Recognizing the Red Flags
To truly be able to recognize the signs and symptoms of disordered eating in your child or teen, it is essential first to understand what describes an eating disorder. Eating disorders are real illnesses. Despite the opinions of some, they are not merely something that is "in the head" of the person who is suffering. Eating disorders do not manifest and exert their control by choice of the individual who struggles with them.
Take a moment to consider the following statistics provided by The National Association of Anorexia Nervosa and Associated Disorders or ANAD:
- In the United States, at least 30 million people of all ages and genders suffer from an eating disorder.
- Every 62 minutes, at least one person dies as a direct result of an eating disorder.
- Eating disorders have the highest mortality rate of any mental illness.
- In a large national study of college students, 3.5% of sexual minority women and 2.1% of sexual minority men reported having an eating disorder.
- 16% of transgender college students reported having an eating disorder.
- Eating disorders affect all races and ethnic groups.
- Genetics, environmental factors and personality traits all combine to create risk for an eating disorder.
The statistics speak for themselves in terms of the severity of this epidemic. Eating disorders are not biased when it comes to those who may be living with one of many different illnesses. Once it has been determined that there could be a concern regarding an eating disorder, it is imperative to seek treatment, but how do you determine if the eating habits of your child or teen are of concern?
There are various diagnosable eating disorders listed by the National Eating Disorders Association. Some are certainly more well-known than others, but many share common symptoms. First, we will go over some of the more common eating disorders and then address the signs to watch for. Finally, we will discuss how to begin the process of seeking treatment.
Prevalent Eating Disorders
Anorexia Nervosa
Anorexia nervosa, or anorexia, is an eating disorder characterized by weight loss (or, in growing children, improper weight gain), difficulties maintaining appropriate body weight for height, age and stature, and distorted body image. People with anorexia will often restrict the number of calories they eat or the types of food they eat to control what they see as unacceptable weight gain. Some individuals will also exercise compulsively or abuse laxatives to further their weight loss.
There are specific diagnostic criteria for anorexia. Your medical provider will need to address this to determine the symptoms of the eating disorder your teen may be experiencing. However, it is essential to note that even if the criteria for anorexia is not met, a severe eating disorder could still be present, which could negatively impact the health of your child.
Bulimia Nervosa
Bulimia is a potentially life-threatening eating disorder that is characterized by a continual cycle of binge eating and purging. Purging is a compensatory behavior such as self-induced vomiting or induction of bowel movements, which are designed to "undo" the effects of the period of binge eating. As with anorexia, there are specific diagnostic criteria. The long-term effects of bulimia can affect the entire digestive system and lead to chemical imbalances in the body that can impact the heart and other major organs.
Avoidant Restrictive Food Intake (ARFID)
Previously referred to as selective eating disorder, ARFID is similar to anorexia in that both disorders involve self-imposed limitations on the amount or types of food consumed. Where ARFID differs from anorexia is that ARFID does not involve psychological distress about body shape and size. Children and teens with ARFID are generally more than your typical picky eater, as they do not consume enough calories to grow and develop properly.
Pica
Pica is an eating disorder that is not as commonly known as the first three. Pica is an eating disorder that involves eating things that are not widely thought of as food items such as hair, dirt, paper and paint chips. The signs and symptoms of pica are a little different than some of the more common eating disorders. Pica often occurs in conjunction with other mental health disorders associated with impaired functioning. Additionally, malnutrition and iron-deficiency anemia are two of the most common causes of pica.
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Signs and Symptoms of Eating Disorders
As noted above, each eating disorder has its own specific diagnostic criteria and symptoms to watch for. However, some signs and symptoms are generally present regardless of the particular disorder. These could include:
- Dramatic weight loss.
- Evidence of binge eating or purging behaviors.
- Dresses in layers to hide their figure, or because they are cold.
- Preoccupied with weight, food, calories, fat grams and dieting.
- Refuses to eat certain foods, progressing to restrictions against whole categories of food.
- Shows physical symptoms such as being cold, or experiencing abdominal pain.
- Denies feeling hungry.
- Develop food rituals (eating foods in specific orders, excessive chewing, rearranging food on a plate).
- Is quick to try new fad diets or seems to be dieting often.
- Consistently makes excuses to avoid mealtimes or situations involving food.
- Feels the need to exercise more than needed.
- Maintains an excessive, rigid exercise regimen despite weather, fatigue, illness, or injury.
- Isolates themselves and spends more time alone, away from friends and family.
- Seems concerned about eating in public.
- Has limited social spontaneity.
- Has a fear of gaining weight and is unable to sustain a healthy body weight.
- Has issues with accepting body weight.
- Shows inflexible thinking and has extreme mood swings.
- Stomach cramps, and other non-specific gastrointestinal complaints (constipation, acid reflux).
- Difficulties concentrating.
- Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate).
- Dizziness.
- Fainting.
- Sleep problems.
- Menstrual irregularities.
- Dental problems, such as enamel erosion, cavities, tooth sensitivity or discoloration.
- Dry skin, dry and brittle nails.
- Swelling around the area of salivary glands.
- Fine hair on the body or thinning of hair on the head, dry and brittle hair.
- Muscle weakness.
- Poor wound healing.
- Impaired immune functioning.
Eating Disorder Treatment
Once diagnosed, an eating disorder treatment of some form may be in the best interest of your child or teen. It is important to stay involved with the development of the treatment program. Ask questions such as:
- What is the diagnosis?
- What treatment plan(s) are being recommended?
- Who will be conducting the treatment?
- What other professionals may be involved during treatment?
- What are the alternative therapies if something is not working?
- Are there any associated medical or psychological concerns that need to be treated?
Having the answers to these questions will help both you and your child feel more comfortable as treatment decisions are made. Eating disorder treatments can take place in several different settings, ranging from minimally to significantly intensive, depending on the needs of the individual.
Eating Disorder Awareness
From the list of questions above, and through conversations with providers, you will learn what the different levels of care mean and how they can be beneficial. It is also helpful to understand the different types of treatment linked to the diagnoses and the treatment type. Regardless of the level of intensiveness, most treatment plans involve a combination of psychological therapy (psychotherapy), nutrition education, medical monitoring and sometimes medications. The duration of each will depend on the specific disorder and the personal needs of the individual. Deciding to seek medical help can be challenging and having a strong team of treatment providers by your side to walk you through the steps can make all the difference both during and after treatment.