Childhood Anorexia

I recently received an e-mail from a woman whose 12-year-old anorexic niece was threatening suicide. The girl’s weight had rapidly dropped from 97 pounds to 68. While hospitalized, she received group therapy with 30- and 40-year-old women, which the aunt found inappropriate.

In another e-mail, a 14-year-old recovering anorexic expressed fears about backsliding. She said she was near death when first diagnosed at age 12.

Although anorexia nervosa usually develops during adolescence, a disturbing number of cases have been appearing in young–sometimes very young–children. The Mirror-Mirror Website notes that 40 percent of nine year-olds have dieted. The National Eating Disorders Screening Program reports that 81 percent of 10 year-olds are afraid of getting fat. According to eating disorders specialist Barton J. Blinder, M.D., anorexia has been observed in children as young as 4. He cites a Mayo Clinic study of 600 patients of all ages which found that three percent were prepubescent anorexics.

Blinder notes that because these children, most of whom are girls, have less body fat than their adolescent counterparts, they become skeletal more quickly. He therefore argues that a 15 percent weight loss, rather than the usual 25, should be a criterion for diagnosis.

On his website, Blinder reports studies suggesting that childhood-onset anorexia can delay puberty, growth, and breast development. He recommends that therapists work with a pediatrician to rule out other medical and psychological illnesses.

Families of young anorexics share many of the same characteristics of clans with older sufferers, such as rigidity and poor conflict resolution, notes Blinder. However, he cites a study by Sargent which found that only families of the prepubescents had a higher divorce rate than that of the general population.

A book on childhood anorexia nervosa is available from Psychology Press.

This problem is international. A report by the Stockholm County Council observes that 20 percent of Swedish first-graders are trying to lose weight. The percentage rises to 25 among fourth-graders, and 33 for those in seventh and eighth grades.

The Council notes that 10 percent of Swedish parents seek pediatric help for their eating disordered infants. Recognizing that no studies have been done in this area, the Council nevertheless suggests that allowing small children some control over when and how they take their food may reduce the risk of anorexia. If mothers introduce tasting portions at four months, the risk of eating disorders may be reduced by the child’s first birthday, according to the Council.

Mirror-Mirror webmaster Colleen Thompson believes dysfunctional family dynamics such as sexual abuse increase the ranks of child anorexics. “If they can’t control what is happening to their bodies during the abuse, they can control their food intake or their weight,” she writes.

Another risk occurs, says Thompson, when parents themselves are preoccupied with body image and weight. She notes the double standard under which many youngsters are raised: boys are encouraged to eat so they can grow up big and strong, while girls are expected to consume sparingly and thus develop slim figures.

Communication is key. According to Blinder, these young children often have difficulty expressing their feelings. Thompson recommends that parents pay more attention to their pre-teens while still encouraging independence. She says that forcing kids to “clean” their plates is very harmful because it makes them feel that they have no control over their lives. By contrast, she observes, sports-related activities such as hiking are excellent ways of developing healthy family relationships.

However, any good thing can be overdone. While athletic competition helps develop a child’s physical health, social relationships, and independence, fanatical training is extremely dangerous. Take, for example, the case of women’s Olympic gymnastics.

The Eating Disorders Site has a review of Joan Ryan’s book, Little Girls In Pretty Boxes. According to the review, “Ryan saw girls 13 and younger training eight hours a day on a diet of little more than apples, laxatives and painkillers, falling into anorexia and bulimia in order to reach unreasonably low weights.”

The review recounts coach Bela Karolyi’s outrageous behavior upon discovering a young gymnast eating a peach after a workout. Karolyi, who trained Olympic champions Nadia Comaneci and Mary Lou Retton, reportedly exploded, branding the girl “lazy and fat.” He then punished the team with an additional two hours of exercises.

A well-developed mind complements a strong body. According to therapist Joanna Poppink, an important preventive measure is training both parents and children. She notes that knowledge empowers adults to better deal with their daughters’ condition, while “early education presented clearly and sensitively with regard to the developmental stage of the audience may provide a powerful way of waylaying an eating disorder.”

Poppink stresses, however, that information alone will not cure. Treatment is still needed.

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