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.

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.

Psychosomatic Theory of Emotional Eating

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.

Development and Prevalence of Emotional Eating in Youth

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.

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.

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.

Probable mechanisms underlying stress-triggered emotional eating include poor interoceptive awareness, a dampened HPA axis stress response, and elevated alexithymia. Following interaction with genetic vulnerability, inadequate parenting and chronic depressive emotions may be associated with increases in emotional eating during adolescence. Emotional eating may also serve as a mediator between weight gain or BMI and depression.

The reviewed literature establishes an association between coping style and perceived stress that accounts for a substantial portion of the variance in emotional eating. At elevated perceived stress levels, an avoidant coping style serves as a risk factor for depressive emotional eating. Comparable findings have been observed for avoidant coping and other poor eating behaviors among adolescents, including watching television during meals, skipping meals, increased binge eating, and greater loss of eating control.

Depressive feelings are typically associated with appetite loss and weight loss. However, a subtype of depression — characterized by atypical features such as increased appetite and weight gain — has been identified. Emotional eating is considered a symptom of this atypical depression subtype, as both share the unusual feature of elevated appetite in response to stress or depression. Certain cross-sectional studies found emotional eating to mediate the relationship between obesity and depression. A prospective study of parents of adolescents found emotional eating to mediate the relationship between maternal stress and weight gain. Depressive symptoms and behaviors were also associated with increased emotional eating, and emotional eating predicted higher BMI independently of depression. No connection among emotional eating, weight gain, and depression was identified in fathers, possibly because both emotional eating and atypical depression are less common among men.

These findings are significant for both obesity and atypical depression interventions. A matched obesity treatment approach has been proposed as a method for treating each individual's specific eating style. Such matched treatment may offer a new pathway to more stable and lasting weight loss or weight maintenance. Accordingly, the following recommendations are made:

First, teaching emotion regulation skills may be an effective component of obesity treatment in children. One principal reason that weight loss programs often fail to produce permanent results may be the absence of a fit between the individual and the treatment approach. Different people overeat for different reasons. As discussed throughout this paper, one individual may overeat after a period of dietary restraint when the cognitive decision to limit food intake is abandoned in response to negative emotions or stress (restrained eating). Another may overeat in response to the sight or smell of appealing food (external eating), while another may overeat when experiencing negative emotions (emotional eating). Each type of eating behavior has its own distinct etiology, and each has its own appropriate treatment. When treatment is matched to the patient's predominant eating style, more lasting weight loss outcomes are expected.

Second, treatment adaptations of Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), and Dialectical Behavior Therapy (DBT) may be especially beneficial for adolescents engaging in emotional eating, as these modalities reinforce coping skills and address emotional vulnerabilities. Evidence suggests that emotional eating and binge eating in adults can be effectively treated with CBT. Empirically supported psychosocial interventions for eating disorders indicate that CBT meets the Level 3 (Possibly Efficacious Treatments) criterion for evidence-based binge eating treatment among youth. Given that this paper's findings point to differences between general emotional eating and depressive emotional eating, clinicians should also be aware that both IPT and CBT are well-established treatments for adolescent depression.

Third, emotional eating must be addressed in parents of overweight children, primarily because of its association with emotional eating in children and consequent weight gain, which makes obesity treatment more difficult. Clinicians can validate the difficulty inherent in feeding a child who is strongly food-motivated. Interventions can also directly address emotional eating in children by teaching them alternative, adaptive strategies for managing negative emotions. Finally, prevention programs aimed at educating parents about effective feeding practices may also help reduce emotional overeating among children.

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