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.