I began as an anorexic when I was 11 years old. Then I discovered bulimia when I was 15 and struggled with the disease until I was 36 years old. This disease robbed me of my health, life, and relationships,” a middle-aged woman with a history of eating disorders posted on an online forum. “I am now 44 years old. I now have cardiomyopathy (weakening of the heart muscle) … unstable blood pressure … I have constant heart palpitations, and I’m on a ton of meds that I have to live on the rest of my life just to live a close-to-normal existence. All for anorexia/bulimia. All to be in control and all to be thin.”
Thirty-three years ago, when her struggle began as a young girl, this woman’s case may have been an anomaly. But today, it’s a far different story. While experts believe the predominant onset of illness is between 12 and 18 years of age, recent studies suggest younger children are more at risk these days than ever before.
In a new clinical report from the American Academy of Pediatrics, published in the December 2010 issue of “Pediatrics,” it is estimated that 0.5 percent of adolescent girls in the U.S. have anorexia, and one to two percent meet criteria for bulimia. There is now an increasing recognition of eating disorders in males, which now represent up to 10 percent of all cases of eating disorders, as well as in children of younger ages. An analysis by the Agency for Healthcare Research and Quality revealed that from 1999 to 2006, hospitalizations for eating disorders in children under 12 years of age increased by 119 percent.
Experts say it’s difficult to measure the reasons for such an increase in younger children. But doctors continue to study the causes of the illness, in hopes that they can change those rising statistics. While there are different factors that contribute to each individual case, some constants remain across the board.
“With young kids, it’s a fear element. It’s an irrational fear element, and it could be that there’s an enormous amount of emphasis (in the home) on dieting and weight, which could produce fear in a susceptible child,” says Dr. Katherine Halmi, a board-certified pediatrician and clinical researcher at Weill Cornell Medical Center. “Remember, the child(ren) who get this, tend to be highly anxious, highly perfectionistic, insecure kids. They are psychologically and, probably, biologically vulnerable to develop anorexia when the environment is provocative.”
A provocative environment that includes, she says, mothers who obsess over dieting and exercise. While there’s widespread disagreement over theories like that one, nutritional experts say that, because of those rising statistics, and because obesity rates in children — another type of eating disorder — are on the rise, it’s more important than ever for parents to reinforce healthy eating habits at home.
“Be a good role model. This is especially critical for mothers with their daughters. Eat well, choosing a variety of foods. Enjoy an occasional dessert, pizza or bag of chips and enjoy them without guilt,” says Christine M. Palumbo, a registered dietician and adjunct faculty member at Benedictine University in Naperville, IL. “Don’t criticize the size of your thighs or belly. And by all means, never suggest to your child that she is overweight. Don’t count calories or exercise just to burn calories you’ve just eaten. Be physically active, because it’s fun and makes you feel good afterward.”
What is anorexia?
According to medical experts, anorexia is an eating disorder in which people intentionally starve themselves. It causes extreme weight loss, which the National Institute of Mental Health defines as at least 15 percent below the individual’s normal body weight.
Food and weight become obsessions. Compulsiveness may cause strange eating rituals or the refusal to eat in front of others. It is not uncommon for people with anorexia to collect recipes and prepare gourmet feasts for family and friends, but not partake in the meals themselves. They may also adhere to strict exercise routines to keep off weight.
The cause of anorexia is not known. It can begin as innocent dieting behavior, but gradually progresses to extreme and unhealthy weight loss. Social attitudes toward body appearance, family influences, genetics, and neurochemical and developmental factors are considered possible contributors to the cause of anorexia.
Doctors say people who develop anorexia are more likely to come from families with a history of weight problems, physical illness, and other mental health problems, like depression or substance abuse. They may come from families that are challenged by appropriate problem solving, being too rigid, overly-critical, intrusive, and overprotective. Those with anorexia may also be dependent and immature in their emotional development, and are likely to isolate themselves from others. Other mental health problems, like anxiety disorders, are often present in anorexia patients.
What is bulimia?
Bulimia is defined as uncontrolled episodes of bingeing (excessive overeating) that are usually followed by purging (self-induced vomiting), misuse of laxatives, enemas, fasting, or excessive exercise to control weight. When an individual with bulimia binges, she usually will eat much larger amounts of food than would normally be consumed within a short period of time (usually less than two hours). Eating binges occur at least twice a week for three months and may occur as often as several times a day.
Early intervention and treatment can be lifesaving
There’s one thing experts can agree on: early intervention and treatment is the key to getting a child or teenager with anorexia and/or bulimia the help needed to eventually save her life. Kidney and other organ damage, heart problems, bone loss, and a host of other health issues can plague a child with an eating disorder well into adulthood, if intervention doesn’t take place early on.
Parents who suspect their child might have an eating disorder should first schedule a thorough exam with the family pediatrician, who can chart the child’s proper weight and height, and rule out any other medical issues. The next step is to find a trained psychotherapist who can begin to work with the child, and in many cases, the family.
Maudsley therapy
Traditional therapies have focused on treating the patient individually, but a newer approach has emerged in recent years, and some experts believe this can be much more effective for young children and adolescents.
The Maudsley Technique is an intensive outpatient treatment that focuses on the family unit — parents play an active and positive role in order to focus on three key elements of treatment:
• Helping to restore their child’s weight to normal levels expected given her age and height.
• Giving the control over eating back to the patient.
• Encouraging normal child/adolescent development through an in-depth discussion of these crucial developmental issues as they pertain to their child.
“Families should be involved,” says Dr. Evelyn Attia, Director of the Center for Eating Disorders at New York-Presbyterian Hospital, a program that is known for being the only specialized, psychiatric inpatient unit dedicated to eating disorder patients in New York state. “We know that (family therapy) will improve the likelihood of success.”
For young children in treatment, the concerns go beyond just specific medical and psychological care. Children in this program also meet with a certified teacher each weekday for classroom time and spend the afternoons completing homework assignments. The hospital works closely with local school districts to ensure the continuity of their coursework. During a patient’s stay at the facility, families can undergo treatment, using some of the Maudsley techniques.
“Eating disorders affect the entire family, especially when the patient is young,” says Attia.
And while doctors say they have learned to incorporate some of the methods used in Maudsley therapy during inpatient care, they also stress that Maudsley is critical to outpatient care, where families have to do the hard work every day to see the results.
While treatment options can vary from program to program, doctors say there’s one thing every family must do: get help quickly — mainly because they want their child to be healthy as soon as possible, but also, because forcing children into treatment before they are old enough to decide for themselves could save their lives.
“The real emphasis needs to be on diagnosing and treating children and teenagers before they reach the age of 18,” Halmi emphasizes. “Once they reach the age of 18, they’re a legal citizen, and they can refuse care. And it’s impossible to commit somebody for treatment, unless they’re near death.”
For more information on the Eating Disorder Center at New York–Presbyterian, visit nyp.org.
For more information on the Maudsley Technique, visit maudsleyparents.org.
Monica Brown is a cable television news anchor and freelance writer. She also conducts public speaking workshops for both children and adults. Monica lives on Staten Island with her husband and two children and can be reached at monicaldbrown@gmail.com.
