Category — 2.9 Children with Mental Illness: Eating Disorders

Eating disorders involve having an unusual relationship with food. A person with an eating disorder either eats too much or too little food. The reason for this unusual relationship is not clear. Some claim is the illness is about how much a person eats and an obsession with staying slim, even if it is bad for that person’s health. Others claim that it is about control. That is, children who have eating disorders do not feel that they have control over any aspect of their life so they try to control what goes into their body (Fig. 1). Many psychologists feel the truth is somewhere in the middle. They believe children who have eating disorders have serious emotional problems that they only seem to be able to deal with by controlling what they eat. In fact, many children with eating disorders have low self-esteem.

Figure 1. Eating disorder

More and more children are being diagnosed with eating disorders. Some of these children are as young as eight or nine years old. Eating disorders are mainly girls’ disorders, but boys can suffer from these disorders too.

Eating disorders can be classified into two categories:

• Anorexia nervosa: children with this eating disorder are obsessed with their weight. They are ultra-thin but may still see themselves as fat. They:
  • Usually eat very little or no food at all;
  • Only eat food that has very few calories (for example, they eat lettuce and cucumbers);
  • Insist on a body weight that is way below what is expected for their age and height;
  • May exercise too much (that is, they may run 30 miles per day, or go up and down the stairs a hundred times a day);
  • May binge on food (over-eat) and purge what they eat vomit on purpose;
  • May use laxatives (which is medication that some adults take when they are constipated) and even give themselves enemas (another type of medication that some adults take, when they are severely constipated), in order to get rid of the food they ate;
  • May lie to their parents and teachers about how much they have eaten;
  • May refuse to admit that they are hungry;
  • Appear very thin and sick;
  • May have dark circles under their eyes;
  • May faint because of little or no energy;
  • May appear very tired, all the time;
  • May have trouble sleeping because they are so hungry;
  • May feel dizzy or nauseous;
  • May have fingers that appear blue;
  • May be losing their hair;
  • May fail to menstruate (if they are a girl who is old enough to be menstruating);
  • May have dry skin;
  • May be constipated;
  • May skip meals;
  • May be dehydrated because they drink lots of water and eat virtually nothing;
  • May be depressed or anxious about gaining weight (despite not eating at all);
  • May be socially withdrawn;
  • May complain about being fat;
  • May weigh themselves several times per day (Fig. 2);
  • May be highly irritable.

Figure 2. Weighing oneself

Bulimia nervosa: children with bulimia nervosa overeat, then try to get rid of what they have eaten. They eat very large amounts of food in very short periods of time. For example, a child could eat in two hours what others would eat in three days or more. They then get rid of what they have eaten by either using lots of laxatives, by vomiting, or by going on a strict diet and/or excessively exercising. They:

• Are obsessed (with their weight and what their body looks like;
• Want to be thin so they try to get rid of the food that they eat;
• Are very afraid of being fat or gaining weight;
• May say that they are fat, even though they are not;
• May purge after eating a very small amount of food;
• May feel that they have no control over how much they eat;
• May fast for several days, after a binging episode;
• May have a negative self-esteem;
• May have sores or scars on their knuckles (caused by constantly inducing vomiting);
• May have damaged teeth and gums;
• May appear withdrawn or sad (Fig. 3).

Figure 3. Withdrawn

Children with eating disorders need help. Those with anorexia nervosa may need to stay in the hospital because of their refusal to eat. Doctors may need to monitor their heart rates (sometimes, the hearts of children with anorexia nervosa beat very fast), electrolyte and hydration levels (how much water they have in their bodies). They also need psychotherapy. This therapy needs to be provided by a licensed clinical psychologist that has experience working with children with eating disorders. The clinical psychologist can offer these children individual therapy to work out any emotional problems and help them develop a healthy relationship with food. Family therapy may also be recommended for these children and their families. Some children with anorexia nervosa benefit from group therapy with other young people who suffer from an eating disorder. Knowing that they are not alone and that others struggle with food issues just like they do can sometimes help these children.

Children with bulimia nervosa may also be hospitalized because of stomach problems caused by constant vomiting. Constantly vomiting could cause tears in the lining of the stomach and could cause heart problems in children. In fact, many children with bulimia nervosa who do not get treatment die of heart failure. These children also need psychotherapy. It needs to be provided by a licensed clinical psychologist with experience working with children with eating disorders. The clinical psychologist will help these children improve their self-esteem (see full Glossary)  and sense of self-worth. He or she will also help these children develop a healthy relationship with food.

In the classroom, the teacher can look for warning signs of eating disorders. They are:

• In the case of anorexia nervosa:
  • Only eating foods that are low in calories;
  • Refusing to buy anything from the cafeteria;
  • Skipping meals;
  • Stating that they are not hungry even if they haven’t eaten anything all day;
  • Appearing sickly, weak or tired.
• In the case of bulimia nervosa:
  • Refusing to eat in front of others;
  • Having too much food with them, or buying lots of food;
  • Wanting to go to the bathroom immediately after eating all the time.

Teachers need to reassure these children that they are welcome in the classroom. They should make every effort possible to give them positive feedback that boosts their self-esteem. The compliments should be sincere and genuine.

Eating disorders do not always have happy endings. Many children with anorexia nervosa die of starvation. Those with bulimia could die from heart failure caused by constant vomiting. These disorders are extremely serious and children who suffer from them should get therapy as soon as possible. Many children who do get therapy lead happy and fulfilling lives.

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