Monday 20 November 2017

How can I help my four-year-old boy who is obsessed with food?

Illustration by Maisie McNeice
Illustration by Maisie McNeice
David Coleman

David Coleman

Clinical psychologist David Coleman advises on what to do with a child obsessed with food and a boy who collects rubbish under his bed.

Question: We have a four-year-old boy who has suffered from a dairy allergy since birth. He is aware that he can't eat certain things. However, he is completely obsessed with food. He continually complains of being hungry. He compares how much food he and others have been given and bursts into tears if he feels that he has been short-changed. Even in others' houses, he continually asks when food will be served and always wants more. We want to change his obsessive relationship with food to avoid every day revolving around when his next meal is.

David replies: It must be really stressful in your house. Your son's obsession with food and eating does sound like it intrudes, dramatically, into your lives. I can imagine that you are very distressed by it, never mind his distress.

Food is such an emotional thing for many of us that you may find that his obsession with food presses all sorts of emotional buttons within you.

We have to be aware that our own associations with food and eating (from childhood) play a huge part in how we respond to our children's need for food, and how they choose to consume it.

Indeed, your own emotional association with food may have been dictating your responses to him and his apparent anxiety about food.

You describe that he has had a dairy allergy from birth. I presume that meant that you had to be really careful, when he was smaller, to ensure that he didn't eat anything that might have led to an allergic reaction. There may have been a lot of anxiety, from you, about his eating. I am interested to know how severe his allergy was. Because, if it was very severe then it must have really upped the ante in terms of the anxiety you may have felt and the vigilance required from you.

If that is the case, then it would have been very easy for your son to also become hyper-vigilant and anxious about the food he ate. It was probably a natural thing for him to have a heightened awareness about what he ate.

It would be equally easy for that, understandable, anxiety and vigilance about his food to develop into an obsession on his part. With all of the focus on his food from other people, it may have been a natural step for him to focus intently on it too.

Even the fact that, I'd imagine, you had to be very controlling of what he ate, until he was old enough to know for himself what was dangerous for him, may have set up a particular dynamic of control for him with regard to food.

Perhaps he just relies on other people to give him the messages (and the approval) to eat. For example, you describe how he will complain of being hungry, even if he has eaten his fill. It is almost as if he has never learned to pay attention to his own body signals of true hunger, or satiety.

You don't mention it, but I wonder about his weight too? Have you had him recently checked by your GP in relation to his growth? Is he within the normal height and weight bands for his age?

If he is, then it might be interesting to see what will happen if you remove some of the restrictions on his eating, allowing him to graze and snack on healthy foods. Giving him some responsibility for what he can eat might remove some anxiety he has.

Has his dairy allergy been rechecked since he was a baby? Often, as children get older, their tolerances for certain foods change. If his allergic reaction has lessened, then that might also be an opportunity to avoid having to restrict his eating.

At the moment, it almost seems like he panics if he can't eat. If he had greater freedom and choice, it might remove the sense of panic and actually allow his eating to rebalance naturally. Often, the most difficult thing we have to do, as parents, is to reduce our control of what children eat. We can fear that they will eat too much or too little (or in the case of allergies, the wrong thing).

But, if we continue to always take responsibility for what children eat, when they eat and how much they eat, they may never learn to regulate their eating for themselves. Allowing them greater choice and greater freedom, about their eating, will help them along that path.

Our nine-year-old son collects rubbish and stores it under his bed. How do we get him to stop?

Question: Our nine-year-old son has a habit of collecting and storing rubbish under his bed. He goes through our household refuse to gather what he likes. He has even picked up rubbish from the street. There is absolutely no reasoning with him. He also won't handle doors, or touch anything in public as he does not want his fingerprints left behind. He has really strong attachments to both of us and finds it challenging to sleep over, for example, with other family members. We are really concerned as this unusual behaviour is escalating at a rapid pace. How do we get him to stop?

David replies: It isn't often that I suggest, from the outset, that families seek professional help to deal with the issues that are brought to me in this forum.

However, there are enough elements to the issues you have described for your son that lead me to suspect that he has Obsessive Compulsive Disorder (OCD). If this is indeed the case, then you and he will need the support of a good child psychologist to resolve the problems.

With your son, both the rubbish collecting (hoarding) and the fears of leaving his fingerprints behind him, such that he avoids touching certain things, fit with something like OCD. The fact that he is also anxious, at times, about separations from you both, further strengthens my belief that he has OCD.

Many people think of someone with OCD as someone who is a bit of a perfectionist, or likes things done in a certain way. In truth, though, OCD goes way beyond simple perfectionism and can be very debilitating. True OCD sufferers will typically have ritualised behaviours that they feel compelled to do in order to stave off some perceived threat of harm to themselves or others.

Alongside the compulsive behaviours, they may also have obsessive thoughts.

Those thoughts tend to be circular, repetitive and dreadfully intrusive. It is like they can be caught in a loop, with a thought going around and around in their head, and the only way they know how to break the cycle is to, perhaps, carry out some action to free themselves.

OCD is hard to live with. It is hard for the child (or adult) who suffers directly with it. It is also hard for family members to watch the compulsive behaviours and to see their son or daughter so caught, and at times, distressed by the loop they are in.

OCD is very much linked to anxiety. Typically, very powerful fears drive the obsessions and the compulsions.

Sufferers of OCD can believe, for example, that if they don't carry out the correct sequence of a behaviour that they or someone close to them might die.

OCD is best treated with Cognitive Behaviour Therapy (CBT). When I work with children with OCD, I usually start by trying to understand where the initial anxiety originated. Once we understand why the child got anxious, we can then trace how they came to carry out the compulsive behaviour as a coping strategy.

Alongside this, I'll teach the child anxiety management strategies, like breathing techniques or guided visualisations/meditations to give them the confidence that they can regulate their anxiety.

Then, armed with an understanding of how the anxiety began, and why, we can apply the anxiety management strategies while stopping or changing the compulsive behaviours.

So, even though the child might get anxious when they can't do their usual rituals or behaviours, they have learned how to calm themselves enough that they can then challenge the irrational fears, cognitively.

It isn't a simple process and can often take quite a bit of work. This is the main reason that I suggest you try to find someone who has experience of OCD and also of working with children, who can do this work with you and your son.

If you'd like to know more about OCD, type the link below into your web browser and find lots of useful information.

For more information visit: mental-health/obsessive-compulsive-disorder

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