Identifying and Intervening: How to Determine if your Teenager has an Eating Disorder

Recently, you’ve noticed your 15-year-old daughter making excuses not to eat dinner with the family. Your younger son jokes about her going on another diet, and her father says, “You need to put some meat on your bones.” She screams back at you that she ate a big lunch at school and is not hungry. When she gets up suddenly to leave the room, her baggy clothes, although stylish, look more oversized than usual.
For the eighth night in a row, you hear vigorous jumping in her room, and think that she’s been practicing her cheerleading routine a lot lately. She’s been more irritable lately and her weight concerns you. You try to talk to her about it, but she denies. You make statements to her like, “You’re looking really thin,” but she says in response, “I’m gaining weight and look fat” If this example sounds familiar to you, it is appropriate for you to be concerned about your daughter’s health and her emotions.

Teenage girls are most at risk for developing eating disorders such as anorexia nervosa and bulimia nervosa. They are also at risk for compulsive overeating and obesity. Boys are also susceptible to eating disorders but these cases are not as prevalent. Teenagers are under a lot of pressure to succeed and fit in. Many spend a lot of time worrying about what others think, and they desperately try to conform to society’s unattainable “ideal” body image. They are led to believe that if they are thin, they will be accepted. School-based surveys indicate that about 80% of high school students believe that they need to lose weight. Over one-half of high school girls acknowledge that they have dieted; 20% of these admit to dangerous weight loss methods.

Recognizing the methods teens may use in an attempt to lose weight may help the informed parent to determine if their teen is at risk. The methods most often used by teens will most often include some or all of the following:

Visible food restriction and self-starvation
Eating low calorie and low fat food almost exclusively
Obsessions with calories and fat content of foods
Eating very slowly
Visible binging and/or purging
Pre-occupation with food, weight, and cooking
Talking themselves out of hunger—making excuses not to eat
Hiding food in strange places (i.e. closets, car)
Limited choice in foods
Unusual food rituals such as shifting the food around on the plate; cutting food into tiny pieces; and chewing food and then spitting it out
Reading books about weight loss
Obsessions with exercise
Mood swings—depression, fatigue, irritability, anxiety
Insomnia—-poor sleeping patterns
Change in peer relationships—isolation from peers
Physical changes—weight loss, loss of menstrual cycle, hair loss, complaints of feeling cold, dizziness and headaches
Distorted self-perception of their body shape
Parents frequently ask how to identify symptoms of anorexia nervosa and bulimia. Unfortunately, many teenagers successfully hide these serious and sometimes fatal disorders from their families for many months or years. Parents should be on the lookout for the various symptoms and warning signs listed above. If you are able to identify with any of the symptoms mentioned above, it may mean that your teenager meets criteria for having an eating disorder.

The treatment of teens with eating disorders is challenging. The effects of the disorder can be extremely serious, sometimes leading to acute medical instability, suicidality and even death. The psychotherapist who works with teens with eating disorders often finds themselves in the untenable position of attempting to support the teen’s health and self-esteem, while the teen attempts to hold onto the eating disorder despite it’s potential consequences.

If your teenager demonstrates any of the signs and symptoms of an eating disorder as described above, do not hesitate to consult your teen’s pediatrician, a psychotherapist, or a psychiatrist whom specializes in eating disorders. Early identification and intervention will help to ensure that your teenager can return to a healthy and happy life.