Silent eating disorder that mainly affects children
There have always been picky eaters. But a child’s refusal to eat pasta unless his mother makes it, or exclusion of the product from his diet because his favorite brand has been discontinued, may be hiding something more than simple food obsession.
Although unknown to the general public, about ten years ago, avoidant/restrictive food intake disorder (TERIA) was included in Reference Guide to Diagnostic Criteria belonging American Psychiatric Association. The behaviors described above are common in patients with this disorder, also known as ARFID, but must be accompanied by other events, such as significant weight loss, nutritional deficiencies, and/or impaired psychosocial functioning.
THERIA affects 3.2% of children aged 8 to 13 years, 70% of whom are boys.
“TERIA affects 3.2% of children aged 8 to 13 years, 70% of whom are boys,” explains Dr. Eduard Serrano, head of the eating disorders unit at the Sant Joan de Déu hospital, where several infants with the condition are treated. this disease. . “Not eating leads to weight loss, which can affect their growth and even compromise their health. In the most severe cases, they are hospitalized and fed through a tube. We now have three such patients.”
Being underweight is a common characteristic of other eating disorders. And if you add to this the little training that still exists in some medical centers on TERIA, it is easy to understand why it is underdiagnosed. Some experts even call it a silent disorder because, despite its prevalence, it remains one of the least understood.
Children with TERIA may refuse entire food categories
“It differs from other EDs such as anorexia nervosa or bulimia in that there is no fear of weight gain and no body image distortion. In general, we find children who want to get better,” says Barbara Cytoler, clinical psychologist at the Val d’Hebron hospital.
However, its inclusion in the APA Diagnostic Criteria Reference Manual allowed additional research to begin and several types of patients to be identified. Those interviewed by experts identified three factors: lack of appetite, who has little interest in food and is almost never hungry; sensory properties that limit food products by their texture, smell, color, cooking method and/or temperature; and anxiety, which is usually caused by a traumatic episode such as choking or food allergies. All of them can eliminate entire categories of foods from their diet.
According to a study by the Karolinska Institutet
The heritability of TERIA is 70-85%, making it one of the mental disorders most transmitted from parents to children.
“The anxiety profile is the most common, accounting for 50% of cases,” Serrano says. Although it is also often possible to combine several profiles at the same time. “We once treated an 11-year-old boy who ate only chips, rice, onion rings and bread. He was obese and had many physical problems. “He presented a mixture of anxious and sensual profile.”
It has also been observed that many of these boys and girls are on the autism spectrum or ADHD. “These children have a hard time with food because it affects all their senses,” says Zitoler, who says that since they opened a mental health unit for children and adolescents at the Val d’Hebron hospital last year, they have had deal with three cases of TERIA. “One of them was a nine-year-old girl with a lung transplant who was not eating anything and was being fed through a tube. “I didn’t even know how to move my jaw.”
Some children with TERIA only eat crunchy foods.
Adults can also suffer from this disorder, although it is much less common. Tony Amaro, who currently works as a clinical psychologist at the Eating Disorders Unit at Mutua Terrassa University Hospital, has come across some cases. “I have treated women between the ages of 20 and 22 who were not diagnosed as children.”
As an example, the specialist cites the case of a girl who is currently undergoing treatment at her center. “She was referred to us from the emergency department where she was admitted because she was suffering from dizziness due to severe malnutrition. He had always followed a diet based on yogurt, rice and pasta, but after his parents’ divorce his diet became stricter. As her mother later told us, when she was little, all she wanted was homemade food, and she stopped eating frozen spinach because the brand she liked was no longer available.”
I have met women between the ages of 20 and 22 who were not diagnosed as children.
In addition to these cases, which went undetected during the childhood of victims, Amaro notes that anorexia with autistic disorder is increasingly common in adult women. “This makes me think that TERIA can lead to anorexia if not caught early.”
How to treat it?
The disorder can have a significant impact on eating, but it can also completely change the social lives of people suffering from it, making everyday activities like eating out impossible. Therefore, adoption of multidisciplinary treatment is key once the disorder is identified. “First we need to develop work with the patient and family, identify the theoretical construct that the victim has about food: what is his opinion about it, what idea does he have about this food… Then comes the behavioral part. , which involves gradual and gradual exposure,” says Cytolet.
Family plays a key role in TERIA treatment.
In both children and adults, the family plays a very important role in the favorable development of the disease. “They know how the child behaves at home and what he eats, and when it comes to adults, they can control the treatment and make significant changes,” adds Amaro.
Although the heritability of TERIA is very high (according to a study by the Stockholm-based Karolinska Institute, it is passed from parents to children in 70-85% of cases), Serrano insists that it should not be blamed on the family. “Although it is up to them to ensure that it does not take hold and is detected at an early stage,” he concludes.