Sleep Disorders in Children and Adolescents

What are the Types of Eating Disorders in Children and Adolescents?

• Pika
• Retrieval (Ruminating) Disorder
• Avoidant/Restricted Food Intake Disorder
• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating Disorder (defined for the first time)
• Another Identified Feeding Disorder and Eating Disorder
• Unspecified Feeding Disorder and Eating Disorder

What Causes Eating Disorders in Children and Adolescents?

• Genetic factors
• Emotional and social factors (such as parental attitudes and behaviors, social media, etc.)
• Organic factors

What are the Symptoms of Eating Disorders in Children and Adolescents?

1. Pica
(common in infancy and childhood)

• Consistently, for at least 1 month, do not eat substances that have no nutritional value, that have no nutritional value.
• The attitude of eating non-nutritive, non-nutrient substances is not compatible with the developmental level of the person.
• This eating behavior is not a culturally based or socially normal practice.
• If this eating behavior occurs in the context of another mental disorder (e.g., pervasive developmental disorder, autism, schizophrenia), it is severe enough to warrant further clinical evaluation.

2. Retrieval (Ruminating) Disorder
(common in infancy and childhood)

• Frequent regurgitation of food for at least 1 month. The food may be chewed again, swallowed again or spit out.
• Frequent regurgitation cannot be attributed to a concomitant gastrointestinal disease or other health condition.
• This eating disorder does not only occur during the course of anorexia neurosis, bulimia neurosis, binge eating disorder or avoidant/restricted food intake disorder.
• If these symptoms occur in the context of another mental disorder (e.g. a developmental disorder or another neurodevelopmental disorder), they are severe enough to warrant further clinical evaluation.

3. Avoidant/Restricted Food Intake Disorder

1. 1. An eating disorder characterized by persistent failure to meet appropriate nutritional and/or energy requirements, accompanied by conditions related to
      • Significant weight loss (or failure to achieve expected weight gain or stunted growth in children)
      • A marked nutritional deficiency
      • Dependence on enteral (tube feeding) or oral nutritional supplements
      • Significant decline in psychosocial functioning
   2. This disorder is not better explained by a lack of accessible food or a culturally approved practice.
   3. This eating disorder does not only occur during the course of anorexia nervosa or bulimia nervosa and there is no evidence that it is a disorder of how a person perceives their body weight or shape.
   4. This eating disorder cannot be attributed to a co-occurring health condition or better explained by another mental disorder. If this eating disorder occurs in the context of another condition or disorder, it is more severe than the condition or disorder in question and requires separate clinical attention.

4. Anorexia Nervosa
(%95 kızlarda, ergenlerde yaygın)

1. 1. The attitude of restricting energy intake according to needs leads to a body weight that is significantly low in the context of the person's age, gender, developmental pathway and physical health. Significantly low body weight is defined as below the usual minimum or, for children and adolescents, below the expected minimum.
   2. Being very afraid of gaining weight or becoming fat, or engaging in persistent behaviors that make it difficult to gain weight, despite a markedly low body weight.
   3. There is a disturbance in how a person perceives their body weight or shape, the person places undue importance on body weight and shape in their self-assessment or never realizes the significance of their low body weight at the time.

5. Bulimia Nervosa
(10 times more common in women than men, common in adolescents)

1. 1. Recurrent binge eating episodes. A binge eating episode is characterized by the following two things:
      • Eating clearly more food in a discrete unit of time (e.g. any two-hour period) than most people would eat in similar circumstances, for a similar amount of time.
      • During this period, there is a feeling of loss of control over eating (e.g. feeling that one cannot stop eating, feeling that one cannot control what or how much one eats)
   2. Engaging in repetitive, inappropriate compromising behaviors to avoid weight gain, such as self-induced vomiting, misusing laxatives, diuretics or other medications, eating almost nothing, or exercising excessively.
   3. Both of these binge eating behaviors and inappropriate compromising behaviors occurred at least once every 1 week over an average of 3 months.
   4. Self-evaluation is unduly influenced by body shape and weight.
   5. This disorder does not only occur during periods of anorexia nervosa.

Not heavy; 1-3 times a week on average,
Moderate; 4-7 times a week on average,
Heavy; 8-10 times a week on average,
Extreme level; inappropriate preventive behavior 14 or more times per week on average.

6. Binge Eating Disorder

1. 1. Recurrent binge eating episodes. A binge eating episode is characterized by both of these items:
      • Eating clearly more food in a discrete unit of time (e.g., in any two-hour period) than most people would eat in similar circumstances, in a similar amount of time.
      • During this period, there is a sense of loss of control over eating (e.g. feeling that one cannot stop eating, feeling that one cannot control what or how much one eats)
   2. Periods of binge eating are caused by at least three of these items
      • Eating much faster than usual.
      • Don't eat until you feel uncomfortably full.
      • Overeating when you are not physically hungry.
      • Don't eat on your own because you are ashamed of how much you eat.
      • Then self-loathing, depression or great guilt.
   3. There is a marked distress associated with binge eating.
   4. These binge eating behaviors occurred at least once a week for an average of 3 months.
   5. Binge eating is not accompanied by recurrent inappropriate compromising behaviors as in bulimia nervosa, and binge eating does not occur only during the course of bulimia neurosis or anorexia nervosa.

Not heavy; 1-3 times a week on average,
Moderate; 4-7 times a week on average,
Heavy; 8-13 times a week on average,
Extreme level; binge eating 14 or more times a week on average.

7. Another Identified Feeding and Eating Disorder

• Atypical Anorexia Nervosa: All diagnostic criteria for anorexia neurosis are met, except that the person's body weight is within or above normal limits despite significant weight loss.
• Bulimia Nervosa (low frequency and/or limited duration): All diagnostic criteria for bulimia nervosa are met except that binge eating and inappropriate compromising behaviors are present on average less than once a week or for less than 3 months.
• Binge eating disorder (low frequency and/or limited duration): All diagnostic criteria for binge eating disorder are met except that the binge eating is, on average, less than 1 time per week and/or lasts less than 3 months.
• Extraction disorder: Repeated expulsive behavior, without binge eating, to affect body weight or shape (e.g. self-induced vomiting or misuse of laxatives, diuretics or other medications).
• Night eating disorder: Recurrent periods of nocturnal eating, characterized by eating after waking up from sleep or excessive consumption of food after dinner, are also called eating disorders. The person is aware of eating and remembers having eaten. Night eating is not better explained by external influences such as changes in the person's sleep-wake cycle or local social values. Night eating causes significant distress and/or impaired functioning. The disordered eating pattern is not better explained by another mental disorder, including binge eating disorder or substance abuse, and cannot be attributed to another health condition or medication.

8. Unspecified Feeding and Eating Disorder; It is used when clinicians do not want to identify the specific reason for not meeting the diagnostic criteria for any of the specific Eating and Nutrition Disorders in Children and Adolescents and when there is insufficient information to make a more specific diagnosis (e.g. in emergency department settings).

How is Eating Disorder Diagnosed in Children and Adolescents?

• Attributing more meaning to body shape and weight than they should,
• Thinking about eating for most of the day,
• Disordered eating attitudes and behaviors,
• Overeating during times of stress,

are symptoms that help diagnose eating disorders in children and adolescents.

How is Eating Disorder in Children and Adolescents Treated at Private Moodist Hospital?

People with Anorexia Nervosa usually do not seek treatment voluntarily. They tend to deny or hide their eating disorder symptoms. They often seek treatment at the insistence of their parents. For this reason, the participation of parents in the treatment process is very important and necessary.

Early diagnosis is one of the most important factors determining the effectiveness of treatment for Anorexia Nervosa. The first goal of treatment in the short term is to stabilize the diet and medical condition. The first choice of nutrition is always oral nutrition.

Outpatient treatment is the first choice in the treatment of Anorexia Nervosa. Inpatient treatment is preferred when outpatient progress cannot be achieved or if the patient's medical/psychiatric condition requires hospitalization.

Patients with Bulimia Nervosa usually do not need inpatient treatment because their weight is normal or above normal. However, situations such as vomiting or drug abuse can lead to medical emergencies. Patients with Bulimia Nervosa can seek treatment on their own or at the suggestion of their families. They may be more willing to seek treatment and more open to psychotherapeutic interventions than individuals with Anorexia Nervosa.

Antidepressant and antipsychotic drugs are frequently used in the treatment of eating disorders in clinical practice. Especially if there are obsessive thoughts, anxiety symptoms and depressive complaints accompanying the disease, drug treatment should be preferred. However, medication alone is not sufficient in the treatment process. Drug treatment must be supported with psychosocial interventions.

What happens if eating disorders in children and adolescents are not treated?

For Anorexia Nervosa, a short duration of illness, good relations with parents and onset in adolescence are signs of a better prognosis, whereas the presence of another psychiatric illness, a long duration of illness, significant weight loss and vomiting behavior are signs of deterioration. In terms of weight regain, about half of the cases improve, while in a quarter the prognosis is moderate and in the remaining quarter the improvement is quite resistant.

Although of patients treated for Bulimia Nervosa show complete resolution of symptoms after 5-10 years, eating problems persist in the remaining . Low self-esteem, obesity and personality disorders are associated with a worse prognosis. Physical illnesses and suicidal thoughts accompanying Bulimia Nervosa increase the risk of death. Although binge eating episodes persist in some cases, self-induced vomiting, laxative use or excessive exercise behaviors disappear, and in some cases there is a transition to Anorexia Nervosa.

What Can Be Done to Cope with Eating Disorders in Children and Adolescents?

People with eating disorders are often afraid to ask for help. Some try to find a way to start a conversation about their problem, while others have such low self-esteem that they don't even think they deserve any help.

Whatever the case, eating disorders can get worse without treatment and cause physical and emotional damage. The sooner you start to help, the better their chances of recovery. While you can't force someone with an eating disorder to get better, having supportive relationships is crucial to their recovery.

Advice for Parents of Children with Eating Disorders

Eating Disorders in Children and Adolescents are serious conditions that cause both physical and emotional damage. Eating Disorders can lead to irreversible and even life-threatening health problems such as heart disease, osteoporosis, menstrual irregularities and kidney failure.

To help prevent eating disorders in young people, moms and dads need to talk a lot with their children. It may not be easy, but it is important to start.

• Talk about eating habits and body image.
• Encourage healthy eating habits.
• Discuss the media's messages about self-esteem and body image with your relative.
• Promote a healthy body image.
• Avoid nicknaming or joking about the person's physical characteristics.
• Avoid commenting on another person's weight or body shape.
• Develop self-esteem. Recognize and respect their achievements and support their goals.
• Remind your loved one that your love for them is unconditional and not about their weight or appearance.

Also remember the importance of setting a good example as a parent. If you as a parent are constantly dieting, using food as a way of coping with your emotions or talking about losing weight, this can make your child feel dissatisfied with the way they look. Instead, make conscious choices about your lifestyle and take pride in your body as a parent.

The information on this page has been prepared by the Medical Team of Private Moodist Hospital.