In recent years we have been witnessing a considerable lowering of the debut age of eating disorders, with boys and girls who also at 9 years old, present typical symptoms of the expression of the psychopathology of adolescent and adult age.
However, the lower the debut age, the more the manifestations of eating disorders can be faded and different: some girls significantly increase physical activity or you can see significant changes in the way they feed (for example, they diminish food, remove and section the foods, totally eliminate some foods …).
These changes are often underestimated by pediatricians and parents and labeled as “transient events” that are resolved spontaneously. There is no doubt that the evolutionary age is characterized by physiological “crisis” transientbut it is equally important to make one early evaluation that can exclude an initial structuring of a food problem.
In the evaluation, especially when we talk about children, We cannot fail to take into consideration the context or the interactive system in which it is inserted. The arduous task of the clinician will be to try to understand if there are and what are the difficulties of that child, in that specific moment of life and within that specific family context.
The characteristics of the family
In the past there was a tendency to study the characteristics of the family, looking for the deficits and dysfunctional dynamics responsible for the origin of the eating disorder.
- Gull (1874) and Lasegue (1873) considered families as an obstacle to treatment.
- Minuchin (1978) had identified a particular functioning of anorexic families. According to this author, one could highlight:
- a profound entangling (hyper-ventilation and poor differentiation of boundaries);
- overprotectivity (members show a high degree of concern and mutual interest and lack of autonomy)
- avoidance of the conflict (the family has a low tolerance to the conflict, which remains latent or avoided)
- rigidity (the family is particularly resistant to change, especially to attempts to differentiate individuals).
- Mara Selvini Palazzo (1998) speaks of a couple stall to indicate an unusual of the couple who leads parents to be particularly overprotective towards the daughter to whom she is implicitly asked to remain eternally small. The daughter would therefore be assigned the task of filling the couple’s emotional emptiness and dissatisfaction, finding himself unable to free himself from the family. The pathology of eating disorder would arise when the girl realizes that she is used as a tool rather than being considered as an individual.
In the face of the identified characteristics and dynamics, we must ask ourselves a question: Are the functioning and characteristics highlighted, are we certain pre -existing and be the cause of the eating disorder, or in some cases they can be the consequence?
The causes of eating disorders in children
To date we know that the etiology of eating disorders is complex and It is not possible to identify a single causal factor. The theories that supported the centrality of the family as the cause of anorexia nervosa, for example, led to coining derogatory terms such as the mother “anorexogenic“Unfortunately still persists today.
Stereotypes on Family causes of eating disorderscan lead to one excessive guideline of parents and a worsening of relationships.
Recent data indicate that the involvement of parents in the processing promotes the reduction of psychological and medical morbidity, especially in patients with a short duration of the eating disorder.
Furthermore, it does not seem possible to identify a structure or a specific operating pattern of the family with a child suffering from eating disorder.
Over time and on the basis of the most recent studies, we have gone from a family vision centered mainly on the presence of pathology and risk factors, to one focused on its resources.
In evolutionary age we are now talking about the approach based on family resilience, an approach oriented to the resources and potential of recovery and change (Walsh, 2008).
The family is a dynamic system (the change of a member influences the entire system and vice versa), but which tends to maintain its homeostasis, its balance. The evolutionary changes of children require a constant adaptation of the entire family system, as well as critical moments.
Here change the family paradigm and focus on its resources, it can be functional in order to support the creation of a new balance useful to deal with the food problem of the child.
