Help! What Do I Do If I Think My Teenager Has An Eating Disorder?
You’re not sure how to help your teenager, and you can’t seem to get through to them.
You want to help, but you feel like everything you do just makes things worse. You feel stuck and unsure how you can help your teenager who seems to be struggling with food and body. If this is you, you’re not alone! So many parents struggle to understand eating disorders and how their teenagers are affected by them. We want to commend you for taking the time to read this article! You’re already helping your child by researching and educating yourself.
Eating disorders are incredibly complex, and they can look very different from child to child. Some teenagers exhibit signs of disordered eating, while others exhibit full blown eating disorders. And because disordered eating and eating disorders exist on a spectrum, many of the behaviors are the same but the severity and frequency of behaviors changes. In addition to this, culturally, we’re taught to associate thinness or extreme thinness with anorexia and larger bodies with binge eating or bulimia, but the truth is: eating disorders come in ALL size bodies and you cannot tell by looking at your teen’s body size what eating disorder they may be struggling with.
The nature of eating disorders vary from teen to teen which can make it extremely difficult for parents, like you, to identify whether or not your child is battling an eating disorder.
What’s the difference between an eating disorder and disordered eating for teenagers ?
It’s important to understand the difference between disordered eating and an eating disorder for several reasons: 1) To avoid normalizing your teens disordered eating behaviors, 2) To help teens feel validated in their diagnosis, and 3) To help your teen share their experience without fear of not being taken seriously.
An eating disorder, according to the DSM-5, is defined as a “behavioral condition characterized by severe, persistent disturbance in eating behaviors and is associated with distressing emotions and thoughts”. Eating disorders are thought to develop from a triad of biological, sociocultural, and psychological influences. There are different types of eating disorders, including the following:
Anorexia nervosa and atypical anorexia (the latter being more typical than the former)
While eating disorders are mental health diagnoses, disordered eating is a common behavior associated and seen with eating disorders. Some disordered eating behaviors may not necessarily tick all the boxes to receive an eating disorder diagnosis, but it’s still important to recognize the behaviors as disordered and disruptive for your teenager. Disordered eating behaviors still deserve attention and treatment, even if they’re not clinically an eating disorder.
What are the signs and symptoms of eating disorders in teens?
Despite what you may have been taught, eating disorders don’t have a look. Eating disorders aren’t just thin teenage girls avoiding meals or purging in the bathroom. This is partially why they can be so difficult to identify and diagnose. While eating disorders don’t have a “look”, they do have similar behavioral patterns and characteristics that help to give you insight into whether your teen child is struggling.
Some typical signs and symptoms of eating disorders in teenagers include:
Frequently skipping meals or snacks
Making excuses for not eating
Sudden weight changes
A shift in clothing choice usually to baggy and/or long sleeves and loose pants
Binge eating and/or eating in secret
Counting or cutting out calories, carbs, or other food groups
Obsession over quality of food
Having a very restricted diet that avoids foods or food groups
Fixation on healthy eating
Frequent talk of weight or desire to lose weight
Social isolation and withdrawal from activities
Frequently body-checking in mirrors or reflections
Calluses on knuckles from inducing vomiting after eating
Repeatedly going to the bathroom right after meals
Eating alone or secretively
Exercising excessively, even in states of illness or injury and exercising after meals
Choosing exercise over social events, family events, or school
You can’t physically tell whether your teen has an eating disorder or disordered eating simply by looking at them, this is why body weight and size is not on this list. Your teen could be at what is considered a “healthy” weight*, and still exhibit signs of an eating disorder. The thoughts and feelings around food, exercise, and body image help give insight as to whether or not your teen is struggling.
Why is my teenager struggling with an eating disorder?
You’re probably wondering why this is happening to your teenager, especially if you’ve never struggled with body image or your relationship with food yourself, or if you didn’t struggle in the same way. Alternatively, you might be feeling like your teen’s potential eating disorder is your fault because your relationship to food and your body is not so great.
The development of an eating disorder is multifactorial, and it is never just one thing, such as parenting, that impacts the development of a eating disorder for teens. Teenage years are also an incredibly sensitive time for adolescents. They’re navigating the complexities of social situations, high school, planning for college, sports, bodily changes, and more. For some teens, they feel tremendous pressure to perform, to succeed, and may feel other stressors about the world they live in, their safety, and their future.
When teens feel this way, they turn towards what they have available to cope with the overwhelming feelings they have. For many teenagers, their eating disorder is their coping mechanism, even if temporary. They use their eating disorder to feel a sense of control or stability, to numb out, or to try to regulate their emotions in stressful or changing environments.
Factors that put teenagers at increased risk for developing eating disorders include:
Stressful situations - Your teenager is likely trying to figure out what they are going to do with their life. They’re deciding where they want to go to college, if they want to go to college, where they want to move, etc. They’re worried about passing standardized tests and ensuring they get into a good school. All super big decisions that change the trajectory of life! It’s no shock that they may feel anxious or stressed during this period of uncertainty and pressure.
Coexisting mental illnesses - Research shows that eating disorders often coexist with other mental conditions, including anxiety, depression, substance abuse, OCD, and more. Eating disorders can arise as an attempt for your teenager to cope with other mental illnesses. For example, if your child is experiencing anxiety, they may use binging, restriction, or purging behaviors in an attempt to control their anxiety. Teens experiencing depression often lose their appetite and develop an eating disorder, and the eating disorder itself can cause your teen to feel more depressed causing increased lose of appetite. Those struggling with OCD (obsessive compulsive disorder) also utilize eating disorders as a means to feel in control. If you feel that your teen has another mental illness, it’s best to seek psychiatric evaluation.
Social media and pressure to fit in - Now more than ever, teenagers are feeling intense pressures to fit into the social norm. Diet and wellness culture are continuing to dominate social media, giving teens access to all sorts of false, inappropriate, and misleading information. Your teenager may be struggling to attain unrealistic body standards set by models, celebrities, and social media influencers. To make matters worse, a current popular social media trend called "What I Eat In A Day" (WIEIAD) is dominating Instagram, Youtube and TikTok. These videos are extremely harmful to teenagers and adolescents and teach them that nutrition is a one-size-fits-all. If your teenager is struggling with disordered eating, it’s likely that they may feel the pressure to conform to unrealistic standards set by social media.
Bodily changes and comparisons associated with puberty - Accepting changes to our bodies both physically and emotionally during puberty can be extremely difficult and serve as a great source of stress for many teenagers. Their body composition is changing drastically, such as an increase in body fat percentage, which is necessary and needed, and this can create a multitude of body image issues. Add to this parents worry about their kid gaining weight, and potential stress from doctors as your teen goes through puberty to “watch your kids body weight”. Additionally, your teen is experiencing drastic hormonal changes that create strong emotions. Your teen may be stuck in a cycle of self-comparison as they wonder why their body looks so different from those around them.
Dieting and restrictive talk in the home - Teenagers learn from those around them, especially from those in the same home as them. If you, your partner, or anyone else in the home frequently diets, discusses losing weight, restricts foods or food groups, or obsesses over body image and eating healthy, it may be time to consider how you may be impacting your teenage child. Parents and guardians often unintentionally pass on their food and body related concerns to their children. An “almond mom”, a popular term currently circulating the media, refers to a mother (can also be applied to dad’s and caregivers) that demonstrates problematic behaviors towards food, exercise, and body image that puts their child at a great risk for developing an eating disorder. While this phenomenon is almost always unintentional, it’s still important to consider how your teen’s home environment may be contributing to their disordered eating behaviors.
It’s our recommendation at Bravespace Nutrition, that parents seek out support from an anti-diet, eating disorder dietitian so that you as a parent/caregiver can work on your relationship to food and your body which is a essential to support your teenager in healing their relationship to food and body.
Pressure to perform well - It’s common for teens to experience an intense pressure to perform well, both academically and physically, while in middle school and high school. Pressure from parents, coaches, and teachers can overwhelm teens and cause them to feel intense anxiety and stress. They might turn towards disordered eating as a means to self-soothe and cope with the intensities of teenhood.
Traumatic experiences- Trauma is the “the lasting emotional response that often results from living through a distressing event. Experiencing a traumatic event can harm a person's sense of safety, sense of self, and ability to regulate emotions and navigate relationships.” These can be things like experiencing a school mass shooting, experiencing divorce or parents, sexual assault/abuse, emotional neglect, and much more. Many teens have experienced some form of trauma, if not multiple forms, and eating disorders often arise as a way to cope with the aftermath of the traumatic event and how it impacts their sense of the world around them.
Four things you can do if you suspect your teen has an eating disorder:
Trust your parental instincts.
If you feel that there is something wrong, there most likely is something wrong. Don’t be afraid to take action and seek help. It’s likely that your teen may express anger, withdrawal, and discomfort in the treatment process. It’s not uncommon that teens will not want to get help or support. As mentioned earlier, even though their eating disorder is harmful, it’s one of their coping mechanisms. When you threaten to take away that coping mechanism, your teen can feel betrayed, angry, and hurt. This is a normal reaction. It can feel overwhelming, and the uncertainty of potentially disrupting your child’s normal life can prevent parents from seeking help. We want to empower you to take that leap of faith and seek assistance. You can’t do this on your own, and you don’t have to!
Seek medical treatment for your child.
We want to encourage you to seek prompt medical treatment for your child no matter what size body your teenager is in. Eating disorders come in all size bodies even if your child “looks healthy” or is in a larger body. This includes psychiatric evaluation, therapeutic intervention, and dietetic services. Eating disorders are complex illnesses that require a team-based, interdisciplinary treatment approach. Although it may feel overwhelming at first, eating disorder patients rarely reach full recovery without an interdisciplinary team. It’s crucial for your teen to receive help from a variety of practitioners to have the best chance for recovery.
Avoid conversations about dieting, weight, and restriction.
Perhaps the most challenging of all, it’s important to engage in self-reflection in this process. Look at your own behaviors around weight, food, dieting, and body image. Ask yourself these questions:
Do I frequently skip meals or avoid eating in an attempt to alter my physical appearance?
Do I constantly talk about calories or label foods as “bad”?
Do I restrict certain foods or food groups?
Do I frequently comment on my own weight or my teen’s weight?
Do I frequently make comments about what my child is or isn’t eating?
Do I constantly rotate between diets or dieting programs?
Do I lock cabinets or prohibit my child from reaching places where food is stored?
Do I have fatphobia or internalized weight stigma that I am unknowingly projecting onto my child?
If the answer is yes to any of these questions, we invite you to speak with our virtual non-diet, eating disorder dietitians at Bravespace Nutrition to learn how you can alter your home environment to better serve your teen! It’s likely that your teen is already experiencing overwhelming internal thoughts about food and body image on their own. While it may be tempting to get your child to eat or discuss your concern about their weight, it’s best to avoid conversations about weight, food intake, dieting and body image around your teen, even if you’re not directly speaking to them.
Promote a positive environment with food and body image.
It’s incredibly important to maintain a positive environment about food and body image. Learning about intuitive eating and how it may positively impact your teen’s relationship with food can be helpful! You can also practice modeling inclusive language, and challenging your own beliefs about bodies, by learning about the Health At Every Size (HAES) movement. These frameworks serve as guidelines for you and your teen to practice anti-diet approaches and give your teen the best chance for recovery. We recommend you seek help from an anti-diet registered dietitian that specializes in intuitive eating to help create the best environment with food and body image possible!
Note from earlier in the article: *Health is not determined by body size and this language is usually guided by BMI criteria and medical weight stigma.
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