Definition Antecedents and Consequences of Child Emotional Eating

Child emotional eating: definition, antecedents, and consequences

Introduction

The latest Diagnostic and Statistical Manual-Fourth Edition-Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000) defines an emotional eating episode as necessarily encompassing both of the following elements: (a) eating, in a distinct time frame, food in a quantity which is certainly larger than that consumed by the majority of persons in similar situations and (b) no control over food consumption in the course of the episode (APA, 2000). Such conduct is marked by mortification, embarrassment, anguish, and attempts at concealing this conduct. It should averagely take place no less than two times weekly for six months. Allison, Geliebter, and Faith (1997) describe emotional eating as a reaction to an array of negative feelings, including depression, anxiety, loneliness, and rage, as dealing with the negative affect. Emotional eating is considered a coping mechanism or approach associated with diffusing negative emotions, though even positive emotions have been reported (Perpiñá et al., 2011). Such conduct as a reaction to negative states of mind is considered an “obesogenic” quality that plays a role in weight gain as well as, eventually, obesity (Croker, Cooke, & Wardle, 2011) among adults as well as children (Braden et al., 2014). Increasing evidence is being found to indicate that over- and binge-eating often transpire even when no other eating disorders are found and maybe ideally perceived as being situated across a continuum ranging from normal to abnormal or disordered eating (Perpiñá et al., 2011).

Emotion regulation and management issues are linked to psychopathologies and supposedly play a significant part in emotional eating commencement and retention. Furthermore, children showing signs of binge eating to address their emotions eat as a reaction to negative influence. Emotional Eating Diagnosis, defined by the Diagnostic and Statistical Manual of Mental Disorders, Edition IV (DSM-IV-TR) (APA, 2000), covers repetitive emotional eating spells characterized by subjective uncontrollability episodes, which are typically reported as stimulated by dysphoric emotions like anxiety and depression. Additionally, impulsive conduct is a transdiagnostic trait among those diagnosed with Eating Disorders, not uncommon in other Eating Disorder clinical subtypes (Monell, Clinton & Birgegård, 2018). While the linkages between disordered eating, emotional regulation challenges, and impulsivity have been analyzed thoroughly concerning the adult population, it is yet to be established whether childhood binge eating is linked to emotion regulation deficits.

Purpose of the paper

This paper’s purpose is emotional eating assessment as a childhood psychological problem. This evaluation will be performed for ascertaining the links between stress, emotional eating, and approaches to coping in teens and young children. In particular, this essay explores risk issues which may trigger emotional eating in children, and whether coping approaches moderate the link between emotional eating and the aforementioned risk issues (Young & Limbers, 2017). Future research must address stress, emotional eating, and coping approaches in early teenage as the childhood-teenage transition increases risk of eating disorder onset (Sierra-Baigrie & Lemos-Giráldez, 2008). Teens depict increased cognitive, emotional, and behavioral self-regulation capabilities. Still, teenage is a turbulent and stressful life stage marked by intensified emotional experiences and greater psychological health issues.

The objective of the paper

This paper’s aim is further expanding on the literature on the topic of emotional eating for identifying avenues to prevent obesity. Further, it aims at discerning distinct psychological factors underlying emotional eating in children and ascertaining emotional eating repercussions in this population group, followed by making clinical recommendations for treating childhood obesity.

Literature review

Psychosomatic Theory of Emotional Eating

This extensively acknowledged emotional eating theory – the first on this subject – provides insights into the mental processes and etiology resulting in overeating and, consequently, obesity (Kaplan & Kaplan, 1957). Eating dysregulation denotes an individual’s insensitivity or unresponsiveness to internal hunger and satiation indications. Individuals might confuse emotional stress and arousal for hunger, thus overheating owing to their incapability of distinguishing physiological states. Innate distress reactions include appetite loss or decreased food consumption on account of physiological effects like high blood sugar and inhibited gastric contractions (Kaplan & Kaplan, 1957). But eating for satisfying hunger is gratifying and fulfilling since eating activates dopamine, opioid, benzodiazepine/GABA neurotransmitter systems, and other neural substrates using a mechanism similar to that of illegal drugs (Johnson & Kenny, 2010). Dopamine is concerned with the motivational elements of eating the body (“wanting”), and while benzodiazepine and opioid systems intervene in hedonic food sensory stimulus assessment. Endogenous opioid neuropeptides in the human body are concerned with reward processes like appetite stimulation, in addition to reactions to discomfort and stress (Young & Limbers, 2017).

People experiencing negative emotions might turn to food as their emotional defense for alleviating aversive moods (Kaplan & Kaplan, 1957). Kaplan and Kaplan (1957) stand among the foremost scholars who integrated the anxiety reduction theory with the psychosomatic obesity theory, hypothesizing that obese individuals overeat when they experience anxiety, as overeating reduces this feeling. Obese persons were assumed to be incapable of differentiating between hunger and anxiety, owing to the learned reaction to eat as a reaction to hunger and anxiety. Later, Bruch (1961) put forward a second potential emotional eating cause: faulty sensations linked to hunger and confusion between feelings, particularly negative ones. According to the psychosomatic theory, hunger and its fulfillment weren’t intrinsic; the two physiological states’ recognition must be learned. Obese persons might have confusing, wrong experiences hindering their ability to distinguish between hunger and other signs of discomfort. Thus, emotional eating functions to cope with and decrease negative emotions, alleviate stress and increase positive emotions (Macht & Simons, 2011). The theories put forward by Bruch (1961) and Kaplan and Kaplan (1957) collectively suggest that obese persons overeat when they experience stress and other negative emotions. Thus, emotional eating turns into a conditioned link between negative mental states and the food reward (Young & Limbers, 2017).

Individual differences potentially decide whether stress or other negative mental states cause a person to overeat, and the reason for emotional eating to be potentially reinforcing for certain persons. Emotional eating elicits positive emotions temporarily; however, doing so regularly for alleviating negative mood states increases with time, with the person prevented from utilizing his/her emotions for practicing more adaptive reactions (Levenson, 1994). Hence, increased emotional eating is regarded as a maladaptive reaction to stress. Mortification and guilt typically stem from overeating and tend to replace the positive mental state quickly, subsequently causing the individual to consume further food (Morgan et al., 2002). Thus commences a vicious cycle in which emotional eating takes the form of a stressor triggering further food consumption (Morgan et al., 2002). In the absence of a concurrent growth in physical activities for burning the extra calories consumed in such eating spells, the body may store excess fat resulting in weight gain.

Development of Emotional Eating

Familial relations and parenting prove salient during the initial days of emotional eating commencement (Topham et al., 2011; van der Horst & Sleddens, 2017). High behavioral and psychological control, coupled with lack of maternal support, are linked to the greater emotional eating incidence among teenagers. Another research work reveals that discounting and rejecting parenting approaches were related to the greater emotional eating incidence among elementary school goers (Schuetzmann et al., 2008). A study sample of children between 6 and 8 years of age indicated that emotional eating was linked negatively to an authoritative parenting style with an open familial expression of feelings and love. In contrast, emotional eating was linked positively to parents who minimized the child’s negative feelings (Topham et al., 2011). Besides the parenting approach, parents may unconsciously model the practice of emotional eating to their children or even actually teach them to regulate and soothe using food (Topham et al., 2011). Emotional eating might be more strongly reinforced and pronounced due to repetitive instances of consuming one’s favorite foods following adverse experiences involving stress and other negative emotions.

Emotional Eating in Childhood and Adolescents

As youth emotional eating hasn’t been widely researched in America, one cannot easily determine incidence rates for emotional eating alone (Nguyen-Rodriguez et al., 2009; Young & Limbers, 2017). There is a broad incidence range for emotional eating, overeating, and binge eating among little children and teenagers, ranging from 10 to 60 percent (Nguyen-Rodriguez et al., 2009; Shapiro et al., 2007). Greater emotional eating rates have been recorded among teenagers (Braet et al., 2008; Martyn-Nemeth et al., 2009; Nguyen-Rodriguez et al., 2009) when compared with younger children. For instance, Martyn-Nemeth et al. (2009) discovered that a fourth of teenagers from one community sample self-reported turning to food for dealing with several issues in life, including those involving romantic interests, their parents, or other personal problems; further, this was linked to weight gain. But this research only utilized the Project Eat Survey, a general measure of eating behavior and nutritional health and doesn’t concentrate exclusively on emotional eating (Martyn-Nemeth et al., 2009). Further studying a small sample out of the overall population, roughly twenty-two percent of Latin American middle school goers self-reported practicing emotional eating in their answers to the Dutch Eating Behavior Questionnaire (Nguyen-Michel, Unger & Spruijt-Metz, 2007).

Relatively, Braet et al. (2008) discovered that a scant 10.5 percent of overweight young children self-reported emotional eating in their answers to the Dutch Eating Behavior Questionnaire. While eating habits are adopted early on in life, varying prevalence rates cause certain scholars to propose that emotional eating generally commences during adolescence (Van Stien, van der Zwaluw & Engles, 2010). Fewer emotional eating reports by little children suggest more natural responses to stress, including appetite loss when encountering emotional stressors. However, longitudinal studies indicate that youth emotional eating and weight gain continue throughout life (Young & Limbers, 2017; Van Strien et al., 2010). Moreover, children developing dysregulated emotional regulation patterns typically continue displaying those patterns in their teenage and adult life.

Gender Differences in Emotional Eating

The association of emotional eating and stress has been more closely scrutinized among females, who are found to engage in more unhealthy practices to lose or control their weight than males (Neumark-Sztainer et al., 2002). Small to teenaged girls report higher emotional eating levels in a few research efforts (Braet et al., 2008; Limbers, Young & Beaujean, 2016). Nguyen-Rodriquez et al.’s (2008) study revealed that 16.5 percent of teenage boys and 20.4 percent of teenage girls approved of and supported emotional eating as indicated by the Dutch Eating Behavior Questionnaire. In comparison to girls, boys experienced lesser benefits from food intake for elevating their mood. Also, numerous research works indicate robust potential and cross-sectional linkages between binge eating and emotional eating among eating-disordered and non-clinical teenage girls (Young & Limbers, 2017). For instance, emotional eating proved to be a key predictor for binge eating spells in the future among teenage girls (Linardon, 2017).

On the other hand, other research works haven’t reported any gender differences in self-reported emotional eating (Braet & Van Strien, 1997; Caccialanza et al., 2004). A cross-sectional study did not find any gender differences when it came to emotional eating scores; rather, worries and perceived stress were linked to emotional eating in females and males (Nguyen-Rodriguez et al., 2009). Gender-stratified studies found perceived stress, anxiety/tension, and worries related to female emotional eating, confused mood to be associated with emotional eating among males, and depression to be unrelated to emotional eating among both sexes (Nguyen-Rodriquez et al., 2009). Another research suggested that males were more prone to overeating as a reaction to general emotional aspects. Simultaneously, females were more prone to eating as a reaction to feeling unsettled and depressed.

Stress Overview

Adolescents might be especially prone to experiencing stress (Miller & Lumeng, 2018). Teenage is marked by biological, mental, and physical changes. For instance, physical maturation, the urge to become independent from parents, mental development, and social interactions’ significance all occur together (Blakemore, 2012). Additionally, clear growths in incidences of psychological ailments occur, including depression, anxiety, substance abuse, and schizophrenia, in teenagers (Roberts & Lopez-Duran, 2019). While there is some ambiguity concerning how these vulnerabilities may be explained, being exposed to teenage stressors has been suggested to have a meaningful part to play.

Stress and Obesity

Experiencing more stressful life events has been linked to harmful emotional eating, increasing risks of youth obesity (Jalo et al., 2019; Van Strien, 2018). Cross-sectional research illustrates that being exposed to greater psychosocial stressor levels, whether in connection with academics, long-term goals, physical illness, substance abuse, or familial issues, was linked to a greater likelihood of childhood and teenage overweightness obesity (Patist et al., 2018). Obesity by itself can prove to be a stressor since weight gain adversely affects physical, social, and psychological health and functioning.

Another stressor is low socioeconomic standing, with youngsters especially vulnerable to being exposed to factors like poverty and exhibiting other behaviors which make them increasingly likely to develop obesity (Gundersen et al., 2011). For instance, low socioeconomic standing has been linked to greater sedentariness and increased body mass index among teenagers (Young & Limbers, 2017), attributable to elements like a lack of resources in the locality (for instance, inaccessibility of fresh, healthy vegetables and fruits, not many safe and accessible parks or playgrounds, etc.) and a lack of financial resources for households (for instance, the pressure of providing energy-dense foods to obliterate family members’ hunger and inattention to nutritional value) (Gundersen et al., 2011).

Chronic stress endangers adaptive regulatory systems, potentially leading to biological changes which weaken stress adaptive processes and heighten risks of further stressful incidents (Tomiyama, 2019). Recurring, relentless psychological distress galvanizes the HPA (hypothalamic-pituitary-adrenal) axis; protracted HPA axial activity up-regulates hormones that influence appetite and promote weight gain. Granger, Susman, and Francis (2013) discovered that cortisol released as a reaction to psychosocial stress might be associated with physical activity and caloric imbalance – some age-based variations are witnessed. Study findings indicate that among children aged 8-9, increased release of cortisol was associated with greater BMI scores and energy consumption even when not hungry (Francis et al., 2013). Furthermore, stress may deregulate eating through its influence on the rewards system (Adam & Epel, 2007; Kaplan & Kaplan, 1975). Researchers suggest that disordered eating might account for a basic rewards system deficit – overweight/obese persons may seek instant gratification. Positive reactions to food, including enjoyment, eating fast, and reaction to palatability, are theorized to contribute to consumption, especially in nutrient-rich, fatty, sugary foods (Kaplan & Kaplan, 1975).

Stress and Emotional Eating

Youngsters reporting greater perceived stress levels are more frequent emotional eaters (Faith, Allison, & Geliebter, 1997; Nguyen-Rodriquez et al., 2008). Dupéré et al. (2018) indicated that high school goers experiencing stressful life events changed their eating habits – for instance, on the day of the final exams, female students increased their overall energy consumption, while male students consumed fattier foods. Further, Geiker et al. (2018) discovered that stress-induced surplus energy consumption, especially of “comfort” foods high in energy, was linked to greater BMI. Still, further studies on minority teenagers revealed a link between emotional eating and perceived stress, irrespective of weight status (Nguyen-Rodriguez et al., 2008). On the whole, children with weak stress responses are more susceptible to overweightness, as prospective research indicates that emotional distress is closely associated with increased obesity with time.

Mechanisms of Emotional Eating

‘Disinhibitor’ of Dietary Restraint

Negative emotions and stress can weaken (by releasing or disinhibiting) dieters’ self-control concerning self-imposed limited food consumption. When one under-eats, one’s body cannot differentiate between self-imposed restraint and actual food shortage, going into a kind of starvation mode: metabolic rate decreases (anabolism), with appetite and hunger, increased (Van Strien, 2018). In the end, the dieter experiences immense deprivation, making them highly susceptible to giving up their diet, which is especially true during stressful times. Indeed, during stress or following negative emotional induction, several research efforts displayed dieters consuming more food than non-dieters. Hence, dieting constitutes a risk factor increasing the propensity to engage in emotional eating (Polivy & Herman, 2017). Another result of dieters’ ongoing struggle against hunger sensations might be losing total contact with feelings of satiation or hunger, posing another emotional eating risk factor. The inclination to eat as a reaction to stress or negative emotions represents an a-typical reaction to stress. The typical reaction is not to eat as physiological stress responses mirror internal sensations linked to feeding-induced satiation.

Emotional eating in the form of a ‘disinhibitor’ needs inhibition (or restraint) beforehand by definition. But it is still unclear whether or not restraint eating stems from emotional eating, which may vary for different subgroups (Van Strien, 2018).

Emotional Eating as Independent of Dieting

Emotional eating might not even be associated with dieting. As explained in the following sections, it might result from weak interoceptive awareness, confusing internal states of satiation and hunger, and physiological signs linked to emotions (Van Loenen et al., 2020), weak emotion regulation approaches, or alexithymia. Emotional eating is also linked to reversed HPA axial stress reaction (i.e., a blunted rather than the usual elevated cortisol reaction to stress) (van Strien, Roelofs & de Weerth, 2013).

Poor Interoceptive Awareness, Alexithymia and Emotion Dysregulation

The unnatural reaction of engaging in emotional eating is believed by some to be acquired and a potential result of parenting styles weakening children’s emotional and psychological growth (Ferrer et al., 2017). When caregivers constantly respond inappropriately to children — through neglectfulness, overprotectiveness, hostility, or manipulation — the result might be a child with weak interoceptive awareness (i.e., weak awareness of their feelings of satiation and hunger), elevated alexithymia (trouble with identifying their feelings and explaining them to others) and struggles with adequate emotional regulation (Van Strien, 2018).

Indeed, elevated alexithymia and weak interoceptive awareness were linked positively to self-reported emotional eating (Pink et al., 2019). The former further moderates the relationship between food consumption and stress. Females displayed high alexithymia exhibiting the a-typical reaction of eating identically or even more following stress events (e.g., having to speak before an evaluative audience). Weak emotional regulation approaches (e.g., suppressing emotions) and maladaptive coping approaches (e.g., emotion-centered coping, using distractions to avoid stress, etc.) were related to emotional eating well.

Reversed HPA Axis

Emotional consumption of food was linked to PTSD and many African Americans (less than 1000), exposure to trauma during adulthood, and emotional abuse during childhood (Michopoulos et al., 2015). According to the study conducted by Michopoulos and associates (2015), both emotion dysregulation and depression served as mediators between emotional eating and emotional abuse or childhood trauma. A probable underlying mechanism for this type of emotional eating might be a reversed stress reaction of the HPA axis as a probable result of chronic childhood stress. Rather than reacting to stress with the usual neurovegetative symptom like appetite loss and hyper-activation, the HPA axis might respond to stress with (unusual) neurovegetative symptoms such as weight gain and increased appetite together with hypo-activation. With this regard, emotional eaters or feeders do not have the usual post-stress decrease of hunger but rather have the same or higher hunger feelings after experiencing stress. A reduced HPA axis working as a reaction to stress also clarifies why emotional feeders are more welcoming to the food’s reinforcing value as well as its utilization as temporary self-medication to reduce the effects of negative emotions and stress (but take a look at the meta-analysis of the affect regulation model by Haedt-Matt and colleagues (2014).

Negative, stressful encounters in childhood, especially those that involve parent-child associations, were, in various studies, proven to have permanent impacts on stress-responsive neurological systems (Van Strien, 2018). Although emotional feeders have also been found to respond to severe stress with increased cortisol, Tomiyama, Dallman & Epel (2011) discovered that women who suffered acute stress (as a result of being caregivers to chronically sick children) had higher scores for emotional feeding and displayed a diminished HPA axis activity when compared to women without acute stress.

Consequences of emotional eating

Emotional eating is linked to adverse outcomes to both the individual and the community. People suffering from emotional eating and other related disorders display considerable physical issues independent of their weight (for instance, joint pain, headaches, type II diabetes, fibromyalgia) and higher mortality and morbidity as an outcome of the connection of BED (binge-eating disorder) with weight (that is, most emotional eaters are either overweight, obese, or seriously obese; thus the complications linked to these conditions are also experienced) (Musci, Hart & Ialongo, 2014). Also, psychosocial impairment is common; people with BED often report higher emotional well-being impairment than physical well-being. Compared to people without any eating disorders, individuals with BED report considerable higher impairment in their function because of emotional issues and feeling less energized with life (Doll, Petersen & Stewart-Brown, 2005).

On top of psychosocial distress reports, comorbidity with several other psychiatric disorders seems to be the rule. According to a recent, huge, population-based research of teenagers, BED displayed lifetime incidence rates similar to BN and had some of the highest comorbidity rates with whichever mood (45.3 percent of people with BED displayed these comorbidities), any worry (65.2 percent), and substance dependence or abuse (26.8 percent), or any behavioral disorder (42.6 percent) (Swanson et al., 2011. Additionally, BED also has the highest comorbidities number, with 37 percent of those with BED displaying more than two comorbid disorders. Notions exploring mood control and disorders and affective disturbance often display a strong connection between eating pathology and depressive symptoms. It is suggested that this connection surfaces because various disorders are other disorders’ risk factors. Most notably, suicidal behaviors and thoughts among people with BED are quite high. Swanson et al. (2011) mentioned that lifetime suicidal ideation rates were considerably higher than those for people not suffering from these conditions (18.3 percent for SBED and 34.4 percent for BED). Suicide attempt rates were also significantly high among individuals with BED (15.1 percent).

Conclusion and recommendations

Emotional feeding or eating is not a formal eating disorder. It might be part of a different psychiatric disorder to deal with stresses or emotions in life. Emotional eating is often linked to bulimia, depression, BED, and several other anxiety disorders. Also, it could be a means of coping with daily stresses.

Probable distress-triggered emotional eating mechanisms include low interoceptive awareness, a dampened HPA axis stress reaction, and high alexithymia. After interaction with genetic vulnerability, insufficient parenting and many depressive emotions might be linked to increments in emotional feeding during teenagehood. Emotional feeding might also serve as a mediator between weight gain or body mass index and depression.

The review develops some association between coping style and perceived stress and accounts for a considerable variance amount in emotional feeding. At elevated perceived stress levels, an avoidant coping style served as a risk element for depressive emotional feeding. Comparable findings have been seen for an avoidant style of coping with other poor eating patterns among adolescents. This type of coping among adolescents has been linked to unhealthy eating patterns like watching TV during mealtime or skipping meals, higher binge eating, and increased control eating loss.

Feelings of depression are usually associated with appetite loss and consequent loss of weight. However, there is a sub-kind of depression described by the unusual features of bigger appetite and weight gain. Emotional feeding is considered a symptom of this type of depression since they both share the unusual feature of elevated appetite due to stress or depression. Certain cross-sectional studies found emotional eating to be a mediator between obesity and depression. According to another perspective research conducted on teenagers’ parents, emotional feeding served as an intermediary between maternal stress and weight gain. Depressive symptoms and behaviors were also linked to increased emotional feeding; emotional feeding also foresaw higher BMI independent of depression. No connection between emotional eating, weight gain, and depression was discovered in fathers, probably since both emotional and a-typical depression are less frequent among men.

Recommendations

These particular findings are of significance to both interventions for obesity and a-typical depression interventions. A matched obesity treatment approach has also been proposed, a suitable method for the treatment of the specific style of eating of the respective individual. Matched obesity treatment might offer a fresh path to more stable weight loss or maintenance of weight. It is thus recommended that;

1. Teaching emotion control skills could act as an effective method for the treatment of obesity among children. One of the top reasons that most weight loss programs fail concerning permanent and stable weight loss for many people might be the lack of a fit between individuals and the treatment approach. Different people have different reasons for over-eating. As mentioned earlier, an individual might over-eat after a slimming period when the cognitive decision to consume less food than the desired gets abandoned (for instance, due to negative emotions or stress); (restrained eating). Another individual might over-eat when they smell or see tasty food (external feeding), and another individual might over-eat when they are undergoing negative emotions (emotional feeding). Each kind of feeding behavior has its very own etiology. Each one of them also has its treatment. When the treatment is matched to the patient’s feeding behavior, the weight loss is expected to be more permanent.

1. As per all the findings stated here, the treatment adaptations of CBT (Cognitive Behavioral Therapy), IPT (Interpersonal Psychotherapy), and DBT (Dialectical Behavioral Therapy) might be especially useful among teenagers partaking in emotional feeding to reinforce coping skills and understand emotional weaknesses. Proof suggests that emotional eating and binge eating among adults could be effectively treated using Cognitive Behavioral Therapy. Empirically backed psychosocial interventions for feeding disorders suggested that Cognitive Behavioral Therapy meets Level three (Possible Efficacious Treatments) criterion for evidence-based binge eating treatments among the youth. Given this paper’s findings suggest differences between general emotional feeding and depressive emotional feeding, clinicians need to be aware of findings that Interpersonal Psychotherapy and Cognitive Behavioral Therapy are well-established adolescent depression treatments.

1. An emotional eating style needs to be addressed amid parents to overweight children, mainly because of its connection to emotional feeding and consequent weight gain, making obesity treatment challenging. Clinicians can also confirm the difficulty natural in feeding a baby that is strongly motivated by eating. Additionally, interventions can also directly address emotional eating among children by teaching them an alternative, adaptive tactics of managing adverse effects. Lastly, prevention initiatives and programs to enlighten parents about effective eating practices might also help reduce emotional over-feeding among children.

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