What Is an Eating Disorder and When to Worry

All teenagers worry about their appearance. Self-esteem can be precarious during adolescence, and body consciousness comes with the territory. But if you’ve noticed that your child is fixated on weight, you’re probably worried. So what is the difference between normal behavior and behavior that might indicate an eating disorder?

• Distorted Body Image: While other people see a normal (or painfully skinny) kid, teenagers with eating disorders look into the mirror and see a different person entirely. They have a distorted perception of their own appearance, and no amount of reassurance from family and friends—all of them saying, “You’re not fat”—will change that conviction.
• Fixated on Appearance: Young people who develop eating disorders are extraordinarily focused on their appearance as a measure of self-worth. While other kids tend to stake their identities on their interests and accomplishments, these teenagers have their emotions, and their lives, wrapped up in thoughts of food and appearance.
• Extreme Dieting: Anorexia nervosa, the most common eating disorder, is self-imposed starvation, usually by a young woman who is otherwise high-functioning. Personality types more likely to develop the disorder include athletes, perfectionists, and over-achievers. They are driven to maintain a dangerously low body weight because of a distorted self-image. Detecting anorexia can be very difficult because it typically affects high-performing kids.
• Overeating: Kids with bulimia nervosa, the other most common eating disorder, indulge in periodic and usually secretive binges. Many kids with bulimia say they feel out of control during their binges and describe them as “out of body experiences.” To compensate, many will purge afterward or diet strenuously. Teenagers with the disorder may be very influenced by body ideals perpetuated in media and popular culture. It can be difficult to diagnose the disorder because people with bulimia can have a normal body weight or may even be overweight.

Kids with eating disorders often try to keep their unhealthy eating habits and behaviors a secret, but there are still some signs that parents might notice.

• Losing weight unexpectedly and/or being dangerously thin (Despite their extreme thinness, kids with anorexia usually don’t think that they are unhealthy and actually want to lose even more weight.)
• Obsessing over calorie counts, nutritional facts, and diets
• Spending many hours exercising to burn off calories
• Skipping meals
• Avoiding eating socially
• Irregular periods, thinning hair, and constant exhaustion

• Exercising excessively or using diet pills or laxatives
• Going to the bathroom immediately after meals
• Spending a lot of time in the bathroom
• Having a sore throat, sore knuckles, discolored teeth, and poor enamel
• Hoarding food in her room
• Having large amounts of food that go missing at home

Eating disorders can affect all kinds of kids for all kinds of reasons. Still, there things you can do to help your child build a healthy relationship with food and eating and reduce the risk that they might develop an eating disorder.

• Try to establish healthy eating habits. Make a routine of eating healthy, balanced meals as a family.
• Discuss foods in terms of how healthy they are, not how “good” or “bad” they are.
• Don’t criticize your child’s weight or appearance. Adolescence is a difficult time for most kids, and it’s essential to provide them with a nurturing and supportive environment.
• Some kids are more likely than others to develop eating disorders. Be extra vigilant if you have a family history of eating disorders or if you know that your child is under extreme pressure to look a certain way.

Eating disorders in children are very serious and can be deadly, but they’re also treatable. If you think your child has an eating disorder, you should contact a doctor for help immediately.

Hospitalization is sometimes necessary, but for many kids with eating disorders, the recommended treatment involves staying at home and recovering under their family’s care. Family-based treatment (FBT) coaches parents on guiding their child’s recovery and evidence shows that it helps kids return to a healthy weight more quickly than other treatments. Enhanced cognitive behavioral therapy (called CBT-E) and adolescent-focused therapy (called AFT) have also been shown to be effective in many cases, though they generally work more slowly than FBT.