Who gets eating disorders?
Anyone can develop an eating disorder. How eating disorders evolve is still poorly understood. Risk factors, such as perfectionism, difficulty with emotion regulation, high achievement orientation and a history of dieting have been identified, but researchers are still working to understand why some individuals with such experiences and traits develop an eating disorder and some do not.
There are some things we do know. Individuals with eating disorders come from families of every constellation and level of conflict. Parents do not cause eating disorders. However, they are instrumental in supporting children and teenagers in recovering from these illnesses. Eating disorders are also not necessarily a result of trauma. Some individuals with eating disorders have a history of such experiences, but many do not.
Both genders, all socioeconomic classes, and all ethnic groups are susceptible to developing an eating disorder. In fact, research indicates that one fourth to one half of new cases of Anorexia in prepubertal children occur in males.
Impact of malnutrition on cognition and emotions
Malnutrition impacts all organ systems, including the brain. This impact can be present despite an individual being of normal weight or overweight since it depends upon balanced and complete nutrition as well as overall caloric intake.
Other affects of malnutrition
Concentration, focus, and memory can be impacted leading to additional stress as the child or adolescent and those around him or her recognize that these abilities are weaker than before. ADHD should never be diagnosed when an individual is malnourished or his or her nutritional status has not been determined by a medical professional.
Emotions are greatly impacted as well. Malnutrition can cause symptoms of overall emotion dysregulation, including irritability, anxiety, rigidity, depression, sadness, and behavioral outbursts.
Obsessive-compulsive symptoms are often heightened by poor nutrition and sometimes resolve when nutrition is improved.
We carefully monitor symptoms of inattention, anxiety, and depression within the context of nutritional status. We maintain a cautious approach to diagnosing additional mental health concerns, given the potential impact of malnutrition.
How eating disorders are conceptualized
Eating disorders are complex biopsychosocial disorders which require medical, psychological, and nutritional intervention.
Common symptoms and behaviors
The individual typically experiences significant body image disturbance or distortion.
The individual overemphasizes the importance of weight/appearance on self-worth and identity. In general, there is a belief that being thin or losing weight will result in a positive outcome (e.g., increased success, increased peer acceptance) or that gaining weight or being fat will result in a negative outcome (e.g., failure, peer rejection).
These thought patterns are associated with behaviors intended to decrease weight or prevent weight gain and are not behaviors that would be recommended by a medical professional. These behaviors may or may not logically be expected to result in weight loss, particularly in children and adolescents who may have a misunderstanding of what results are realistic for a given behavior.
Eating disorders are often associated with significant symptoms of depression and/or anxiety. These concerns may warrant a separate diagnosis or may be a result of malnutrition, even in those who appear to be of normal weight.
Eating disorder behaviors are maladaptive coping strategies. They are ways to manage negative situations and emotions that are effective in the short-term and damaging in the long run. Therefore, engaging in these behaviors often makes sense to the individual when parents and other adults are baffled.