Talking About Teen Eating Disorders

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According to the National Institute of Mental Health, the prevalence of eating disorders in adolescents is 2.7% of the population. This number may seem small, but the impact that eating disorders have is incredibly significant on a person’s life who is being impacted.

Disordered eating is the experience of eating behaviors that are disturbed and include unhealthy patterns such as restricting food intake, compulsively eating, or skipping meals. Individuals dealing with eating disorders will have a variety of symptoms, but all will have a preoccupation with either food or their body. Eating behaviors, either limiting or overeating, will begin to take over a teenager’s life if they are experiencing disordered eating.

An eating disorder is an illness that requires serious treatments for both the physical symptoms presented such as weight loss or malnutrition and the emotional symptoms such as self-hate and fear of food. The teenage years are often prone to disordered eating because teenagers are experiencing their bodies changing and have heightened emotional responses to this. They are also inundated with media that tells them one thing about beauty: to be beautiful is to be fit and thin.

Our media is teaching young men and women that if they do not fit into this societal norm that they are not worthy, that they do not matter. Well, it’s no wonder that they’re literally killing themselves to be thin if thinness is equal to being loved.

As a parent you must be prepared to have these conversations with your children. You need to know how to talk to your teenager in a way that validates that their worth is not related to their physical presentation. You must talk with your children about the symptoms of eating disorders so they can recognize and advocate for themselves if they notice an issue arising. And you must also know how to talk to them about treatment if they are experiencing symptomology consistent with disordered eating.

Kinds of eating disorders

In order to talk with your children, you must be educated about eating disorders. There are several different kinds of eating disorders that your teen could develop. Let’s review a few common disorders.

Anorexia Nervosa

Anorexia Nervosa, most commonly referred to as anorexia, is the experience of viewing one’s self as extremely overweight even if a person is extremely underweight. This teenager will avoid food and restrict caloric intake. They will likely fear food and count their calories, carbohydrates, and other nutritional factors. Symptoms of anorexia include being underweight, having restrictive eating patterns, having a fear of food, a consistent desire and plan to be thin, consistently thinking about one’s body, and having a distorted body image. Anorexia is very dangerous for the body. It causes heart failure, and other organ failure. It can lead to death if not properly treated.

Bulimia Nervosa

Bulimia Nervosa, most commonly referred to as bulimia, is also a common eating disorder. It involves purging behaviors. A person will copious amounts of food, called binging, and then purge the food. There are several different ways that a person can purge. Most commonly people are vomiting, using laxatives, and excessively exercising. Symptoms of bulimia include a cycle of binging and purging, having self-esteem related to body shape and weight, and having a fear of gaining weight. These individuals most often maintain a healthy weight, whereas individuals with anorexia do not. Bulimia, while not as dangerous as anorexia, is still dangerous. It causes imbalances in electrolytes, potassium, and calcium. It can cause a heart attack or stroke.

Binge eating disorder

Binge eating disorder is a very common eating disorder, especially during teenage years. A person will eat a large amount of food and feel unable to control their binges. However, they do not purge their food. This behavior often leads to obesity and puts individuals at risk for heart disease, stroke, and diabetes.

Red flags

Now that you know some of the symptoms to look out for, the first way we suggest to talk with your teenagers about eating disorders is to talk with them about red flags. These are behaviors that start to make you as a parent worried. They should worry your teens if they are presenting them as well.

Some red flags are when teens skip meals or eat in secret, when they worry about their body or being fat, when they are looking for their flaws in the mirror, when they misuse laxatives, when they go to the bathroom after eating, when they eat more than is normal, and when they feel guilt about eating.

Some examples of ways you could use the red flags in a statement to your children include:

• “I have noticed that after we have dinner you typically go to the bathroom right away. It worries me a little. Can you tell me about this?”
• “I have noticed you saying you’re fat lately. This is concerning to me and I want to help get you support if you are feeling this way.”
• “I have noticed you are missing meals and losing weight. I worry that perhaps you are starting to develop an eating disorder, can we talk about this?”

Communicate openly

As your teenagers are growing and aging, it is important to talk with them openly about the pressures that can lead to behaviors associated with eating disorders. Even if they are not presenting classic red flag symptoms, it is still necessary to talk about these influences.

We recommend talking with your teenagers about the media and its impact on them. Ask them about what they are watching, listening to, and reading. Ask them about the way it makes them feel about who they are, their relationships, their bodies, and other domains. This will provide you a lot of feedback about their relationship with their body and food. A person who is struggling with an eating disorder may be interacting with media that is concerning, such as dieting websites and other programs.

You should also talk with your children about their self-esteem. This will help you to understand if they require extra support or not. You should always provide love and respect to your child about the things they are working on and accomplishing. Support the goals they have and listen when they get excited about something. Cheer them on. This kind of parental support and love will be a preventative factor for low-self esteem and potential mental health issues such as disordered eating. If they view themselves as worthy by all their interests and accomplishments, they will be less likely to build their worth on their weight and physical appearance.

Finally, teach your teens from a young age about healthy eating and exercise. Teach them to have a relationship with food where all things are good in moderation. Food should never be viewed as bad. Teach them about the different wellness domains and how to manage wellness across them: physical, emotional, social, financial, intellectual, vocational, spiritual, and environmental. This will help reduce the likelihood of any eating disorder development.

Talk about treatment

If you have been discussing preventative behaviors and red flag behaviors with your teen, and it still isn’t changing their dangerous behavior you must be prepared to talk to your teenager about eating disorder treatment. Your teen needs to know that you will seek treatment for them and ask that they hold themselves accountable for treatment. You can open the conversation up by saying something like this:

“I have noticed that over the last few weeks or months you have continued to skip meals and lose weight. I think it’s time we ask for some help from a professional for disordered eating. Can we work together to find you some supports?”

This is a great opener to the treatment conversation. You should be prepared that your teen will push back. This is a normal part of the recovery process that you will need to respond to. For example:

“I know you don’t want to believe you could be sick and I know it feels good to lose weight but this is becoming dangerous and I love you and want to see you healthy so I’d like to find resources for you and your health and safety”

You should be prepared to discuss several different treatment options with your teens including outpatient supports, an intensive outpatient program, and an inpatient residential treatment program.

If your teen is beginning to present eating disorder symptoms, the first level of treatment is typically outpatient treatment. This will likely include seeing a physician on a regular basis, working with a counselor, and working with a nutritionist. The goal being to maintain healthy weight and reduce symptoms. This is typically coordinated by the family and their choice of providers, often at the referral of the pediatrician or primary care physician.

The next level of treatment for eating disorders is an Intensive Outpatient Program or IOP for short. This is a several day per week, several hours per day outpatient program. Your teen will access all of their services at the facility where the IOP is held. This could include primary care, nutritional support, counseling, and psychiatry. The treatment program can last several weeks or months, where the goal is often to return to normal weight and reduce symptoms.

The most intense, and often most successful, form of treatment is an inpatient residential treatment program. The teenager will live in a hospital campus setting and access all services in-house. This will jump start the recovery process. They likely attend individual and group therapy daily, will have individual and class instruction on nutrition and healthy eating and exercise. They will access psychiatry as needed and other supports as needed including blind weighing and even tube feedings to return individuals who are underweight to appropriate weights. The goal of inpatient is to return the teenager to a baseline where they are safe to be back in the community with less intensive supports.

They will often transition from inpatient to an IOP and then to ongoing outpatient supports as a sort of step down transition plan. Inpatient support often involves a lot of family support and family therapy and classes as well. You should be prepared to explain to your teen that you will be heavily involved in the recovery process.

If you are worried about how to talk to your teen about risk factors, recognizing signs, and getting treatment, we suggest you seek your own mental health supports. Working with a counselor to assist with parenting will be an incredible investment for yourself, your teen, and the health of your family. The therapist can help you navigate these difficult conversations and take care of you as you care for your teenager.

Whatever your concerns are with your teenager’s mental health and wellness, the answer is always going to be to talk with them.

At Hillcrest, we pride ourselves on providing comprehensive mental health treatment for teenagers who are struggling with an eating disorder and may need residential treatment to help them manage it. Have your parent or guardian contact us today!

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