Feeding and Eating Disorders I

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Overview – Feeding and Eating Disorders, Part 1

Feeding and Eating Disorders represent a group of complex mental health conditions that can seriously impair one’s health and social functioning. They can involve a child or adult of any age and typically involves a refusal to eat certain food groups, textures, solids, or liquids for a period of at least one month, which causes them to not gain enough weight or grow naturally. In children, feeding disorders resemble a failure to thrive, except there is no medical or physiological condition that can explain the very small amount of food the children consume or their lack of growth. 

Feeding disorders usually are first diagnosed in early childhood rather than in the adolescent years. Although eating disorders can affect anyone at any age, adolescents and young women are the most likely to be affected. Up to 13 percent of youth may develop an eating disorder by the time they are 20. It is believed that as many as 20 million women and possibly 10 million men have suffered from some type of eating disorder. 

It is often the case that a serious disruption has occurred, or some type of psychopathology has been identified between the child and caregiver. The temperament of the child may also be a factor in the development of feeding difficulties. It is important to consider the characteristics of both the children and caregivers interdependently rather than separately. It is especially critical to look at maternal factors when considering the cause of feeding disorders. This is because maternal anxiety disorders, depressive disorders, and/or other eating disorder symptoms exhibited during pregnancy and/or post-partum, have been linked with feeding difficulties in offspring. It is also critical to identify and evaluate the temperament of the child. Studies have revealed that many of the children with feeding difficulties appear to have a difficult temperament. Exhibited behaviors may include displays of angry moods, temper tantrums, and aggression.

Feeding and Eating Disorders, Part 1, presents information on four types of disorders, one type each day for four days.  These are:  

Pica Disorder

The word Pica comes from the Latin word for ‘Magpie,’ a bird known for eating almost anything. A psychological disorder, it is characterized by an appetite for substances that are largely non-nutritive. The substance may be biological such as hair (trichophagia) or feces (coprophagia), natural such as ice (pagophagia) or dirt (geophagia), and otherwise chemical or manmade items. It can occur during pregnancy when the mother may develop specific cravings involving soil, chalk, or ice. An abused child who is not adequately nourished may eat nonfood substances.

It is developmentally normal for infants to put objects in their mouth, which may lead to accidentally ingesting a nonfood substance. For a diagnosis of Pica, a minimum age of 2 years is suggested, with the persistent eating of nonnutritive, nonfood substances over a period of at least one month. What constitutes a non-nutritive nonfood substance may vary by culture, so it is important to obtain a “culture history.”

Pica is often co-morbid with other mental disorders and may be seen in Autism Spectrum Disorder, Schizophrenia, Anorexia Nervosa, and non-suicidal self-injury. Individuals feigning a Factitious Disorder may ingest nonfood items in order to imitate the symptoms of a more serious disorder. 

Rumination Feeding Disorder

Rumination Feeding Disorder is a functional gastroduodenal disorder in which food is brought up, then re-chewed and re-swallowed, or spat back out. It may be diagnosed when repeated regurgitation of food occurs over a period of at least one month. The repeated regurgitation is not attributable to an associated gastrointestinal or other condition. If the symptoms occur in the context of another mental disorder (e.g., intellectual disability or intellectual developmental disorder, or another neurodevelopmental disorder), they usually warrant additional clinical attention. 

The cause of rumination syndrome is not always clear, but an increase in pressure within the abdominal area is known to play a role. When an individual’s rumination syndrome goes untreated, damage to the esophagus may occur. 

Unlike eating disorders that involve weight management, rumination disorders can affect young infants as well as children and adults with mental disabilities. Young infants often arch their backs and make sucking movements with their tongue to stimulate regurgitation. In a large study done in Sri Lanka, rumination peaked in boys at age 14 while symptoms peaked in girls at age 16. Overall, the rates were relatively consistent between age and sex.

Avoidant/Restrictive Feeding Disorder

Avoidant/restrictive Feeding Disorder, sometimes called selective eating disorder, is a condition in which people eat only within an extremely narrow spectrum of foods. It is a serious mental health condition that causes the individual to restrict food intake by volume and/or variety. This may be based on appearance, smell, taste, texture, brand, presentation, fear of aversive consequences, lack of interest in food, or a past negative experience with the food. It may lead to nutritional deficiencies, failure to thrive, or other negative health outcomes. 

Avoidant/restrictive Feeding Disorder does not appear to be caused by a concern for body appearance or in an attempt to lose weight. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder or by lack of available food or by an associated culturally-sanctioned practice. 

A diagnosis of Avoidant/Restrictive Feeding Disorder may be made due to behaviors that include:

  • An apparent lack of interest in eating food 
  • An avoidance based on the sensory characteristics of food
  • A significant nutritional deficiency
  • A dependence on enteral feeding or oral nutritional supplements
  • A marked interference with psychosocial activities
  • A concern about aversive consequences of eating, which may be exhibited as significant weight loss or failure to achieve expected weight gain or faltering growth in children
Unspecified Feeding or Eating Disorder

Social Anxiety is an anxiety disorder characterized by an irrational fear or discomfort of being in unfamiliar social situations or social situations outside one’s own home. Individuals may be afraid that they will be judged or criticized by others so would rather stay home. Others become almost panic-stricken simply at the thought of any social setting where they might become the “center of attention,” such as at a birthday or anniversary party. A few may even isolate themselves, stop dating, refuse a proposal of marriage, drop out of school, or even quit a job. 

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