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Anorexia Nervosa in Children

What is anorexia nervosa?

Anorexia nervosa is an eating disorder. It is a form of self-starvation. Children and teens with this disorder have a distorted body image. They think they are overweight. This leads them to severely restrict how much food they eat. It also leads to other behavior that prevents them from gaining weight. Anorexia nervosa is sometimes called anorexia.

What causes anorexia nervosa?

The cause of anorexia nervosa is not known. It usually begins as regular dieting. But it slowly changes to extreme and unhealthy weight loss.

Other things that may play a role in anorexia are:

  • Social attitudes toward body appearance

  • Family influences

  • Genetics

  • Brain chemical imbalances

  • Developmental issues  

Teens who develop anorexia are more likely to come from families with a history of:

  • Weight problems

  • Physical illness

  • Other mental health problems such as depression or substance abuse

Teens with the disorder come from families that are challenged by appropriate problem solving, being too rigid, overly critical, intrusive, and overprotective. These teens may also be dependent and emotionally immature. They are also likely to isolate themselves from others. Teens with anorexia often have other mental health problems such as anxiety disorders or affective disorders.

Who is affected by anorexia nervosa?

About 90% to 95% of those with anorexia are female. But those numbers are changing as more males are now becoming affected. The disorder was first seen in upper- and middle-class families. But anorexia is now found in all socioeconomic groups and in many ethnic and racial groups.

What are the different types of anorexia?

Anorexia has 2 subgroups:

  • Restrictor type. People with this type of anorexia severely limit how much food they eat. This usually includes foods high in carbohydrates and fat.

  • Bulimic (binging and purging) type. People with bulimia eat too much food (binge) and then make themselves throw up. They may also take large amounts of laxatives or other medicines that clear out the intestines.

What are the symptoms of anorexia nervosa?

Each child’s symptoms may vary. Symptoms may include:

  • Low body weight

  • Intense fear of becoming obese, even as the child is losing weight

  • Distorted view of his or her body weight, size, or shape. Sees his or her own body as too fat, even when very underweight. Says he or she feels fat, even when very thin.

  • Refuses to maintain minimum normal body weight

  • In girls, missing 3 menstrual periods without another cause

  • Doing too much physical activity to help speed up weight loss

  • Denies feeling hungry

  • Preoccupation with food preparation

  • Strange eating behaviors

Many physical symptoms linked to anorexia are often due to starvation and malnourishment. However, each child’s symptoms may vary. Physical symptoms may include:

  • Dry skin that when pinched and let go, stays pinched

  • Fluid loss (dehydration)

  • Belly pain

  • Constipation

  • Lethargy

  • Dizziness

  • Fatigue

  • Can’t handle cold temperatures

  • Abnormally thin (emaciated)

  • Development fine, downy body hair (lanugo)

  • Yellowing of the skin

People with anorexia may also be socially withdrawn, irritable, moody, or depressed. The symptoms of anorexia nervosa may seem like other health problems or psychiatric conditions. Always see your child's healthcare provider for a diagnosis.

How is anorexia nervosa diagnosed?

Parents, teachers, coaches, or instructors may be able to identify a child or teen with anorexia, although many people with the disorder first keep their illness very private and hidden. However, a child psychiatrist or a qualified mental health professional usually diagnoses this condition in children and teens. A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and in some cases, psychological testing contribute to the diagnosis. If you see symptoms of anorexia in your child, get an evaluation and treatment early. Early treatment can often prevent future problems.

Anorexia, and the malnutrition that results, can harm nearly every organ system in the body. This makes early diagnosis and treatment even more important. Anorexia can be fatal. Talk with your child's healthcare provider for more information.

How is anorexia nervosa treated?

Your child's healthcare provider will figure out the best treatment plan for your child based on:

  • How old your child is

  • Your child’s overall health and medical history

  • How sick your child is

  • How well your child handles certain medicines, treatments, or therapies

  • If your child’s condition is expected to get worse

  • The opinion of the healthcare providers involved in your child's care

  • Your opinion and preference

Anorexia is usually treated with a mix of individual therapy, family therapy, behavior modification, and nutritional rehabilitation. Treatment should always be based on a full evaluation of the teen and the family. Individual therapy usually includes both cognitive and behavioral techniques. Medicine (usually antidepressants) may be helpful if your child is also depressed.

Anorexia causes frequent medical problems. It’s also possible for a child or teen with this disorder to die during the course of treatment. Because of this, both your child's healthcare provider and a nutritionist must be active members of the management team. Parents play a vital supportive role in any treatment process. Your child may need to be hospitalized for medical problems linked to weight loss and malnutrition.

What are the complications of anorexia nervosa?

Medical problems that may result from anorexia include:

Heart (cardiovascular). Most anorexic patients who are hospitalized have low heart rates. Heart muscle damage that can occur because of malnutrition or repeated vomiting may be life threatening. Common heart problems that may occur include the following:

  • Fast, slow, or irregular heartbeat (arrhythmias)

  • Slow heartbeat (bradycardia)

  • Low blood pressure (hypotension)

Blood (hematological). About 1/3 of people with anorexia have a low red blood cell count (mild anemia). About 50% of people with this disorder have a low white blood cell count (leukopenia).

GI (gastrointestinal). Normal movement in the intestinal tract often slows down with very restricted eating and severe weight loss. Gaining weight and taking some medicines can help to restore normal intestinal movement.

Kidney (renal). Dehydration often linked to anorexia leads to highly concentrated urine. Your child may also have increased urine production (polyuria). This may happen when the kidneys' ability to concentrate urine decreases. Kidney changes usually return to normal when your child is back to normal weight.

Endocrine (hormones). In girls, an abnormal absence of menstrual periods (amenorrhea) is one of the hallmark symptoms of anorexia. This often happens before severe weight loss and continues after normal weight is restored. Reduced levels of growth hormones are sometimes found in teens with anorexia. This may explain the delayed growth sometimes seen in people with anorexia. Normal nutrition usually restores normal growth.

Bones. People with anorexia are at a greater risk for broken bones. When anorexic symptoms start before peak bone formation has been reached (usually mid to late teens), there is a greater risk of decreased bone tissue (osteopenia) or bone loss (osteoporosis). Bone density is often found to be low in girls with anorexia, and low calcium intake and absorption is common.

Can anorexia nervosa be prevented?

There is no known way to prevent anorexia. But early detection and intervention are important. They can reduce the severity of symptoms, enhance normal growth and development, and improve the quality of life for children and teens with this condition. Encouraging your child to have healthy eating habits and realistic attitudes toward weight and diet may also be helpful.

Online Medical Reviewer: Ballas, Paul, DO
Online Medical Reviewer: Nelson, Gail A., MS, APRN, BC
Date Last Reviewed: 10/1/2016
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