Child Emotional Eating: Causes, Development, and Consequences

Introduction

The Diagnostic and Statistical Manual of Mental Disorders, 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, within a distinct time frame, a quantity of food that is clearly larger than what most people would eat in similar circumstances, and (b) a lack of control over food consumption during the episode (APA, 2000). Such behavior is marked by shame, embarrassment, distress, and attempts at concealment, and it should occur on average no fewer than twice weekly over a period of six months. Allison, Geliebter, and Faith (1997) describe emotional eating as a reaction to a range of negative feelings — including depression, anxiety, loneliness, and anger — as a means of dealing with negative affect. Emotional eating is considered a coping mechanism associated with diffusing negative emotions, though positive emotions have also been reported as triggers (Perpiñá et al., 2011).

Such behavior as a reaction to negative mood states is considered an "obesogenic" quality that contributes to weight gain and, eventually, obesity (Croker, Cooke, & Wardle, 2011) among both adults and children (Braden et al., 2014). Increasing evidence suggests that overeating and binge eating often occur even in the absence of other eating disorders and may be best understood as situated along a continuum ranging from normal to disordered eating (Perpiñá et al., 2011).

Emotion regulation difficulties are linked to psychopathology and are thought to play a significant role in the onset and maintenance of emotional eating. Children who binge eat to manage their emotions do so in reaction to negative affect. As defined by the DSM-IV-TR (APA, 2000), emotional eating is characterized by repetitive episodes marked by a subjective sense of loss of control, typically triggered by dysphoric emotions such as anxiety and depression. Impulsive behavior is also a transdiagnostic trait among those diagnosed with eating disorders and is not uncommon across eating disorder clinical subtypes (Monell, Clinton, & Birgegård, 2018). While the relationships between disordered eating, emotion regulation difficulties, and impulsivity have been analyzed extensively in adult populations, it remains to be established whether childhood binge eating is similarly linked to emotion regulation deficits.

This paper's purpose is to assess emotional eating as a psychological problem in childhood. This evaluation will examine the links between stress, emotional eating, and coping strategies in teenagers and young children. In particular, the paper explores risk factors that may trigger emotional eating in children and whether coping strategies moderate the relationship between emotional eating and those risk factors (Young & Limbers, 2017). Future research must address stress, emotional eating, and coping approaches in early adolescence, as the childhood-to-adolescence transition heightens the risk of eating disorder onset (Sierra-Baigrie & Lemos-Giráldez, 2008). Adolescents demonstrate increased cognitive, emotional, and behavioral self-regulation capabilities, yet adolescence remains a turbulent and stressful life stage marked by intensified emotional experiences and greater psychological health challenges.

Psychosomatic Theory of Emotional Eating

This paper also aims to expand the literature on emotional eating in order to identify avenues for preventing obesity, to identify the distinct psychological factors underlying emotional eating in children, to ascertain its repercussions in this population, and to offer clinical recommendations for treating childhood obesity.

The psychosomatic theory of emotional eating — the first theory on this subject and still widely acknowledged — provides insights into the psychological processes and etiology that result in overeating and, consequently, obesity (Kaplan & Kaplan, 1957). Eating dysregulation refers to an individual's insensitivity or unresponsiveness to internal hunger and satiety cues. Individuals may confuse emotional stress and arousal with hunger, thereby overeating because they are unable to distinguish between physiological states. Typical stress responses include appetite loss or reduced food consumption due to physiological effects such as elevated blood sugar and inhibited gastric contractions (Kaplan & Kaplan, 1957). However, eating to satisfy hunger is gratifying because it activates dopamine, opioid, and benzodiazepine/GABA neurotransmitter systems — and other neural substrates — through a mechanism similar to that of addictive substances (Johnson & Kenny, 2010). Dopamine is associated with the motivational aspects of eating ("wanting"), while benzodiazepine and opioid systems mediate hedonic assessment of food's sensory stimuli. Endogenous opioid neuropeptides are involved in reward processes, including appetite stimulation, as well as responses to discomfort and stress (Young & Limbers, 2017).

People experiencing negative emotions may turn to food as an emotional defense mechanism to alleviate aversive moods (Kaplan & Kaplan, 1957). Kaplan and Kaplan (1957) were among the first scholars to integrate the anxiety-reduction theory with the psychosomatic obesity theory, hypothesizing that obese individuals overeat when anxious because overeating reduces that feeling. Obese individuals were thought to be incapable of differentiating between hunger and anxiety, owing to a learned response to eat in reaction to both states. Later, Bruch (1961) proposed a second potential cause of emotional eating: faulty sensations linked to hunger and confusion among feelings, particularly negative ones. According to the psychosomatic theory, hunger and its fulfillment are not innate; recognition of these two physiological states must be learned. Obese individuals may have confusing or distorted experiences that hinder 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 individuals overeat when they experience stress and other negative emotions, such that emotional eating becomes a conditioned link between negative mental states and the food reward (Young & Limbers, 2017). Individual differences may determine whether stress or negative mood causes a person to overeat. Emotional eating can temporarily elicit positive emotions; however, relying on it regularly to alleviate negative mood states increases over time, preventing the individual from using more adaptive emotional responses (Levenson, 1994). Consequently, increased emotional eating is regarded as a maladaptive response to stress. Shame and guilt typically follow overeating and tend to replace the temporary positive mood state, causing the individual to consume even more food (Morgan et al., 2002). This begins a vicious cycle in which emotional eating itself becomes a stressor that triggers further food consumption. When not offset by increased physical activity to burn the extra calories consumed, excess fat may accumulate, leading to weight gain.

Family relationships and parenting prove especially important during the early stages of emotional eating onset (Topham et al., 2011; van der Horst & Sleddens, 2017). High behavioral and psychological control, coupled with a lack of maternal support, are linked to greater emotional eating incidence among teenagers. Other research has found that dismissive and rejecting parenting approaches were associated with greater emotional eating among elementary school-age children (Schuetzmann et al., 2008). A study of children between 6 and 8 years of age found that emotional eating was negatively associated with an authoritative parenting style characterized by open familial expression of feelings and affection, while it was positively associated with parents who minimized their child's negative emotions (Topham et al., 2011). In addition to parenting style, parents may unconsciously model emotional eating for their children or may actively teach them to regulate and soothe themselves using food (Topham et al., 2011). Emotional eating may be more strongly reinforced when children repeatedly consume favorite foods following adverse, stressful experiences.

Development and Prevalence of Emotional Eating in Youth

Because youth emotional eating has not been widely researched in the United States, establishing precise incidence rates is difficult (Nguyen-Rodriguez et al., 2009; Young & Limbers, 2017). The reported prevalence of emotional eating, overeating, and binge eating among young children and teenagers ranges broadly — from 10 to 60 percent (Nguyen-Rodriguez et al., 2009; Shapiro et al., 2007). Higher rates of emotional eating have been recorded among teenagers (Braet et al., 2008; Martyn-Nemeth et al., 2009; Nguyen-Rodriguez et al., 2009) than among younger children. For instance, Martyn-Nemeth et al. (2009) found that a quarter of teenagers in one community sample self-reported turning to food to cope with various life problems — including those involving romantic relationships, parents, or personal issues — and that this behavior was associated with weight gain. However, this study relied solely on the Project EAT Survey, a general measure of eating behavior and nutritional health, and did not focus exclusively on emotional eating. Studying a separate subsample, approximately 22 percent of Latino/a middle school students self-reported emotional eating on the Dutch Eating Behavior Questionnaire (Nguyen-Michel, Unger, & Spruijt-Metz, 2007).

In comparison, Braet et al. (2008) found that only 10.5 percent of overweight young children self-reported emotional eating on the Dutch Eating Behavior Questionnaire. While eating habits are established early in life, varying prevalence rates have led some researchers to propose that emotional eating typically begins during adolescence (Van Strien, van der Zwaluw, & Engels, 2010). Fewer emotional eating reports among younger children suggest more typical stress responses, such as appetite loss when encountering emotional stressors. Longitudinal studies, however, indicate that emotional eating and weight gain in youth persist throughout life (Young & Limbers, 2017; Van Strien et al., 2010), and children who develop dysregulated emotional patterns typically continue to display those patterns into adolescence and adulthood.

The relationship between emotional eating and stress has been more closely examined among females, who are found to engage in more unhealthy weight-control practices than males (Neumark-Sztainer et al., 2002). Some studies report higher emotional eating levels in girls than in boys (Braet et al., 2008; Limbers, Young, & Beaujean, 2016). Nguyen-Rodriguez et al. (2008) found that 16.5 percent of adolescent boys and 20.4 percent of adolescent girls endorsed emotional eating on the Dutch Eating Behavior Questionnaire. Boys reported fewer benefits from food intake for mood elevation than girls did. Numerous studies also report consistent cross-sectional links between binge eating and emotional eating among eating-disordered and non-clinical adolescent girls (Young & Limbers, 2017). For instance, emotional eating proved to be a significant predictor of future binge eating episodes among adolescent girls (Linardon, 2017).

Other studies, however, have found no gender differences in self-reported emotional eating (Braet & Van Strien, 1997; Caccialanza et al., 2004). One cross-sectional study found no gender differences in emotional eating scores; instead, worries and perceived stress were linked to emotional eating in both females and males (Nguyen-Rodriguez et al., 2009). Gender-stratified analyses found that perceived stress, anxiety, and worry were associated with emotional eating among females; confused mood was associated with emotional eating among males; and depression was unrelated to emotional eating in both sexes (Nguyen-Rodriguez et al., 2009). Another study suggested that males were more prone to overeating in response to general emotional states, while females were more prone to eating in response to feeling unsettled and depressed.

Adolescents may be especially susceptible to stress (Miller & Lumeng, 2018). Adolescence is marked by biological, psychological, and physical changes — including physical maturation, the drive for independence from parents, cognitive development, and an increasing significance of social relationships — that occur simultaneously (Blakemore, 2012). There are also notable increases in the incidence of psychological disorders during this period, including depression, anxiety, substance abuse, and schizophrenia (Roberts & Lopez-Duran, 2019). Exposure to adolescent stressors has been proposed as a meaningful contributor to these vulnerabilities.

Conclusion and Recommendations

Emotional eating is not a formal eating disorder. It may be part of a broader psychiatric disorder used to cope with stress or emotions, and is often linked to bulimia, depression, binge-eating disorder, and various anxiety disorders. It may also serve as a means of coping with everyday stressors.