Kids Health Info

Eating disorders - types and treatment

  • Eating disorders are not common but they are very serious psychiatric illnesses. They can lead to physical, emotional and social problems and can sometimes require hospitalisation.

    Eating disorders have the highest rate of mortality (death) of all psychiatric illnesses - either from medical complications or by suicide.

    Many young people worry about body image and will often try dieting and/or exercise to lose weight but these behaviours by themselves are very different from eating disorders. 

    Types of eating disorders

    1. Anorexia nervosa

    A young person with anorexia nervosa (AN) is generally very underweight, which can be very dangerous to their health. The problem is caused by a distorted body image where the young person thinks she/he is fat or overweight when they are not. This leads to intense fear about gaining weight and very strong and overwhelming negative thoughts and emotions about food, eating and their appearance. These thoughts are much stronger than they would be for a typical young person who is worried about their weight or appearance. AN beliefs are so strong that they will make eating a healthy amount of food very difficult for the young person, leading to starvation. This starvation can have serious medical consequences. 

    2. Bulimia nervosa

    A young person diagnosed with bulimia nervosa (BN) will have episodes of binge eating, i.e. eating very large amounts of food quickly, and feel out of control while doing it. This illness will then make the young person take extreme actions to avoid gaining weight such as vomiting and/or doing excessive exercise. People with BN are also very critical of their body shape, size and weight.  Often people with BN will be of an average weight which makes identification of this illness very difficult

    3. Eating disorder not otherwise specified (EDNOS)

    A young person diagnosed with eating disorder not otherwise specified (EDNOS) may have some features of AN, BN or both.  A diagnosis of EDNOS means the young person does not meet all the criteria to diagnose AN or BN, but they still have many of the features of an eating disorder. EDNOS is still a very serious psychiatric illness caused by extreme abnormal thoughts and behaviours aimed at losing weight. EDNOS is just as dangerous as annorexia nervosa or bulimia nervosa, is very distressing for the young person, and requires the same treatment.

    Signs and symptoms

    There are behavioural, psychological and physical signs that someone may have an eating disorder. These may include:

    • Significant weight loss.
    • Consistently reducing fat, calorie counting, skipping meals, fasting and avoiding certain food groups such as dairy or carbohydrates.
    • Excessive and/or compulsive exercise.
    • Greater preoccupation with body shape, weight and appearance than an average person.
    • Intense fear of gaining weight.
    • Distorted body image (e.g. complaining of feeling or looking fat when they are actually a healthy weight or underweight).
    • Distress and/or anger at meal times.
    • Bathroom visits and/or showers after meals.
    • Frequent weighing of self.
    • Unusual eating behaviours such as cutting food into tiny pieces.
    • Avoiding social situations involving food. 
    • Avoiding eating meals by making excuses.
    • Obsessive interest in food and cooking but then not eating anything they cook.
    • In females, the loss or disturbance of menstrual periods.
    • Sensitivity to the cold; feeling cold most of the time, even in warm environments.
    • Lethargy, tiredness, fainting, dizziness.
    • Moodiness/irritability.
    • Social withdrawal and wanting to be alone more.
    • A drop in the ability to concentrate.


    Why does someone get an eating disorder?

    It is not known why someone gets an eating disorder. There is no single cause but many factors contribute to the development of an eating disorder. These may include social, psychological and biological factors. Eating disorders occur across all ages, cultural and socio-economic groups. However, there are a number of factors which make a person more at risk of developing an eating disorder. These may include the following:

    • being female
    • being a teenager
    • always wanting things to be perfect
    • being a high achiever
    • obsessive thinking
    • having ineffective (weak) coping strategies.


    Treatment

    Eating disorders have very serious medical and psychological consequences and need both psychological and medical treatments.

    Psychological treatment

    Family based treatment

    Family based treatment (FBT) is the preferred treatment for a young person who has AN, EDNOS that resembles AN and sometimes BN.  FBT, which is often called the "Maudsley approach" (named after the London hospital where it was developed), involves weekly appointments with an FBT clinician. The whole family may need to attend each appointment because it is believed the best treatment for the eating disorder is using the family as the treatment resource to ensure the young person eats a healthy amount of food.

    The family is supported by the FBT clinician to re-feed their child and to reverse/help stop the starvation. The aim of the treatment is to help the whole family come together to fight against the eating disorder and help support the young person regain control over their life. 

    Individual psychological treatment

    Family based treatment is the recommended treatment for most adolescents with eating disorders. However, an alternative treatment for BN that has also been found to be effective is a treatment called "cognitive behavioural therapy" (CBT).  CBT focuses on identifying and challenging the abnormal thoughts about food and body image that are associated with bingeing and vomiting behaviours. It often involves the young person monitoring (keeping an eye on) their own behaviour and using strategies to reduce the amount of bingeing and purging they do. This type of treatment is generally provided in a one-on-one setting.

    Medical treatment

    A young person diagnosed with an eating disorder will also need to attend regular medical appointments with their paediatrician or clinical nurse consultant. These appointments may be weekly at first. As medical stability is reached, appointments will move towards fortnightly and then monthly. 

    Sometimes young people with eating disorders need medication but it is recommended that medication occurs together with psychological treatment.

    Nutritional consultation by your treatment team

    The treatment team consults with a dietitian when needed. The dietitian gives the team nutritional advice which will help them support parents/guardians to provide a healthy and balanced diet for their child. 

    Hospital admissions

    Eating disorders can be so dangerous to a young person's health that it is not safe for the young person to be at home.  This is often referred to as being "medically unstable".

    A young person is medically unstable when there are significant changes in their weight, hydration, blood pressure or pulse. If a young person with an eating disorder is medically unstable they will be admitted to hospital until the treatment team considers them to be medically safe and have an appropriate treatment plan in place. The length of admission may be days, weeks or months depending on how unwell the young person with an eating disorder is and how well they respond to treatment.

    For more information


    Contact

    The Royal Children's Hospital Eating Disorders Program
    Centre for Adolescent Health
    T: (03) 9345 5890

     

     Developed by the RCH Dept of Adolescent Medicine. First published December 2010.

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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.