Eating Disorders

Recently, you've noticed your 15-year-old daughter just picking at her food. Your son jokes about her going on another diet, and her grandmother says, "You could use some meat on your bones." She looks down and screams that she ate a big lunch at school and is not hungry. When she gets up suddenly to leave, her baggy clothes, although stylish, look more oversized than usual. For the sixth night in a row, you hear vigorous jumping in her room, and think that she's been practicing her dance routine a lot lately.

Although you want to just pass it off as a stage of adolescence, you are worried. She's been depressed for a while, and her weight concerns you. But when you try to talk to her about it, you cannot communicate. "You're too thin," you say, and she says, "I'm too fat."

You're right to be concerned - according to the American Academy of Child and Adolescent Psychiatry, anorexia nervosa and bulimia nervosa are eating disorders that are increasing among teens and kids, especially among young women.

What Are Eating Disorders?

Generally, eating disorders involve self-critical, negative thoughts and feelings about appearance and food, and eating behavior that harms normal body composition and functioning. A person with anorexia nervosa typically starves herself to be thin and experiences excessive weight loss. A person with bulimia nervosa may experience weight fluctuations, but rarely the low weight associated with anorexia. Bulimia nervosa is characterized by binge eating and purging. Both disorders may also be characterized by compulsive exercise. Unfortunately, many teens successfully hide these disorders from their families for months or years.

The National Association of Anorexia Nervosa and Associated Disorders estimates that five million women and one million men, including children, have eating disorders. The American Anorexia/Bulimia Association estimates that 1% of teenage girls in the United States develop anorexia nervosa and up to 10% of those may die as a result. Approximately 5% of college women in the United States have bulimia.

The Causes and Symptoms of Eating Disorders

Different types of emotional stress, such as depression caused by a biological problem or difficulties adapting to problems within the family, may lead to a disturbance in a child or teen's relationship with nutrition.

Dr. Edward Versteeg, a clinical psychologist who specializes in treating people with eating disorders, explains that once a person is starved to a certain degree, body image distortions tend to become more severe and extreme as the weight loss drops lower and lower. So as the person loses more and more weight, she actually sees herself as getting fatter and fatter. Body image distortions are primarily associated with anorexia.

Sometimes, problems at home (such as drug or alcohol abuse) may be risk factors for disordered eating behaviors. The eating disorder may be the child's way of coping with the problems encountered in her home life.

Some research suggests that media images contribute to the rise in the incidence of eating disorders. Most women in advertising, movies, TV, and sports programs are very thin, and this may lead girls to think that the ideal of beauty is thinness. Boys, too, may try to emulate a media ideal by drastically restricting their eating and compulsively exercising.

The Effects of Eating Disorders

Eating disorders may be diagnosed in children younger than 11 years, but the average age of diagnosis is 14 to 15. Ninety percent of children and teens with eating disorders are girls. Kids and teens with anorexia tend to be perfectionistic and shy, as well as bright and high achievers in school and athletics. Kids and teens with bulimia tend to be more impulsive and outgoing. Girls with anorexia usually do not engage in sexual behavior because of their embarrassment about their bodies. Behavioral problems, such as sexual promiscuity, crime (often shoplifting), and drug and alcohol abuse are common in teens with bulimia. When kids with bulimia are caught up in a binge eating and purging cycle, they may become very impulsive. "They feel like they're invisible, immune from the law, and they just feel really impulsive or embarrassed to buy some of the things that they want," Dr. Versteeg contends.

Malnutrition in developing girls and boys with eating disorders has serious consequences. Dehydration can occur, as well as other medical complications. In advanced stages, it affects the brain and causes symptoms such as dizziness, fainting, agitation, confusion, inability to concentrate, and loss of memory. Anorexia may cause growth retardation, puberty delays, bone mass problems, arrhythmias of the heart (irregular heartbeat), blood pressure problems, and gastrointestinal shut-down. Bulimia may cause medical complications such as tears and severe inflammation of the esophagus, gastric disturbances, blood pressure problems, and erosion of tooth enamel from continuous vomiting.

Warning Signs

Parents should know the early warning signs and symptoms of eating disorders.

Anorexia danger signs include:

*significant weight loss

*continual dieting (although thin)

*feelings of fatness, even after weight loss

*fear of weight gain

*lack of menstrual periods

*preoccupation with food, calories, nutrition, and/or cooking

*preference to eat in isolation

*compulsive exercise

*binge eating and purging

*insomnia

*brittle hair or nails

*depression with social withdrawal

Bulimia danger signs include:

*uncontrollable eating (binge eating)

*purging by strict dieting, fasting, vigorous exercise, and/or vomiting

*abuse of laxatives or diuretics ("water pills") to lose weight

*frequent use of the bathroom after meals

*reddened finger(s) (from inducing vomiting)

*swollen cheeks or glands (from induced vomiting)

*preoccupation with body weight

*depression or mood swings

*irregular menstrual periods

*dental problems, such as tooth decay

*heartburn and/or bloating

*problems with drugs, alcohol, sexual activity, or crime

If you suspect your child has an eating disorder, be sure to talk to your child and explain why you need to visit a doctor or dietitian. A medical professional can help you and your child take steps toward healthier eating and nutrition.

When an eating disorder becomes apparent, Dr. Versteeg advises parents to avoid making comments about appearance, since, "Anything you say about their appearance is probably going to be misinterpreted, or at least not experienced in the way that you intended." He also says it is very important to show lots of love and respect: "Try to see the world from the daughter's perspective. Understand that she just may not be seeing things the way you see things right now, and choose your battles carefully." Don't try to force food on your child - if you fear your child is malnourished or has an eating disorder, talk to a doctor or nutritionist immediately.

Treatment: The Earlier, the Better

The focus of treatment for eating disorders is helping kids cope with their disordered eating behaviors and thinking. Treatment includes medical supervision, nutritional restoration, and behavioral therapy, which addresses beliefs about body size, shape, eating, and foods. Ellen Feingold, MD, an adolescent medicine specialist, says the average duration of treatment is months, and approximately 20% of patients have to be hospitalized. Hospitalization occurs when a child or teen is severely malnourished. In-hospital treatment for eating disorders lasts an average of 2 months, followed by outpatient aftercare, which may last several more months.

Whatever the reason for the eating disorder, if parents and children can work together to understand the problem, the results will be more favorable.

Generally, the earlier the intervention, the shorter the treatment period. If a parent can discover an eating disorder before malnutrition or continual binge-purge cycles occur, the duration of treatment is shorter.

Can eating disorders be cured? "Yes, but some people feel that they always will have to be on the lookout for eating disorder thinking," says Dr. Versteeg. "Other people say they have completely left it behind, so it tends to be really individual." The best tools for parents are education and quality treatment. "There's lots of denial associated with eating disorders," says Dr. Versteeg, "but many children who have made it into treatment have expressed [that] they wished their parents would have been even more persistent."

Preventing Eating Disorders

Your behavior as a parent may help your child to avoid eating disorders. Encourage, don't belittle, your child daily. By focusing on your child's strengths, you will build self-esteem.

Dr. Feingold encourages parents to "work on making the ideal of beauty the healthy ideal." She says it is important for parents to base their children's self-esteem on who they are and what they do, not how much they weigh. Dr. Versteeg encourages families to learn to share feelings in general, and parents "to model good feeling-sharing and good listening skills."

In addition, your own body image may influence your child's body image. If you constantly say "I'm fat," complain about exercise, and practice "yo-yo" dieting, your son or daughter may feel that it is normal and acceptable to have a distorted body image.

Finally, illustrate what a healthy lifestyle is to your child. Involve your child in the preparation of healthy, nutritious meals on a regular basis. Let your child know that it's OK to eat when you're hungry, and refuse food when you're not. Also, make exercise a fun and rewarding family activity, as well as a regular one. If you have healthy attitudes about food and exercise, your child will have a good example from which to learn.

Updated and reviewed by: Kim Rutherford, MD
Date reviewed: September 2001
Originally reviewed by: Steve Dowshen, MD, and Edward Versteeg, MD