My baby is starving. Where does anorexia come from?

Contents

Not eating out of misfortune
Beyond the safety line
You cannot force-feed, but relationships can be mended
What to be careful about and how to respond to disturbing symptoms
What to do when you suspect a child has anorexia?

The most difficult thing is to accept the fact that a child’s illness is psychological, because he or she is unhappy, lonely and lost, has low self-esteem, thinks that no one understands him, is not important to anyone. According to the parents, the child has everything: designer clothes, a smartphone, foreign holidays and very good grades at school. So why does he want to starve himself to death?

Dr. Żechowski: It still happens that children see a child psychiatrist for the first time after many months of the disease. Sometimes, despite significant emaciation, the parents deny the diagnosis, persistently looking for the somatic cause of the child’s condition.
Dr. Karakuła-Juchnowicz: Why does the child want to starve itself? There are many answers, but certain constellations of personality traits, family structures, behaviors and situations that provoke the occurrence of anorexia are repeated.
– It happens that anorexia is a way to get the attention of conflicted or intending to divorce parents. Hospital stays, mutilation, suicide attempts – such events consolidate parents in caring for a child – explains the psychiatrist
– Eating disorders often affect people who are not very assertive, are unable to refuse or protect their borders, believing that they must be polite to everyone, avoiding conflicts at all costs – explains the doctor
ARTICLE FROM MAGAZINE: NEWSWEEK TEENAGE PSYCHOLOGY 1/2021
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Anorexia nervosa, or anorexia nervosa, is a mental disorder characterized by a drastic reduction in food intake (often also intense exercise and inducing vomiting) in order to reduce body weight. It is indicated by a BMI (body mass index) below 17,5. Its effects are emaciation and malnutrition as well as somatic disorders, incl. hormonal and electrolyte disturbances, inhibition of sexual maturation, bone decalcification. – Statistical data say that only 50 percent. patients with anorexia nervosa manage to recover from the disease – says psychiatrist Dr. Hanna Karakuła-Juchnowicz. Another 20-30 percent. reaches incomplete remission or experiences relapses. About 20 percent. failure to achieve remission. Usually these are people who start therapy too late or do not consent to it.

Not eating out of misfortune

Anorexia is not just a disease of models, ballerinas and dancers for whom a slim figure means to be or not to be. Ordinary high school girls or students of older primary school grades also suffer from it. It is rare among boys, but in recent years there has been an increasing number of cases. It happens in all environments: both in intellectual and working class families, as well as in pathological ones.

– Today, parents know much more about her than 30 years ago, when I started my medical practice – admits Dr. Cezary Żechowski, a psychiatrist for children and adolescents. This does not mean, however, that they always understand the specificity of this disease and react appropriately to the situation. It still happens that children see a child psychiatrist for the first time after many months of the disease. Sometimes, despite significant emaciation, the parents deny the diagnosis, persistently looking for the somatic cause of the child’s condition.

There are no children who are too young to develop anorexia

The most difficult thing is to accept the fact that a child’s illness is psychological, because he or she is unhappy, lonely and lost, has a low self-esteem and the feeling that no one understands him is not important to anyone. According to the parents, the child has everything: designer clothes, a smartphone, holidays abroad, and very good grades at school. Why does he want to starve himself to death?

– There can be many answers to this question – says Dr. Karakuła-Juchnowicz. However, certain constellations of personality traits, family structures, behaviors and situations that provoke the occurrence of anorexia are repeated. Sometimes a child lacks the attention and understanding of parents, a sense of security and being important, a sense of agency, which is the result of incorrect family relationships – lists the psychiatrist.

It sometimes happens that the triggering factor of the disease is the fear of growing up and the lack of acceptance for changes taking place in the body. During puberty, babies often have a greater appetite, resulting in a rounded body shape. It happens that people from the environment express anxiety aloud that the child will gain weight or comment on the increase in weight, change in appearance, enlarging breasts or hips. Some teens take these comments deadly seriously.

Adults have no idea that seemingly innocent terms such as fold, donut, bellies or donut can be very difficult for a child. The authors of unpleasant comments are often also peers. Girls who start to grow up earlier than their peers are more exposed to it, notes Dr. Żechowski. The opposite is true for boys – the environment favors those who mature earlier. Usually they become group leaders.

It happens that the slowdown in the process of separation and individuation of the child in adolescence becomes a risk factor. They include difficulties in establishing and maintaining satisfactory relationships with peers, less independence, lower self-esteem, less openness to new experiences, especially in the peer group. Trauma, including sexual harassment or abuse, as well as physical and psychological violence, can also be a risk factor.

Beyond the safety line

Eating disorders often affect people who are not very assertive, are unable to refuse or protect their borders, believing that they must be polite to everyone, avoiding conflicts at all costs. They suppress negative emotions, and this causes self-harm that manifests itself in not eating. Children who are very polite and subordinate are also at risk.

– It happens that anorexia is a way to get the attention of conflicted or intending to divorce parents – adds Dr. Hanna Karakuła-Juchnowicz. Hospital stays, mutilation, suicide attempts – such events consolidate parents in caring for their children.

– We had a teenage patient with anorexia at the clinic. Her first symptoms of the disease coincided with the information about the planned divorce of her parents. Individual and family therapies allowed her to understand the mechanisms that led to her illness and to accept her new family situation. The moment when she symbolically allowed her father to leave the house, accepting this fact as the best solution for all household members, was a turning point in the therapy and started the healing process.

Perfectionism is also a risk factor for anorexia. If a child grows up feeling that he has to be the best at everything, strives not only for the best grades in school, but also for a perfect body, this becomes the most important for his / her self-esteem. Quite often, the attitude of the environment plays an important role here. It is about obsessive use of diets and training by relatives, friends or celebrities, giving the wrong patterns and recipes how to lose weight. Or to support the use of a diet, even when its weight falls below the safe limit.

In people with anorexia, non-eating stimulates the brain’s reward center, which can be pleasantly stimulating and a state similar to euphoria. By following a restrictive diet and training regime, they get a reward, not only in the form of better well-being, but also the attention of others. Parents, grandparents, but most of all peers notice a slender figure and reward it with praise. The girl then thinks: «It has been a long time since I felt so fantastic. I am in control of my life. Finally, I feel that I am better at something than others. My friends can’t deny themselves chips and bars, and I can only eat apple peel and core all day! ».

You cannot force-feed, but relationships can be mended

It is difficult for healthy people to understand how not to feel hungry and have the strength to exercise vigorously for several hours when the menu is limited to a few lettuce leaves. You can. Losing weight is like a drug.

Why is the goal for young girls to achieve an extremely skinny figure? What’s so attractive about that? – A characteristic feature of anorexia nervosa is a disturbed body image. This means that the child loses criticism towards him, begins to perceive him in a different way than the environment – says Dr. Karakuła-Juchnowicz.

Parents and the doctor see an emaciated body, and a girl suffering from anorexia sees an ugly fat girl she hates. In pursuit of a perfect figure, he will do anything to lose weight even more. The substantive conviction that she might die because of this probably will not impress her in any way. How to change it?

For a parent or guardian, the information that their child is going to starve to death is a blow to the heart. The need to feed offspring is one of the strongest instincts. The instinctive reaction is to try to feed the child at all costs, to tighten discipline, to watch over him at meals.

– While persuasion may prove effective in the case of several-year-olds, it does not work for adolescents – warns the psychiatrist. Forcing them to eat can only make matters worse, destroy a poor relationship.

The key to curing anorexia is to provide support, repair the relationship and communication between the child and his immediate environment, rebuild his self-acceptance, self-esteem, and teach how to express feelings. For this you need the help of an experienced therapist. First, however, you need to take care of the child’s safety.

– In the long term, nutritional deficiencies may lead to serious somatic complications, which may be associated with depression, anxiety, and suicidal thoughts. Then hospital treatment is necessary in the children’s psychiatry ward – explains Dr. Żechowski.

If the psychiatrist determines that the young patient’s life is not in serious danger, treatment should be outpatient. Sometimes it is necessary to initiate drug therapy to improve the child’s mood and allow him to move on. However, the core of anorexia treatment are: rebuilding the correct weight, family therapy and individual therapy of the child.

– There are not many studies on the effectiveness of different types of therapies in the treatment of anorexia, but in the literature, FBT therapy is in the first place, followed by cognitive and dynamic therapies – says Dr. Żechowski. – In Polish conditions, it seems that the method itself is not as important as the psychotherapist’s experience, his clinical knowledge and understanding the problems of people with eating disorders. Family-Base Therapy (FBT for short) is becoming more and more popular in the United States, Canada and Australia.

– It is based on taking control of the nutrition of a sick child by the parents – explains Dr. Żechowski. It is the parents who decide on the menu and time of meals, and control the portions of food. Therapy consists of several sessions in which the therapist accompanies the family, observing the interactions and communication in this group. It allows you to see the mechanisms that support or delay the treatment process. When safe nutrition is ensured, therapy focuses on examining the relationships between family members, peers and the child’s environment in order to maintain the improvement achieved. However, it is not a universal solution. If the FBT fails, other forms of assistance must be sought.

What to be careful about and how to respond to disturbing symptoms

Signs that may be an eating disorder:

Excluding certain products from the menu, e.g. bread, dairy products, meat. Try to find out what the motives for this change are. Maybe the child is actually overweight and feels bad about it, or is being teased by his peers? Offer support, visit a dietitian.
Excessive interest in the so-called healthy lifestyle. The child suddenly starts cooking healthy dishes and offers them, often does not eat them.
Excessive increase in physical activity.
Avoiding meals at a shared table. The child says that he is not hungry because he has recently eaten, insists that he be allowed to eat in his room, but does not eat the right portions, hides or throws away the food.
Rapid weight loss without obvious discomfort.
In girls, menstruation stops, very dry skin, brittle hair and nails.
The child directly or indirectly communicates that he is not satisfied with his appearance due to the alleged overweight or obesity.
He is sad, apathetic, isolates himself in his room, gives up his hobbies and meets his peers less often.
He spends much more time at the computer, visits pro-ana websites, whose authors promote the view that anorexia is not a disease but a lifestyle.

What to do when you suspect a child has anorexia?

Don’t look for an answer to the question: why did this happen to your child?
Don’t blame yourself, it won’t change anything. Focus on action. The sooner a child is under the care of a specialist, the more likely it is to recover from the disease.
Ask your pediatrician to examine your baby. The doctor will order basic laboratory tests, and on their basis, he will assess the child’s condition and decide whether it requires consultation with a child psychiatrist. He will check if his weight is within the normal range. BMI (body mass index) below 17 is a disturbing signal.
If you are still in doubt, enroll your child in an appointment with a child psychiatrist or psychologist experienced in working with patients with eating disorders.
Remember that if it is an eating disorder, you will need treatment, dietary support and psychotherapy to help your child regain a real body image and accept it, express emotions and be assertive, and improve communication with other family members and peers.

Content consultants:

Dr hab. Hanna Karakuła-Juchnowicz, MD, PhD, physician, specialist in psychiatry and specialist in community psychiatry, and an academic teacher. He is the head of the XNUMXst Department of Psychiatry, Psychotherapy and Early Intervention and the Department of Clinical Neuropsychiatry at the Department of Psychiatry at the Medical University of Lublin.

Cezary Żechowski, MD, PhD, child psychiatrist, psychotherapist, academic teacher of the Cardinal Stefan Wyszyński University in Warsaw, heads the Department of Clinical Psychology at the Cardinal Stefan Wyszyński University in Warsaw, medical director of the Allenort Center for Children, Youth and Families Therapy in Warsaw.