4053X1 1999 Nov25

Child Psychopathology
Normal eating behavior
Eating disorders
Reading: Chapter 13
Normal eating development
Troublesome eating habits and limited
food preferences are common in early
childhood among boys and girls
Family rituals surround eating, e.g.,
getting children to eat new foods
Societal norms and expectations affect
girls more than boys, particularly at
Continuity in eating behavior and
later problems
Picky eating,
Other risk factors: Early pubertal
maturation, high body fat, concurrent
psychological problems, poor body image
Diagnostic criteria for pica and
rumination disorder
Table 13.1 & 13.2 of the text
What is wrong with this
1. Glamorizes anorexia, a deadly physical
and mental illness, as "cute"
2. Sends the message that starving oneself
leads to beauty and approval
3. Insults eating disorders sufferers, their
loved ones and women everywhere who
are tormenting themselves to meet an
unattainable beauty ideal
Anorexia nervosa
Refusal to maintain
weight, intense fear of
gaining weight,
disturbance in
perception of body size
Denial of thinness
Menstrual cycle stops
due to low body fat
Restricting type: Diet,
fasting or excericise
Bulimia nervosa
Binge eating follows
change in mood,
stress, or hunger
Purging involves selfinduced vomiting,
diuretics, laxative
abuse, or by other
compensation (e.g.,
Weight is usually
average or slightly
above average
Diagnostic criteria in Tables 13.4
and 13.5
1-2% of population, more
common than 30 years ago
More common in females than
males (approximately 10:1
ratio); Purgative behaviors may
Usually strikes between age 14 18, but exists in adulthood and
even late childhood
50% show complete recovery,
others may continue irregular
eating and body dissatisfaction
Neurobiology and genetic contributions
– addiction models have looked at
endogenous opiods released when hungry
Sociocultural factors
– belief that self-worth, happiness, and
success are determined by appearance
– dieting/ nondieting cycle
– prevalence of social models (e.g., 90120)
Family interaction patterns
– Enmeshment, alliances, conflicts,
victimisation, parental pressure
Psychological factors
Autonomy, competence, and
control are themes
Phobic avoidance of normal
adult body weight or sexual
maturity in anorexia
Binge/Purge cycle becomes
Unattainable standards of
Bulimia related to poor impulse
control , sexual acting out,
borderline or histrionic
personality disorders
Treatment is difficult:
Hospitalisation, i.v.
feeding at “set point”
may be necessary
Contracting for weight
gain to earn privileges
(e.g., access to family)
& avoid food battles
Family therapy to deal
with autonomy and
Individual counselling
Dietary education
Hospitalisation may
be necessary if
electrolytes are “out
of whack” (siezures)
or purging must be
Cognitive Behavioral
approaches to
address self control
Antidepressants have
been helpful
Dietary education