Functional Dysphagia (Food Phobia, Fear of Swallowing) in Children

Food Phobia of Childhood:  a “new” eating disorder

By Julie K. O'Toole MD, MPH 

Introduction: Food phobia of  childhood, primarily seen in pre- or early pubertal children, was first described as such by Bryan Lask (pediatric psychiatrist) and Rachel Bryant-Waugh (psychologist) in the early 1990’s as a result of their work at Great Ormond Street Children’s Hospital in London. To my knowledge, with the exception of one article reporting work with a single young boy, food phobia has not been discussed as an entity in the American pediatric literature except under the general title “dysphagia” where it is likely to come to the attention primarily of pediatric gastroenterologists and otolaryngologists.  In the adult literature it is usually referred to as “choking phobia”. More recently Dr. Lask has chosen to refer to it again as “functional dysphagia,” although we at the Kartini Clinic for Disordered Eating prefer the more intuitive “food phobia”. In our experience, pediatricians report they are often at a loss about what to do with these challenging patients. We are grateful to Drs. Lask and Bryant-Waugh for calling attention to this condition.

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The cost-effectiveness of anorexia nervosa treatment.

Assuming an approach consisting of inpatient weight restoration, followed by treatment of gradually diminishing intensity (partial hospitalization, then outpatient psychotherapy plus medication management), incremental cost-effectiveness ratios were calculated and compared with a limited intensity, "usual care" model. Relative to many other medical interventions, such comprehensive treatment of AN appears to be quite cost-effective.

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Plan family meals to prevent children's eating disorders

Now researchers say they know one simple way families can help prevent the problem.

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Family Involvement and Focused Intervention May be Key to Helping Teens with Bulimia

Family-based treatment for adolescent bulimia nervosa (FBT-BN) is more effective than an individual-based therapy called supportive psychotherapy (SPT) in helping teens overcome bulimia according to an NIMH-funded study. Participants who received FBT-BN also showed faster treatment effects than those who received SPT. The study was published in the September 2007 issue of the Archives of General Psychiatry.

Daniel le Grange, PhD, of the University of Chicago, and colleagues randomly divided 80 teenagers with bulimia, ages 12-19, into two treatment groups, FBT-BN or SPT. FBT-BN, adapted from a similar treatment for teenagers with anorexia nervosa, first focuses on empowering parents to take action and help stop their teenager's bulimia-related behaviors, such as binge eating and purging. The treatment also tries to help parents see that the behaviors are separate from their child. Finally, FBT-BN helps the family address how bulimia affects the teenager's development.

In contrast to the family-based therapy, SPT focuses on the individual and does not specifically address the eating disorder; it was adapted from a similar treatment for adults with bulimia nervosa. SPT aims to help the affected adolescent resolve underlying problems that may have contributed to the eating disorder. The treatment also encourages patients to think about how they are affected by personal issues and what they can do about them in the future. Both groups received treatment for 20 visits over six months and were also re-assessed six months following the end of treatment.

Six months after the end of treatment, 16 of the 41 participants (39 percent) who received FBT-BN were in remission, compared with 7 of the 39 people (18 percent) in the SPT treatment group. For this study, the researchers defined remission as showing no binge eating or other bulimia-related behaviors in the preceding four weeks. The participants who received FBT-BN also showed reductions in all bulimia-related behaviors by midtreatment, earlier than people who received SPT.

Based on their findings, the researchers suggest that FBT-BN is more effective than SPT for treating adolescents with bulimia. Further study is needed to determine which component of FBT-BN was key to successful treatment, involving the family or focusing on the eating disorder. The researchers also note that there is room for improvement in finding even more effective treatments that help teenagers with bulimia stop the cycle of binging and purging.

SOURCE: Le Grange D, Crosby RD, Rathouz PJ, Leventhal BL. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Arch Gen Psychiatry. 2007 Sep;64(9):1049-56.