A Parent's Guide to Identifying Eating Disorders

Featured Article, Growth and Development

Parents want to protect their children. It’s their job. When parents see their child restricting calories, exercising more frequently or focusing on body image, it’s natural to worry about whether or not they have an eating disorder. It’s important for parents to learn to navigate this unknown terrain while keeping in mind there is still a lot researchers don’t know.

“We don’t have good data on the number of people affected,” says Dr. Ovidio Bermudez, Medical Director of Child and Adolescent Services at the Eating Recovery Center in Denver and former chair of the board of the National Eating Disorders Association (NEDA), who added that there is more information on girls. “Eating disorders are common and are on the rise,” he continues. NEDA believes that the prevalence of males with eating disorders has been under-reported.

Eating disorders are classified as a mental illness and occur alongside anxiety, depression or obsessive-compulsive disorders and are usually tied to emotional issues like control and low self-esteem. Everybody is at risk of developing an eating disorder regardless of age, ethnicity, gender identity or socioeconomic status. Dr. Bermudez has seen eating disorders in children as young as 7 to 8 years old.

Factors that can cause eating disorders

A combination of biological and environmental factors plays a role. Protective factors — being raised in a nurturing family environment, not being concerned about appearance and not feeling the need to seek approval or fit in — predisposes whether one may develop an eating disorder.

“People don’t choose to have an eating disorder,” says Dr. Bermudez. Studies have shown there is a genetic link for developing an eating disorder but researchers have not identified one specific gene. Rather it is thought to be multifactorial, like diabetes.

Both anorexia nervosa and bulimia nervosa are familial illnesses. If you are anorexic and your mother was bulimic, there is an increased chance that your child will develop an eating disorder. Some of the personality characteristics that predispose a person for developing bulimia include being a high achiever, harm avoidance and novelty seeking; whereas some of the personality characteristics that predispose a person for developing anorexia include disciplined, patterned and repetitive behaviors.

Symptoms to look out for

The most common eating disorders diagnosed in young people are anorexia and bulimia. According to NEDA, bulimia is usually diagnosed at around age 17 or later while anorexia is usually diagnosed in the mid- to late-teens. “Nobody walks the same path,” says Dr. Bermudez. Adolescents and adults with eating disorders can shift symptoms from anorexia to bulimia and also the other way. He calls this the crossover phenomenon, where individuals’ symptoms can go back and forth as more anorexia like or more bulimia like.

Common signs of anorexia from the NEDA website include:

  • rapid weight loss
  • a preoccupation with calories, dieting, fat grams, food and weight
  • refusing certain foods
  • restricting entire food categories
  • commenting about feeling “fat” or overweight
  • food rituals
  • avoiding mealtimes or situations where there is food
  • an excessive, exercise regimen
  • withdrawing from friends and social activities and becoming isolated, secretive and withdrawn
  • an intense fear of weight gain or being “fat” even if underweight
  • a strong need for control
  • rigid thinking
  • denying the seriousness of low body weight.

Common signs of bulimia from the NEDA website include:

  • binging and purging behaviors like frequent bathroom trips after meals
  • the presence of packages or wrappers of diuretics or laxatives and signs of vomiting
  • appearing uncomfortable eating around others
  • food rituals
  • skipping meals or eating small portions at meal time
  • an excessive exercise regimen
  • withdrawing from friends and social activities
  • frequent diets
  • an extreme concern with body shape and weight and body weight within the normal weight range or even being overweight

There is a higher prevalence of eating disorders diagnosed in females. While there is no clear cut answer as to why, Dr. Bermudez suggests it could be a combination of biological factors and cultural influences. “Our culture emphasizes thinness and beauty,” he said. Boys are less likely to seek help out of shame that they have “a woman’s disease.” He cautions that this can happen in girls also.

Until adolescence, you see very few differences between how genders present with eating disorders. Beginning around age 12, there is a paradigm shift, and you begin to see differences; females focus on their weight and want to be thin, typically called the “drive for thinness,” and boys focus on muscle mass and want to be cut and buff, typically called the “drive for muscularity.” To achieve this, for example, girls restrict calories and run while boys restrict calories and run but supplement their diets with protein powder. “The intent is the same but the behaviors can be different,” said Dr. Bermudez.

Misconceptions about eating disorders

There are a lot of misconceptions about eating disorders. Common ones according to NEDA include:

  • thinking it’s a fad
  • thinking dieting is normal
  • thinking it’s not an illness
  • placing heavy importance on appearance, beauty, food or eating.

A lot of parents feel ashamed and blame themselves for their child’s illness. To clarify, Dr. Bermudez explains, “Kids do not choose it, and parents do not cause it,”

Treatment options

If you suspect your child has an eating disorder, “honor your gut feelings,” says Dr. Bermudez, “and seek help.” The first step is to have your child assessed by a clinician familiar with eating disorders. “The best tools are early recognition and timely intervention,” he says. If parents wait too long, additional intervention like hospitalization might be required.

“The professional community may not support parental concerns,” he says. “If they do not support these concerns, it could lead to the risk that some people may not be recognized early and receive timely intervention.”

Treatment plans are individualized for each patient and are based on a child’s age, stage of development, behavior and level of maturity, among other factors. A clinician may not focus on drive for thinness with boys, for example, but teach them how to accept their level of muscularity and how they view themselves versus how others view them.

The first step is to treat the symptoms. If a child is underweight, it’s important to focus on gaining weight and normalizing their food intake; if a child is purging, it’s important to interrupt the behavior and this is the premise of the first stage of family based treatment.

“The most evidence-supported treatment is family-based treatment,” offers Dr. Bermudez. Children must meet inclusion criteria – they must be teens, suffering from anorexia, their health must not be comprised, and parents can participate. Based on this model, parents act as agents of change. “This approach is pro parent involvement.  Even for children who have become more medically compromised, it is important to use a focus that is family centered.  That is why at Eating Recovery Center we have made a commitment to FBT,” he says.

Children don’t want to be discovered. “It’s important to keep the lines of communication open,” he adds.

February 22-28 is National Eating Disorders Awareness Week. For more information about eating disorders, visit NEDA’s website at nationaleatingdisorders.org. If you suspect your child has an eating disorder or you would like more information, call their helpline at 800-931-2237.

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