Behavioural eating disorders

Abstract

The eating disorders, anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED), manifest through distorted or chaotic eating and in the case of AN and BN are characterised by a morbid preoccupation with weight and shape. Whilst recent changes in diagnostic criteria have changed the landscape to some extent, eating disorders and partial syndromes, including avoidant/restrictive food intake disorder (ARFID), remain relatively common and early recognition and intervention is helpful. Aetiology is multifactorial, with high heritability. Prognosis overall is good but treatment can be long and intensive, significantly impacting families. An integrated multidisciplinary approach is essential, working collaboratively with families and young people. Psychological interventions focus on the eating disorder, supported by medical monitoring and dietetic guidance. Although working with families is the backbone of treatment for AN, young people also need opportunities for confidential discussion. For BN, family or individual approaches may be equally effective. Evidence for effectiveness of psychopharmacological agents is limited in both AN and BN. Psychological and pharmacological approaches may both be of benefit for BED. Cases of ARFID require individualised approaches, often involving anxiety reduction. Paediatric expertise is of particular value in the assessment and management of acute malnutrition and complications secondary to disordered eating behaviours, in the early stages of re-feeding, and in the monitoring and management of long-term complications such as growth retardation, pubertal delay and osteopenia. This article offers an overview of eating disorders in children offering advice for clinicians who will undoubtedly encounter them in clinical practice.