Andrea was an involved and attentive mother and had always felt close to her daughter, Chloe. So she was shocked when, at Chloe’s annual well-visit, her pediatrician suggested inpatient eating disorder treatment. Andrea knew that Chloe had become somewhat fanatical about running, but she seemed to be eating nutritious foods at home. Chloe had always been lean, and her recent weight loss didn’t seem dramatic, but her physician explained that her heart rate was dangerously low and she worried she was not medically stable.
Andrea is not alone; it’s a refrain I hear from parents often. It’s not always easy to determine when an individual has an eating disorder, and yet these are the most deadly of all psychiatric disorders (aside from opioid addiction). Early intervention and treatment can eliminate the years of suffering that is often associated with these chronic illnesses and can facilitate full recovery.
In my most recent book, Adultish: The Body Image Book for Life, which is a mental health guide for teens and young adults, I include an entire chapter on eating disorders. The most common age of onset for eating disorders is between 12 and 25. And like adults, children may suffer from a number of life-altering and life-threatening eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder and orthorexia.
Alli Spotts-De Lazzer is a therapist who has worked with eating disorder patients and their families for over 17 years and has recently written a book for parents of eating disorder patients. She told me that in a support group she runs for parents of children with eating disorders, she often hears parents express regret about not understanding when — or even how — their child’s eating disorder started.
Here are some things to look out for if you have any concern about your own child.
[READ: What is Atypical Anorexia?]
Signs and Symptoms of an Eating Disorder in Children
— Changes in eating habits
— Changes in activity habits
— Body image concerns
— Moods and irritability
— Changes in social behaviors
[READ: Parents Need to Know: Misguided Nutrition Assignments Put Kids at Risk.]
Changes in eating habits
Although eating disorders are popularly conceptualized as characterized by food refusal, there are different eating disorder diagnoses — such as anorexia nervosa, bulimia nervosa, binge eating disorder — and not all of these disorders are defined by food restriction or weight loss. Thus, indicators of an eating disorder include both eating less than typical and eatingmore. Skipping meals and making excuses not to eat can be red flags as can eating in excess.
Problematic changes in eating habits can also include a focus on the macronutrients or calories in foods or the elimination of entire food groups from one’s diet. Although popular fad diets often recommend these behaviors, they are maladaptive. Further, research has repeatedly found that dieting is one of the primary predictors of some eating disorders. Children and adolescents are still growing and should not be restricting what they eat.
Changes in activity habits or levels
Like Chloe, many people with eating disorders dramatically alter their activity patterns. Excessive exercise may be an indicator of an eating disorder, especially if a child is linking food intake with exercise behavior. In other words, if your child is talking about exercise to compensate for what they’ve eaten or burn off calories, this is at the very least a maladaptive approach to exercise.
Boys’ changes in activity habits can often be difficult to interpret. It’s increasingly normative for teen boys and young adults to be interested in weight lifting and spend time at the gym with their friends. If these habits become excessive (every single day or multiple times per day) or are accompanied by body image concerns and obsessive attention to food choices, it’s likely time to approach your child with questions about the motivation for their exercise and to better understand their mental state.
[READ: Eating Disorders and Body Image Issues in Boys and Men.]
Body image concerns
Body image concerns are not essential to an eating disorder diagnosis but are often present. These concerns are relatively normative among people of all ages and gender and sexual identities, which can make it difficult to determine when they are problematic to a point of warranting intervention.
It is not “normal” or healthy to complain about body size and shape or have an intense fear of weight gain or body changes. And although teens are often somewhat preoccupied with their appearance, an excessive focus on appearance, constantly checking on their appearance (e.g., in reflective surfaces) and worrying about their appearance should be cause for concern. Having a healthy body image means feeling comfortable in your own skin. Worrying about looking “perfect” before leaving the house suggests body image concerns that merit attention and may be indicative of an eating disorder
Moods and irritability
Oona Hanson, a parent coach who works with families coping with eating disorders tells me that, “if teens seem moody or withdrawn, it can be tempting to chalk it up to typical adolescent development. But if your child seems to have lost their sense of humor or joy, that’s a red flag that something isn’t right. It may not be an eating disorder, but it’s definitely a sign they need some support.”
It’s typical for parents to expect their kids to be moody, especially as they enter the teen years. These expectations are based in our own experience of being teenagers and the reality that teens can be moody. How do you know if it’s “normal” moodiness or problematic moodiness? If you’re noticing a shift toward irritability, that may be a red flag.
Spotts-De Lazzer tells me, “a common thing that parents report is a shift to feeling on eggshells around their child.” She suggests that if you are feeling this way, that you talk with your child and consider seeking out support through a therapist or support group. Even if your child is not experiencing an eating disorder or any other mental health concern, they’re likely suffering if their default mood is negative and the whole family will benefit from support.
[READ: Tips for Eating Disorder Recovery.]
Changes in social behaviors
Eating is very social, and eating disorders are often very secret disorders. It is essential that we eat every few hours to function at our best, so if a child is altering their eating habits to avoid regular eating patterns, there may be some deception involved and avoidance of certain social situations. If you notice your child no longer wanting to sit down for family dinners or no longer engaging with friends in social outings involving food, these are signs that something is amiss.
For Andrea and Chloe, early intervention helped stave off the development of a chronic eating disorder, although Andrea still feels that she failed her daughter in not seeing the warning signs sooner.
Hanson tells me that this is not uncommon. “The comment I hear most often from parents of kids with eating disorders is that they wish they had noticed the warning signs earlier.”
Spotts-de Lazzer agrees. “There are so many different red flags when it comes to a kid possibly having an eating disorder! I think one of the most important things is for the parent(s) to honor their sense that something feels ‘off.'”
[READ: Male Body Dysmorphic Disorder and Eating Disorders in Sports]
Getting Help
Eating disorders aren’t a choice or a phase, they’re legitimate illnesses that require physiological and psychological treatments. And they can start very innocently with leaving out certain types of foods, under-portioning meals or not eating after a certain time. If these dieting behaviors go unnoticed, more restrictions or behaviors can ensue leading to chronic disordered eating patterns and clinical eating disorders.
Eating disorders are frequently linked with other teen mental health challenges. A National Institute of Mental Health study of 10,000 teenagers (ages 13 to 18) with eating disorders found that as many as 88% reported suffering from anxiety, depression or a behavioral disorder. Moreover, about a third of those with bulimia, 15% of those with binge eating and 8% of those with anorexia had attempted suicide.
If you are concerned that your child may have an eating disorder, useful information can be found at The Alliance for Eating Disorders and Association of Anorexia Nervosa and Associated Disorders web pages.
More from U.S. News
Things to Tell Yourself When You’re About to Binge Eat
Best and Worst Foods to Eat for an Upset Stomach, According to Dietitians
Best Nutrition Tracker and Calorie Counter Apps for Better Health
How to Tell If Your Child Has an Eating Disorder originally appeared on usnews.com
