How Do I Know If My Child Has An Eating Disorder?

With all the recent news about movie stars and alleged eating disorders, it’s easy to think this is a disease of the rich and famous.

But that would be woefully inaccurate. It’s not just celebrities and there is nothing glamorous about this serious mental illness. In fact, if left untreated, eating disorders – anorexia nervosa, bulimia nervosa or another unspecified eating disorder – can be fatal.

Consider these sobering statistics from the American Journal of Psychiatry (2009) and the National Disorders Eating Association:

• Up to 24 million people in the U.S., all ages and genders, have an eating disorder
• Eating disorders have the highest mortality rate of any mental illness.
  -- The combined mortality rate from all causes among persons with anorexia nervosa, bulimia nervosa and other eating disorders is 70% greater than the national rate for comparable age, sex and year of occurrence.
  -- As a group, the suicide rate among persons with eating disorders is more than 5 times the national rate for the same age, sex and year.
• Anorexia is the single leading cause of death for women between the ages of 15 – 24, and the third most common chronic illness among adolescents
• Eating disorders do not only affect women. An estimated 10-15% of people with anorexia or bulimia are male.
• Athletes are more prone to developing an eating disorder than the rest of the population, with significantly higher rates among elite athletes.
• Eating disorders can cause depression and other mental illnesses. Lack of food and proper nutrition reduces serotonin and endorphins in the brain.

Eating disorders can be found across the socioeconomic spectrum and are colorblind.  They involve self-critical, negative thoughts and feelings about body image. Eating habits then become unhealthy and affect physical and emotional well-being. Onset often begins with adolescence, but can it can start even younger. The way media and culture glorify the very thin is absolutely part of the problem.

More than one-third of persons with an eating disorder begin with normal dieting and progress to pathological behavior. Indeed, over one-half of teenage girls and nearly one-third of teenage boys use some form of unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (although not necessarily to the point of becoming an eating disorder). And while eating disorders are a global epidemic, they are more prevalent in the U.S.

February is Eating Disorder Month. We thought this would be a good time to discuss how you as a parent can spot a problem with your child and provide some advice on how to prevent what is a very serious mental illness. Time is of the essence. A delay could mean a life-long—and possibly life-threatening—battle for you child.

Basic Definitions for Eating Disorders

Anorexia Nervosa:  Essentially self-starvation. Restricting food intake and refusing to maintain a minimally normal body weight. Starkly underweight persons with this disorder typically believe they are overweight or fat.

Bulimia Nervosa: Repeated episodes of binge eating and then engaging in behaviors to prevent weight gain, typically by purging the food. Can be hard to detect because those affected can have normal body weight.

Binge-eating Disorder: Binge eating is episodic overeating that the binger simply cannot control. Can lead to obesity.

Warning Signs of Anorexia and Anorexia With Bulimia

Your son or daughter is clearly loosing weight but will look in the mirror and see themselves as fat. Their brain is sending distorted messages. Here are red flags that you can watch for:

• Skipping breakfast saying they will eat at school (where you can’t see what they eat)
• Coming home and saying they are not hungry because they ate at school
• Hiding their body behind baggy clothing so you cannot see how they look
• Wearing seasonally inappropriate clothing to hide their body
• Developing rituals around eating
  -- Not wanting foods on the plate to touch each other
  -- Cutting food into tiny pieces so it looks like they are eating a lot-- Playing with food on the plate to appear to be eating
• Choosing only “safe foods” to eat like fruit and vegetables
  -- Becoming vegan or vegetarian to avoid what everyone else is eating
  -- Claiming to be lactose or gluten intolerant to avoid foods
• Messing up the kitchen so it looks like they ate
• Hiding food in napkins or pockets
• Wanting to eat upstairs in the bedroom or in any room away from you
• Over-exercising or developing an exercise obsession to stay thin
• Drinking excessive amounts of water, particularly before being weighed
• Swollen or “chipmunk cheeks” from throwing up (the parotid gland becomes inflamed)
• Frequent trips to the bathroom to purge
• Showering after meals to hide vomit

Prevention and Management Tips – Eat Meals Together

The best way to prevent an eating disorder, or spot one that is developing, is to engage with your child. A strong relationship affirms their positive self-image and lets them know you care. Take the time for any issues to unfold in a natural, unhurried way.

Having meals together is a good way to start. 

Sit with them at breakfast and talk about the day ahead. Dinner together is the best way to cap the day. Turn off the TV. Actively listen. It doesn’t really matter what you talk about, as long as you interact. Tell them about your day and how you have handled any issues. Let them see you eat normally.

Eating regular dinners together will also allow you to spot any warning signs or destructive eating patterns. Are they cutting food into tiny pieces or running to the bathroom?  When you clear the table, is food in the napkins? Do they eat incredibly fast, shoving food into their mouth? 

If you suspect your child has an eating disorder, seek help immediately. Talk to their pediatrician. Ask for a referral to a therapist or psychiatrist. No matter how much you may want to, do not put your child on a scale or discuss their weight with them. They will shutdown. Leave the weight discussion to professional therapists. 

Many parents are in denial, but the stakes are too high. More information, including toolkits for parents, teachers and coaches can be found one the website for the National Disorders Eating Association. A list of books about eating disorders from our Patient Library is also available on the Silver Hill Hospital Facebook page.

-- Kathy Fitzgerald
    Licensed Professional Counselor
    Eating Disorder Therapist
    Silver Hill Hospital

We look forward to your comments on this and all Silver Hill Hospital posts. 

Silver Hill Hospital’s blog is intended only to provide information. It is not intended to provide diagnosis or treatment. If this is an emergency, please call 911.