Cimino Silvia, Bevilacqua Arturo, Cerniglia Luca
Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, 00186 Rome, Italy.
Faculty of Psychology, International Telematic University Uninettuno, 00186 Rome, Italy.
J Clin Med. 2025 Aug 26;14(17):6042. doi: 10.3390/jcm14176042.
Recent years have witnessed a concerning rise in early-onset eating disorders (EDs), prompting a re-evaluation of their etiology, diagnosis, and treatment within pediatric populations. This perspective article synthesizes emerging evidence on the multifactorial origins of EDs in children, emphasizing a biopsychosocial framework that integrates genetic, epigenetic, psychological, and environmental factors. While early manifestations often diverge from adolescent or adult profiles-marked by somatic complaints, selective eating, and ritualistic behaviors-the disorders significantly interfere with developmental milestones. The COVID-19 pandemic has further exacerbated vulnerabilities, acting as a catalyst for disordered eating behaviors through increased familial stress, isolation, and disrupted routines. Central to this framework is the role of parental psychopathology and parent-child feeding interactions, which profoundly shape children's emotional regulation and attachment patterns. Recent studies also underscore genetic susceptibilities-especially variants in the DRD4 and DAT1 genes-and epigenetic modifications that may mediate the transmission of risk across generations. The article reviews evidence from observational and genomic studies, highlighting how altered gene expression linked to early environmental stress contributes to the heterogeneity of EDs. Finally, it evaluates prevention and intervention strategies, including family-based treatments, digital health tools, and school-based programs. These strategies are essential for timely detection, individualized care, and reducing long-term impairment. Overall, the paper advocates for a nuanced understanding of EDs in children-recognizing their complex origins and developmental implications-to inform clinical practice, public health policy, and future research in pediatric mental health.
近年来，早发性饮食失调症（EDs）呈令人担忧的上升趋势，促使人们重新评估其在儿童群体中的病因、诊断和治疗方法。这篇观点文章综合了有关儿童饮食失调症多因素起源的新证据，强调了一个整合了遗传、表观遗传、心理和环境因素的生物心理社会框架。虽然早期表现往往与青少年或成人的情况不同，其特征为躯体不适、挑食和仪式化行为，但这些疾病会严重干扰发育里程碑。新冠疫情进一步加剧了脆弱性，通过增加家庭压力、隔离和打乱日常安排，成为饮食失调行为的催化剂。这个框架的核心是父母精神病理学和亲子喂养互动的作用，它们深刻地塑造了孩子的情绪调节和依恋模式。最近的研究还强调了遗传易感性，特别是DRD4和DAT1基因的变异，以及可能介导风险代际传递的表观遗传修饰。文章回顾了观察性研究和基因组研究的证据，强调了与早期环境压力相关的基因表达改变如何导致饮食失调症的异质性。最后，文章评估了预防和干预策略，包括基于家庭的治疗、数字健康工具和学校项目。这些策略对于及时发现、个性化护理和减少长期损害至关重要。总体而言，本文主张对儿童饮食失调症有细致入微的理解，认识到其复杂的起源和发育影响，为临床实践、公共卫生政策以及儿童心理健康的未来研究提供参考。
