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 Eating Disorders
 
Eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) are increasingly prevalent among children and adolescents and now occurring at even earlier age. There is also an increasing prevalence of eating disorders among young males, now estimated at 5-10 % of all diagnosed cases.
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Who is at Risk?
The etiology of eating disorders is multi-factorial, and there is increasing evidence for genetic disposition to trait disturbances such as behavioral rigidity, perfectionism and harm avoidance. Anorexia nervosa can develop in families that have difficulties expressing conflict, while bulimia nervosa often develops in chaotic family systems. Sexual trauma, pubertal concerns and maturity fears are also recognized as contributing factors to eating disorder development.            
 
Cultural trends such as the availability of food and obesity opposite the promotion of unattainable body size ideals largely created by the media has left a large number of youths wanting to be thinner.
Pre-existing psychopathology such as depression, obsessive compulsive disorder or other anxiety disorders are often found in children and adolescents with an eating disorder.
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Recognizing Symptoms of Eating Disorders
 The child with anorexia nervosa may display food avoidance, abnormal perception of their weight and/or shape, weight loss or lack of weight gain, mood disturbances, social withdrawal and denial of hunger. In bulimia nervosa and binge eating disorder, the early signs include morbid preoccupation weight and/or shape, evidence of purging behavior (frequent bathroom trips, laxative use, calluses/scars on back of knuckles), evidence of binge eating, excessive exercise and mood swings.
 
Medical Complications
Eating disorders that are not successfully treated may result in medical complications such as growth retardation, impaired gastrointestinal tract mobility, low bone mineral density, osteoporosis, esophageal tears and dental erosion.
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How We Can Help
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Early detection and treatment is instrumental to recovery from an eating disorder. When evaluating a child for an eating disorder different assessment tools can be used. The Eating Attitude Test (ChEAT) is a self-completed questionnaire with twenty-six items scored on a 6-point Likert Scale. The Eating Disorder Examination (ChEDE) is an interview based assessment evaluating eating constraints, concerns related to eating, weight and shape.
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Medical stabilization and nutrition rehabilitation is essential to correct any cognitive deficits and allow for effective counseling therapy interventions. Once medically cleared, we will build an individual treatment plan based on your child’s specific needs rather than tightly circumscribed approaches.
 
Treatment options will consider the child’s verbal and abstract abilities, emotional awareness and behavioral inhibition.  The adolescent client may benefit from cognitive-behavioral, strength-based therapy as well as family based interventions.
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A good collaborative relationship between the therapist, client and parents is detrimental to the success of any therapeutic model and interventions. The child and/or adolescent client struggling with an eating disorder and entering counseling for the first time is not always motivated for treatment, hence moving with this resistance and rapport building is often the focus at the start of treatment.        
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