Q & A: Warning Signs of a Developing Eating Disorder?

Q: Before frank anorexia nervosa or bulimia nervosa appears in children, are there any other “softer” eating disorders to look out for? (N.M., Houston)

A: Several other eating disorder spectrum phenomena have been described in young children, including food avoidance emotional disorder, selective eating disorder (picky eating), functional dysphagia and pervasive refusal syndrome (Int J Eat Disord 2000;28: 317), as well as rumination disorder and “infantile anorexia.” However, their relationship to subsequent anorexia nervosa and bulimia nervosa is uncertain. For example, in a series of 147 children and adolescents aged 5 to 20 with rumination disorder, 16% were thought to have a psychiatric disorder whereas only 3.4% were diagnosed with anorexia nervosa or bulimia nervosa (Pediatrics 2003; 1:158). Similarly, for children who show picky eating and “food neophobia” at young ages, most of the pickiness relates to vegetables, and children often outgrow at least some of their fussy habits (J Am Acad Child Adolesc Psychiatry 2003;42:76; J Am Diet Assoc 2003; 103:692). While these syndromes are definitely worth noting, and parents understandably seek guidance for their management, further longitudinal studies are needed to ascertain the actual relationships between these early feeding difficulties and subsequent adult eating disorders.

—J.Y.