Spotting ED in Your Teen

Eating Disorders in Teens: How Can Parents Catch Them? Eating disorders are serious, life-threatening conditions that can become chronic and cause lasting health problems if left untreated.  In spite of the critical nature of eating disorders, they often go unrecognized and undiagnosed. This week, a feature in the New York Times, “Recognizing Eating Disorders in Time to Help,” brought attention to the fact that eating disorders in young people while prevalent, are often missed by families and healthcare providers alike.  In the Times piece, the Family Institute at Northwestern University presented alarming statistics: “nearly 3 percent of teenagers between the ages of 13 and 18 have eating disorders...some studies suggest that as many as half of teenage girls and 30 percent of boys have seriously distorted eating habits that can adversely affect them physically, academically, psychologically and socially.” So, why do eating disorders in teens often go undiagnosed, and how do we identify signs and symptoms before the disease has progressed?

• Adolescence is characteristically a time for exploration, maturing tastes, and natural, expected shifts in eating habits.  There may be an interest in novel food fads and experimentation with different nutrition philosophies like veganism, gluten-free, vegetarian.  Typically, we see these shifts as exploratory rather than disordered; which often may well be the case. That said, it’s important for parents to be hyper-vigilant and to understand the fine line between fad dieting and disordered eating.  Parents have to be thoughtful when assessing whether they’re seeing “normal” adolescent behavior or something more problematic and serious.
• Moodiness, irritability and natural separation are telltale signs of pubertal hormonal changes.   That said, isolation, social withdrawal or depressed mood could be signs of an eating disorder or other mental health condition.  Unfortunately, struggles related to food are often hidden from family and friends due to shame or simply as an effort to protect the eating disorder since certain ED behaviors can be reinforcing or serve an important function.  
• Eating disorders have a particularly high prevalence rate among dancers, models, gymnasts, wrestlers and other certain other athletes since slender physiques are often the norm or expectation.  Further, monitoring or controlling one’s food intake and exercise routine are par for the course when engaged in these pursuits. This makes eating disorders that much harder to spot; often the behaviors and resulting physical effects escalate which eventually prompts intervention.  But by this point, the disorder is in a critical stage.

What Can Parents Do?

• If you notice a change in your child’s eating, ask about it.  Don’t be afraid. If you get an angry response, then it’s all the more reason to lean in further to better understand.  
• Be sure to monitor weight trends at the MD with each annual visit.  And don’t hesitate to make an appointment with the doctor for a weight check even if it’s not the time for the annual visit. Any weight loss in a growing young person should be flagged.  It doesn’t necessarily mean there’s an eating disorder but there should be a clear rationale for a weight trend downward.
• Talk to your daughter about her menstrual cycle.  The NY Times article highlighted how young adult and adolescent females with eating disorders can end up with gynecological concerns.  These concerns include delayed puberty, irregular menstruation, pelvic pain, vaginal thinning or dryness. The article focused in on the importance of screening for these health professionals in an effort to catch problems and intervene.
• Attend to eating behavior at the table.  Do you notice any changes? You can look for behaviors like moving food around the plate, taking a long time to eat, cutting food into small pieces, eating foods in a particular order (i.e. veggies first, then protein etc).  Do you observe extended trips to the bathroom or prompt excusal from the dining table to use the bathroom post-meal?
• Pay attention if your child begins to avoid social events that involve food, public meals or if he/she often wants to eat independently (e.g. “I’ll just eat in my room” or “I already ate”).
• Note any exercise that seems driven.  Does your child feel compelled to exercise even if tired, sick or injured?  Does he/she go out of the way to exercise even if there are other important events or people pulling for attention?

• Other signs that something is not right: reduced energy, disengagement from activities that were previously enjoyed, and of course, the growth of fine hair on the body and frequently feeling cold which are symptoms associated with extreme weight loss.

If you note any of the above concerns in your teen, seek consultation from a professional eating disorder treatment provider or clinic. Early intervention is essential since it’s associated with a significantly improved prognosis.  It’s important to note that eating disorders require behavioral intervention; not talk therapy. Traditional talk therapy takes time; it is not structured to aggressively tackle the nutritional inadequacies that lead to urgent physical consequences of an ED.  The research is clear that for childhood and adolescent anorexia, Family-Based Treatment (also called Maudsley or FBT) is the gold standard.  For bulimia in kids and teens, FBT is also the leader.  For binge eating in children/teens, FBT may be right… or sometimes we consider CBT-E with concurrent family involvement and education.  Note: if quality face-to-face treatment is not available in your geographic area, you may want to consider pursuing telehealth options.  References:Brody, J. E. (2018, July 30). Recognizing Eating Disorders in Time to Help. Retrieved from https://www.nytimes.com/2018/07/30/well/recognizing-eating-disorders-in-time-to-help.html