Anorexia nervosa is a severe mental health disorder that usually begins during adolescence. But in the past decades, diagnoses of anorexia in children under the age of 14 have been increasing – and in some places have almost doubled.
Identifying and treating anorexia as soon as possible is crucial to effective treatment and recovery. Without timely treatment, children can experience profound and long-term harm to their mental and physical health. This means that it’s imperative to look out for the signs of anorexia in pre-teens as well as adolescents and seek professional support if there are any concerns.
This blog offers some information about anorexia in under 14s and why early-onset diagnoses are rising. It also touches on some of the treatment and recovery programs available for prepubescent anorexia that can support young people in lasting recovery.
What Is Early-Onset Anorexia?
Early-onset anorexia is usually defined as anorexia that develops in young people younger than age 13. However, some researchers and mental health professionals use the term to describe anorexia in children who have not yet experienced puberty (pre-pubescent).
Is the Age of Onset of Anorexia Decreasing?
Research from Europe and North America shows that the average age of onset of anorexia has decreased over the past few decades. This means that anorexia is developing in young people at an earlier age than before. The most common age to develop anorexia has fallen from 15-19 to 13-18.
At the same time, admissions of children under 14 have increased. While early-onset anorexia is still rare, in some places diagnoses have almost doubled in the past decade.
What Causes Anorexia in Under 14s?
As with anorexia that begins in adolescence or young adulthood, early-onset anorexia develops from a complex interaction of cognitive, emotional, and social factors. This includes personality traits like perfectionism, difficult life experiences, and exposure to social and cultural norms around body shape and weight.
However, the risk factors and triggers of early-onset anorexia (EOAN) tend to be a bit different from adolescent anorexia. For example, teasing, critical comments and harassment are more often reported as triggers for EOAN than they are among adolescents.
How Are the Symptoms of Prepubescent Anorexia Different from Adolescent Anorexia?
While the core symptoms of early-onset and adolescent anorexia are the same, early-onset anorexia has some specific characteristics.
Children with early-onset anorexia often lose weight quicker than adolescents and lose a higher percentage of their body weight. They’re more likely to completely refuse food than teenagers and young adults.
The effects of energy restriction on height growth, bone development, and puberty are also more pronounced among children under 14.
Pre-teens with anorexia often describe co-occurring somatic symptoms like stomach pains and digestive issues. They tend to place focus on the feeling of being ‘full’, rather than counting the calories they eat. This may explain why fluid restriction is common in early-onset anorexia.
Finally, children under 14 are more likely to engage in restrictive eating behaviours, while binge eating and purging are less common.
What Personality Traits and Thinking Styles are Associated with Early-Onset Anorexia?
Research has found that certain personality traits and thinking styles make developing anorexia more likely. For example, anorexia is linked to rigid thinking and difficulties seeing the bigger picture. It’s also connected to social anxiety and a tendency to compare oneself to others.
Like adolescents and young adults with anorexia, children with anorexia also tend to lack cognitive flexibility and show impaired decision-making processes. As with older young people, these traits can cause difficulties with friendships and family relationships, making social isolation more likely.
Some research suggests that low self-esteem and perfectionism – two traits closely linked to adolescent anorexia – are less common in those under 14. However, this research is limited by small sample sizes.
Early-Onset Anorexia and Autism Spectrum Disorder
Data suggests that children with autism spectrum disorder are at a higher risk of developing anorexia than others. While it is still not clear exactly what explains the connection, experts have some ideas.
Some theories point out that children with ASD are more likely to develop mental health disorders in general. Many parts of society and daily life are inaccessible or exclusionary to children with ASD and many do not receive the support they require. This can lead to social and emotional challenges that increase the risk of developing mental health conditions such as anorexia nervosa.
On the other hand, some experts point to the overlap between some autistic traits and traits of anorexia. This includes rigid thinking, difficulties interpreting emotions and challenges understanding social situations. There may also be neurobiological explanations for the overlap.
Why Are Diagnoses of Anorexia in Under 14s Rising?
Research shows that more and more young people under 14 are being diagnosed with anorexia nervosa. While there is no single explanation behind the rise, several factors may play a role.
Social Media Exposure
Studies exploring the rise of anorexia in children and adolescents during the COVID-19 pandemic have highlighted the role of negative social media messages about food and body shape. Exposure to certain social media content may make it more likely for children to become preoccupied with their body weight and shape, experience body dissatisfaction, and internalise society’s ‘thin ideal’. Social media content can also promote restrictive eating behaviours and normalise dangerous practices like dieting.
In recent years, more and more children under 14 have started to use social media regularly. This means that more children are directly exposed to harmful social media content, and social norms and conversation topics pushed by social media may take more space among younger age groups. Consequently, young children may start to develop harmful ideas about body shape, weight, and eating through social interactions at school or home.
Increasing Awareness
Growing awareness about early-onset anorexia may cause quicker and more accurate diagnoses among those under 14. This means that some cases of early-onset anorexia that would have previously been misdiagnosed or overlooked until adolescence are now receiving accurate diagnoses. This may contribute to the rise in recorded cases of early-onset anorexia.
Experts think that many cases of early-onset anorexia are still missed and the disorder is much more common than data suggests.
Treating Anorexia Nervosa in Under 14s
When a child or adolescent receives a diagnosis of anorexia, it can feel scary. But with the proper support, full recovery is possible. This is especially true in the disorder’s early stages; early detection means a quicker recovery.
There are several different treatment options available for children with anorexia. Alongside weight restoration practices, psychotherapies support young people and families to change the thought patterns, behaviours, and interpersonal dynamics that maintain anorexia, promoting lasting recovery.
Psychotherapies should be part of a multidisciplinary individual and family approach, with professionals specialising in child psychiatry and anorexia nervosa.
Some treatment modalities include:
Family-based treatment (FBT)
Family-based treatment is usually the go-to treatment for under 14s with anorexia. Family approaches seek to create a therapeutic relationship with all family members, empowering parents to support their child’s recovery. They may include family therapy, parent skills training, and sibling groups.
Multi-family therapy (MFT)
In multi-family therapy sessions, therapists bring several families together in a therapeutic and social setting. MFT sessions combine elements of group therapy, family therapy, and psychoeducation, guiding families to support their children’s recovery.
Cognitive-behavioural therapy (CBT)
Cognitive-behavioural therapy supports children to identify harmful thoughts and behavioural patterns and replace them with more positive ones. It effectively improves symptoms of co-occurring disorders like anxiety and depression, as well as the attitudes and traits that underpin disordered eating behaviours. Therapists may use tools like pictures or role-plays to communicate concepts and emotions when working with younger children.
The Wave Clinic: Specialist Mental Health Support for Young People
The Wave Clinic offers specialist treatment spaces for young people living with eating disorders and other mental health conditions. We provide exceptional residential and outpatient care, founded in and delivered with unequalled expertise.
Our programs offer diverse evidence-based treatment modalities tailored to each young person’s age and needs. We emphasise the role of the family in mental health recovery, forming the scaffolding that underpins resilience and lasting change.
If you’re interested in learning more about our programs, contact us today. We’re here to support you.
