When we have a child who has an eating disorder, we tend to zero in on topics like food and weight. And it’s true that food and weight are the focus of someone who has an eating disorder.
In many cases the obsession with food and weight, and the resulting eating disorder behaviors, are a sort of secondary condition that lies on top of other undiagnosed mental disorders like Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Syndrome (PTSD) and Autism Spectrum Disorder (ASD).
This is why, very often when we get through the initial behavior modification stage of eating disorder recovery, and address the food and weight obsessions, there is still more work to be done. Many of us who have recovered from an eating disorder must continue to actively treat our underlying conditions, even if our eating disorders are in our past history.
As a parent who has a child with an eating disorder, it’s important for you to understand that it’s very possible that your child’s disorder goes much deeper than food and weight, and includes one of the following conditions that frequently co-occur with eating disorders.
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) falls under Anxiety Disorders, and both Anxiety Disorder and OCD are highly correlated with eating disorders. A research study in 2004 found that 64% of people who have eating disorders also suffer from an anxiety disorder, and up to 41% have OCD in particular. The study also found that 42% of us developed our anxiety disorders in childhood, before our eating disorders began. (ADAA)
Some researchers have even suggested that eating disorders are on the spectrum of OCD rather than stand-alone disorders. This causes some real challenges when treating someone for an eating disorder, since the clinician may not be clear about where one disorder ends and the other begins. (IOCDF)
Most of us think of OCD as being about obsessively washing hands, but eating rituals that are common to eating disorders fall well within the spectrum of OCD. Most of us who have eating disorders have ritualized our approach to food and weight, including how we eat, what we eat, how and when we weigh ourselves, etc.
We may also use eating food, purging or food restriction as a way to manage our feelings of anxiety. Anxiety is often described as the persistent sense that something is terribly wrong. Some of us experience heart palpitations, stomach upset, and trouble breathing. Others of us will faint when facing especially stressful situations. Almost everyone who has had an anxiety attack thinks they are dying. The physical sensations of fear are as pervasive and terrifying as if we were being chased by a lion.
If you have a child who has an eating disorder, your child’s treatment team will probably utilize Cognitive Behavioral Therapy (CBT) and/or Dialectical Behavioral Therapy (DBT), both of which have been shown to be highly effective in treating Anxiety Disorders. If your child suffers from OCD and successfully recovers from an eating disorder, it is likely that she or he will need to maintain mental health hygiene practices to manage the Anxiety Disorder long-term.
Post Traumatic Stress Disorder
Many who have eating disorders have serious trauma in our history, including physical and emotional violence, sexual abuse, neglect, having a serious accident or illness, bearing witness to a serious accident or illness, and more. Some research has shown that up to half of those of us who have an eating disorder have experienced sexual abuse. These traumatic experiences often lead to Post Traumatic Stress Disorder (PTSD), and very often pre-date our eating disorder development.
Most of us think of soldiers returning from war when we hear about PTSD, but the disorder is found in 10% of women and just 4% of men. Studies suggest that the reason for the higher prevalence of PTSD in women is that we are more likely to experience sexual assault, which is more likely to cause PTSD than many other types of events. The most common trauma for women is sexual assault or childhood sexual abuse. About 33% of women experience sexual assault during their lives, many before they reach adulthood. (National Center for PTSD)
Trauma actually rewires the brain and nervous system. It results in chronically increased stress hormones and reduces the ability of the brain to communicate with the body. People suffering from PTSD appear to confuse fear and pain with pleasure, and will commonly push their bodies beyond reasonable boundaries, including over-eating, self-harm, substance abuse, over-exercising and extreme risk-taking. (The Body Keeps the Score) One study found that +33% of individuals who have PTSD are still suffering with the full syndrome a decade later. In other words, it is frequently undiagnosed and under-treated.
It has been suggested that Bulimia Nervosa in particular may emerge as a coping method for the pain of PTSD. While women who have Anorexia Nervosa exhibit standard rates of PTSD (10%), about 25% of women with Bulimia Nervosa are diagnosed with PTSD. (Eating Disorder HOPE)
Regardless of the type of eating disorder your child has, it is important to ensure that the therapy team considers the possibility of PTSD, even if you are convinced that your child has not suffered any trauma.
Unfortunately, as parents we are often the last to know about our children’s trauma, so it’s important for us to step back and allow licensed therapists to conduct a thoughtful exploration of trauma.
Research has found many links between Autism Spectrum Disorder (ASD) and Anorexia Nervosa. (Eating Disorder HOPE) People who are on the autism spectrum often exhibit repetitive behaviors and restrictive behaviors and interests. They also can have sensory sensitivities.
Since the current diagnostic tests for ASD are based on males, many experts say that females are under diagnosed, and it has been theorized that this under-diagnosis and subsequent lack of treatment may mean that girls who present with symptoms of Anorexia are suffering from ASD. (Scientific American)
One symptom of Autism is the ability to hyperfocus, which may translate into extensive rituals around logging calories and body weight as seen in someone who has Anorexia. The continued hyperfocus even when other people suggest relaxing food rules can also be seen as a symptom of ASD.
Another symptom of Autism is being highly sensitive, and many people who have Anorexia have a strong aversion to specific food textures, smells and even colors. Some will talk about the discomfort they feel when chewing, swallowing and digesting food, suggesting high sensitivity in the mouth, throat and digestive tract.
These overlapping symptoms can make it hard to tease apart ASD from Anorexia. The term Avoidant/Restrictive Food Intake Disorder (ARFID) is now used to differentiate people who severely restrict food for purely sensory reasons, which results in low weight, while Anorexia is a disorder in which the active pursuit is low body weight.
If you are parenting a child who has Anorexia and suspect that AFRID and/or Autism may be important disorders to consider in diagnosis, talk to your child’s treatment team. Anorexia, AFRID and Autism all require the person to achieve a certain body weight in order to make progress on a full diagnosis.
Of course, we recommend that you never diagnose your own child for any of these conditions. Trained professionals should be the ones to diagnose and treat your child to ensure optimum results, but parents can certainly ask whether these conditions have been considered as co-existing with the eating disorder.