Eating disorders are complex illnesses that affect people of all ages; the onset of eating disorders typically occurs during pre-adolescence or adolescence. Eating disorders affect millions of adolescents and young adults in the U.S. alone. Given the serious medical complications that may result from eating disorders, it is imperative to identify, diagnose and treat them as early as possible. With early diagnosis and proper treatment, recovery is possible.
The data around adolescent eating disorders is alarming:
- 95% of those with eating disorders are between the ages of 12 and 25 (SAMHSA)
- 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming overweight. This concern endures through life. (Smolak, 2011)
- Among high-school students, 44% of females and 15% of males attempted to lose weight. (Serdula et al., 1993)
- 35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders. (Shisslak & Crago, 1995)
- Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors (ex, skipping meals, fasting, smoking cigarettes, purging) (Neumark-Sztainer, 2005)
Causes of Eating Disorders
Although there is a correlation between the notion of an “ideal” body and eating disorders, there is no consensus as to the root cause of eating disorders. The general belief is that eating disorders result from one or more biological, behavioral, and social factors including genetics, unpleasant experiences/trauma, peer pressure, teasing, family members with eating disorders, among others.
While eating disorders as a group is complex, most begin with either accidental or purposeful weight loss that can lead to unhealthy measures to sustain the loss.
Pre-adolescence and adolescence are particularly challenging years for those with eating disorders given emotional and physical changes, as well as academic, family and peer pressures.
Many teenagers report that the onset of their eating disorder involved comments or teasing by peers, usually about appearance. Whether done in the context of an innocent family nickname or in a malicious bullying event, these instances of feeling shame, or being shamed, based on size or physical appearance are powerful contributors to a teenager developing an eating disorder. The tendency for females, specifically, to ‘bond’ around ‘fat talk’ and negative body discussions have also been associated with the development of an eating disorder.
Teenagers and their families can play a significant role in preventing or stopping early-stage eating disorders by not participating in these types of conversations and by taking bullying concerns seriously.
Diagnosing Eating Disorders
The earlier eating disorders are diagnosed and treated, the more likely the probability of complete recovery. However, many adolescents go undiagnosed and do not receive treatment until their eating disorders are at an advanced stage. One reason is teenagers with eating disorders often try to hide their behaviors. Or teenagers (as well as family and friends) may be in denial about their eating disorders, or simply unaware of the signs and symptoms of an eating disorder.
It can be difficult to identify a teenager with an eating disorder, as they may appear to be a ‘normal weight’. Yet teenagers can be very malnourished even at seemingly ‘normal weights’. They may also appear to eat normally in front of peers or family while secretly restricting food intake, bingeing, purging, or over-exercising.
Different types of eating disorders produce different warning signs, about which friends, family, and patients themselves should become aware.
Types Of Eating Disorders
An eating disorder is commonly defined as an all-consuming desire to be thin and/or an intense fear of weight gain. The most common eating disorders among adolescents are anorexia, bulimia, and binge-eating disorder. Even patients that do not meet all of the clinical criteria for an eating disorder can be at serious risk and should seek medical treatment.
Teenagers with anorexia may take extreme measures to avoid eating and control the quantity and quality of the foods they do eat. They may become abnormally thin, or thin for their body, and still talk about feeling fat. They typically continue to diet even at very unhealthy weights because they have a distorted image of their body.
Signs of anorexia may include:
- A distorted view of one’s body weight, size or shape; sees self as too fat, even when very underweight
- Hiding or discarding food
- Obsessively counting calories and/or grams of fat in the diet
- Denial of feelings of hunger
- Developing rituals around preparing food and eating
- Compulsive or excessive exercise
- Social withdrawal
- Pronounced emotional changes, such as irritability, depression and anxiety
Physical signs of anorexia include rapid or excessive weight loss; feeling cold, tired and weak; thinning hair; absence of menstrual cycles in females; and dizziness or fainting.
Teenagers with anorexia often restrict not only food, but relationships, social activities and pleasurable experiences.
Teenagers with bulimia nervosa typically ‘binge and purge’ by engaging in uncontrollable episodes of overeating (bingeing) usually followed by compensatory behavior such as: purging through vomiting, use of laxatives, enemas, fasting, or excessive exercise. Eating binges may occur as often as several times a day but are most common in the evening and night hours.
Teenagers with bulimia often go unnoticed due to the ability to maintain a normal body weight.
Signs of bulimia may include:
- Eating unusually large amounts of food with no apparent change in weight
- Hiding food or discarded food containers and wrappers
- Excessive exercise or fasting
- Peculiar eating habits or rituals
- Frequent tips to the bathroom after meals
- Inappropriate use of laxatives, diuretics, or other cathartics
- Overachieving and impulsive behaviors
- Frequently clogged showers or toilets
Physical signs of bulimia include discolored teeth, odor on the breath, stomach pain, calluses/scarring on the hands caused by self-inducing vomiting, irregular or absent menstrual periods, and weakness or fatigue.
Teenagers with bulimia often have a preoccupation with body weight and shape, as well as a distorted body image. The clinical diagnosis commonly defines a teenager as having bulimia if they binge and purge on average once a week for at least three consecutive months.
Binge Eating Disorders
Binge eating disorder is characterized by a sense of uncontrollable excessive eating, followed by feelings of shame and guilt. Unlike those with bulimia, however, teenagers with binge eating disorders typically do not compensate for their binges.
Teenagers with binge eating disorder are typically overweight. They may feel like they have no control over their behavior and eat in secret when they are not hungry.
Signs of Binge Eating Disorder might include:
- Eating unusually large amounts of food in a distinct period of time (within 2 hours)
- Eating rapidy
- Hiding food or discarded food containers and wrappers
- Eating in secret because of feeling embarassed by how much they are eating
- Eating when stressed or when feeling uncertain how to cope
- Feeling that they are unable to control how much they eat and disgusted with themselves afterwards
- Experimentation with different diets
Most of the physical signs and symptoms associated with binge eating disorder are long-term including weight gain (often leading to obesity), high blood pressure, diabetes, irregular menstrual cycle, skin disorders and heart disease.
Similar to bulimia, binge eating disorder is commonly diagnosed if teenagers binge on average once a week for at least three consecutive months.
Eating Disorder Treatment
Recommended treatment for adolescent eating disorders usually involves a multidisciplinary approach. Treatment should include medical; psychiatric; individual, group and, in particular, family therapy; along with nutritional rehabilitation aimed at restoring health and body weight and eventually modifying behaviors related to eating and exercise. Treatment should always be based on a comprehensive evaluation of the individual and family.
The frequency of medical complications during the course of treatment requires the close supervision of a medical professional. Medication may be required if certain psychiatric disorders are also present; most commonly depression and anxiety disorders. Teenagers may have obsessive-compulsive disorder or tendencies, and may also suffer from trauma or substance abuse, or engage in self-harming behavior, such as cutting or burning. It is important that eating disorder treatment works to identify and address these co-occurring disorders. Individual therapy usually includes both behavioral and cognitive techniques. Group therapy allows individuals struggling with eating disorders to find a place where they can open up and be honest and real about their struggles, relate to others, and receive much needed support. Family therapy is intially focused on supporting the family in nutritional rehabilitation and later, offering the opportunity to navigate other challenges of adolescence and mental health. Nutritional counseling includes a combination of nutrition education, meal planning and goal setting. It also may include hands-on experiential and skills work. Treatment helps the individual recovering from an eating disorder cultivate a healthier relationship with food in order to gain the skills and education needed to eventually feed oneself going forward.
Common Eating Disorder Myths
You can tell if someone has an eating disorder just by looking at them
Individuals with eating disorders come in all shapes and sizes and many individuals with anorexia may not ever appear so drastically underweight. Additionally, many individuals with severe eating disorders including bulimia and binge eating disorder can be underweight, normal weight, overweight or obese and often fluctuate in weight. Even athletes who appear to be incredibly fit might be struggling with an eating disorder. You cannot define someone’s health by how much they weigh and you cannot determine whether they have an eating disorder just by looking at them.
Eating Disorders are a result of over controlling parents and dysfunctional families
Parents are often unfairly blamed for an individual’s eating disorder. While genetic factors and family relationships can be major contributors to a teenager’s risk for developing an eating disorder, we also know that parents and families play an integral role in helping a loved one recover. For this reason family therapy is a primary therapeutic modality used for adolescents and is also strongly encouraged for adults.
Eating Disorders are a lifestyle choice
Eating disorders are serious illnesses with mental and physical consequences that often involve a great deal of suffering. No one ‘chooses’ to have this illness. Someone, however, can make the choice to pursue recovery. The act of recovery is a lot of hard work and involves more than simply deciding to not act on symptoms. In most cases, the eating disorder has become a person’s primary way of coping with intense emotions and difficult life events.
Eating disorders are benign
Eating disorders are serious psychological conditions and can lead to very serious medical problems. They have the highest mortality rate of any mental illness and are also associated with an increased risk of suicide.
Eating disorders are just a teen phase. They will go away if you ignore them.
While eating disorders generally begin during teen years they are not a normal part of growing up. Puberty is a time of great change biologically, physically and psychologically. Teenagers are often vulnerable to societal pressures and can often feel insecure and self-conscious, which are factors that increase the risk of engaging in extreme dieting behavior. Ignoring signs of adolescent eating disorders can have serious lifelong medical and psychological repercussions.
Recovery from eating disorders is rare
Recovery, though challenging, is absolutely possible. Recovery can take months or years, but with proper treatment, started immediately, many people do eventually recover and go on to live a life free from their eating disorder.