Fears around transition to adolescence plague youngest eating disorder patients

Fear of the transition to adolescence, as well as complex family dynamics, often presents as a complicating factor in treating pre-teens with an eating disorder diagnosis, says the founder of a facility that this year launched a specialized track for young people ages 6 to 12.

Kimberli McCallum, MD, founder and medical director of McCallum Place (with operations in St. Louis and two other Missouri communities), says that in many cases these pre-teens are aggressively clinging to childhood. “Putting these young people in teen groups would be over-stimulating for them,” McCallum says.

She adds that the organization has a long-term goal of creating a totally separate unit for the pre-teen population, as there is presently some shared space between pre-teens and adolescents.

The pre-teen track, which operates at both residential and partial-hospitalization levels of care, is serving a population that is around 80% female. Yet McCallum says, “I still think many eating disorders in boys are missed,” often mistaken as depression, anxiety or obsessive behavior.

Time of change

The body and brain of pre-teens are changing rapidly, but the issues that might be addressed in treatment differ from those of adolescents (it is largely inappropriate to address emerging sexuality in this age group, for example).

“They often have very complicated family situations,” McCallum adds. Divorce and other losses in the family often make these young people vulnerable to a range of problems. She says the field is seeing a significant emergence of eating disorders among pre-teens with a trauma history, as well as individuals who have had food sensitivity issues in their early childhood.

Another potentially complicating factor in treatment is that this younger age group typically is not yet in charge of its food choices at home, McCallum says.

Although facility leaders ideally would like to establish an entirely segregated unit in the future, McCallum says there also can be some advantages to mixed therapy groups. “For the older children, the responsibility of not acting out in front of the younger children can be a good thing,” she says.