How to Better Understand and Treat Children and Adolescents Suffering from Eating Disorders

Eating disorders have existed for centuries and have been extensively researched for decades, but still carry a high mortality risk. Unfortunately, fundamental questions still need to be answered such as: what is the exact reason that dogged self-closure in children and adolescents with eating disorders still results in inaccessibility during treatment and leads to death instead of real healing to such a great extent? Why do young people with eating disorders, emaciated and seriously ill, long to die? How much and by what means does this psychiatric disorder drive the deterioration of the physical symptoms in youth? Establishing a deeper understanding that links these questions will lead to a better understanding of and treatments for patients with eating disorders. Fundamentals of an eating disorder are laid very early on (e.g. genetic influences, attachment and other early life experiences, personality traits, emotional processing), and – besides the distinctly addictive character that can be observed in many cases – certain comorbid psychopathological features like anxiety (in manifold manifestations), depression and body image disturbance may persist for a long time regardless of any possible physical stabilization. Illness-typical (psycho-pathological and physical) changes and above all the predominantly months- to years-long course of the disease are often associated with social isolation and the absence of important developmental steps (like making and maintaining friendships, age-appropriate independence and separation from the parental home, academic and professional advancement). This most likely results in children/adolescents both having a limited quality of life and also only limited desire for fundamental change during the transition into adulthood.

The background to these observations is still limited and further research is required. We lack a deeper, unifying understanding of why we often find it so difficult to reach our patients therapeutically and are therefore unable to bring about lasting changes to their eating disorders. Especially because they often suffer from a significant impairment of self-perception: this not only affects their own body in its reduced state and its actual dimensions, but especially the perception and expression of their own feelings. Since they are also unable to distance themselves inwardly from the disease-specific ways of thinking and processing, they do not feel ill overall. On the contrary, this creates the impression of a new inner "strength", which is surprising for the patients themselves and contrasts with the self-esteem problems that often existed before the illness.

In summary, on the one hand there is the increasingly detailed knowledge of aetiological factors related to eating disorders, while on the other hand the treatment successes are ultimately still limited. One of our concerns is that we have not yet fully understood, for example, the specific neurobiological relationships that could enable successful concomitant psychopharmacological treatment of anorexic patients.
Therefore, the goal of this Research Topic is to rethink and define explanatory models for the development of eating disorders in childhood and adolescence and to place them in a super-ordinate and complementary context in order to provide better explanations to understand and treat children/adolescents with eating disorders. To achieve this aim, existing knowledge needs to be brought together in greater depth, for example by expanding basic research on eating disorders and combining it with clinical studies. Specifically, we should set ourselves the goal of finding out why children fall ill younger and younger, especially since their life expectancy is directly affected. We welcome perspective, hypothesis and theory and also original research articles, reviews (systematic, mini and practice) and clinical trials as submission types.

We especially welcome submissions addressing the following questions:

• Which are specific features of eating disorders in early childhood?
• What do we know about the prevalence, salience and clinical presentation of eating disorders in different cultures?
• What do we know about the risk factors for developing an eating disorder?
• What’s (new) about eating disorders and the concept of neurodiversity?
• What are new findings on common features and differences in relation to eating disorders in males and females?
• Is there a link between gender disorders and eating disorders?
• To what extent have there been changes in recent decades and up to now with regard to epidemiology and socio-cultural influences related to eating disorders?
• What are the most current findings on the connection between neurobiological, hormonal and other somatic aspects?
• Are there any links between rigidity and other specific psychopathological features?
• Can a noticeable connection between attachment, transgenerational and epigenetic aspects be outlined?
• How early can a traumatizing background be recognized that has led to a presentation with an eating disorder?
• Is there an etiologic model concerning the co-occurrence of autoimmune diseases (e.g. celicac disease) and eating disorders?
• Microbiome and eating disorders, cause or effect?
• Are there new and above all promising therapeutic approaches, which possibly also include complementary elements?
• "Recovery as a process": what are really realistic treatment goals? When is a therapy really effective? How can long-term effects be proven?
• Is there a hope for sustainable drug treatment approaches?
• Suicidal tendency: when does it become a threat to the patients' lives? How can it be shown and explained that restrictive eating behavior can be understood as a variant of suicidal behavior?
• Which aspects give further hope for recovery in case of a necessary transition into the adult (mental health) care system and what are the experiences with these change processes?