally effective in changing eating attitudes, depression, and family functioning. Inpatient refeeding programs combining milieu and behavioral approaches do help restore weight in adolescents with AN. However, a combination of outpatient individual and family therapy or partial hospitalization may be as effective in many cases. (Robin, Gilroy, & Dennis, 1998)

Recovery: As with any eating disorder, the first step to recovery is admitting that there is a problem. The primary goal in absolute recovery is rediscovered self image, self-esteem, and most importantly body image in a positive way. To achieve the primary objective, we need to establish new ways of: Coping with painful emotions or bad feelings Improving our ideas on self-image Improving our ideas on body image Creating healthy eating patterns

Recovery: To Improve Coping Skills: Instead of restricting their diet, they can learn to deal with painful emotions by: Writing in a journal, playing a favorite game, or spending sometime with friends. Put yourself in a positive environment

Recovery: To improve Self-Image we can: Make a list of the positive qualities about yourself. Focus on those positive qualities, Challenge! Negative self-talk.

Recovery: To Improve body image we can: To Improve/Change Eating Habits Stick to a regular eating schedule Challenge your strict diets! DON’T DIET! Healthy eating is key. To Improve body image we can: Wear clothes you are comfortable in Be active in a healthy/reasonable way Staying away from scales and fashion magazines

Recovery: True Recovery involves: Listening to your body Listening to your feelings Trusting and Accepting Yourself Loving Yourself Enjoying Life!

References Colton, P. A., Olmsted, M. P., & Rodin, G. M. (2007). Eating disturbances in a school population of preteen girls: Assessment and screening. International Journal Of Eating Disorders, 40(5), 435-440. doi:10.1002/eat.20386 Jeffrey G. Johnson, Ph.D.; Patricia Cohen, Ph.D.; Stephanie Kasen, Ph.D.; Judith S. Brook, Ph.D.http://dx.doi.org/10.1176/appi.ajp.159.3.394 Kids Health, 2015. Kids Eating Disorders. Nemours Foundation. Retrieved online from http://kidshealth.org/kid/health_problems/learning_problem/eatdisorder.html# on February 28, 2015 Mash, E., & Barkley R., 2003, Child Psyhchopathology. The Guilford Press, 2nd Edition. Melinda S. & Segal J., 2015. Eating Disorder Treatment and Recovery. Tips and strategies for overcoming anorexia and bulimia. Retrieved online from http://www.helpguide.org/articles/eating-disorders/eating-disorder-treatment-and-recovery.htm#top on February 28, 2015. Michelle New, P. (2011). Kids and eating disorders. Retrieved from http://kidshealth.org/kid/health_problems/learning_problem/eatdisorder.html# Robin, A. L., Gilroy, M., & Dennis, A. B. (1998). Treatment of eating disorders in children and adolescents. Clinical Psychology Review, Vol. 18, No. 4, pp. 421–446.

Questions What are some different causes of preteen eating disorders? Give examples of one. What are possible ideas you have that can be used to diagnose an eating disorder, and what are some ways we can treat it? What are some some things you can do daily to improve your self-image and your body image?