Question: My 12-year-old daughter struggled with being overweight until she hit a growth spurt. Her weight stayed the same, but she grew a few inches. No one has ever mentioned her weight, but she recently became obsessed with her looks, constantly feeling that she is fat, reading food labels, and skipping meals. She eats minimally. She started exercising several times a day and avoiding carbs. In two months, she lost 20 lbs. We have encouraged her to eat, but she says she gets full quickly and is not hungry. We suspect she may be purging, as she immediately goes to the bathroom after meals. She no longer joins us for mealtime and seems to come up with excuses. We fear she has developed an eating disorder. What should we do? 

It sounds like you are in tune with your adolescent and have recently become aware of the changes in her eating behaviors. While this article provides general information about eating disorders, it is not medical advice. Please have your daughter see a trained mental health professional to assess her further for an eating disorder to provide you with specific treatment recommendations. The sooner your adolescent gets help, the better. 

Types of Eating Disorders

There are different types of eating disorders based on the Diagnostic and Statistical Manual of Mental Health Disorders (DSM5). Patients often have symptoms from different categories of eating disorders and don’t fall into one category, at least, not all the time. Still, these eating disorders pose similar dangers to patients’ health. Eating disorder symptoms also may change over time. 

Before we go into the types of eating disorders below, it is important to assess the adolescent for any other mental health disorders. They may also be struggling with depression, anxiety, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), substance abuse, and self-injurious behavior. 

Bulimia Nervosa

Patients have obsessive and irrational thoughts about their body, food, and exercise. They will start with “a diet” but then compulsively binge eat. They set very rigid standards against certain “bad foods”. As they feel pressure from these self-imposed standards, they violate their own rules and binge. They then feel  distressed due to having “overeaten” and compensate by vomiting, fasting, excessive exercise, laxative, or diuretic use. 

Binge Eating Disorder (B.E.D.)

Patients engage in episodes of eating large amounts of food in a short period of time, accompanied by feeling out of control, and continuing to binge eat despite feeling overly full. For example, they may eat several large pizzas in one setting. Patients typically think of constantly dieting while feeling a compulsion to constantly eat. Patients typically struggle with shame, anxiety, and guilt around eating. B.E.D. can be found in people with bodies of any size. 

Anorexia Nervosa

Patients have a distorted view of their bodies, obsessive and illogical thoughts about food and exercise, and an irrational fear around eating. Their irrational fear also involves fear of weight gain. They eat too little and are likely to have low body weight as a result. However, there are some patients who have normal or larger body weight. Patients eat a narrow range of food and become extremely anxious around eating high-caloric food. 

Avoidant/Restrictive Food Intake Disorder

Patients eat too little to maintain their nutritional needs, but do not have the body image concerns seen in anorexia nervosa. 

Other Specified Feeding and Eating Disorder

This diagnosis covers eating disorders that do not meet specific criteria for anorexia nervosa, binge eating disorder, or bulimia nervosa, but cause significant distress and impairment. 

Orthorexia Nervosa

It is not listed in DSM5 but has been proposed as a diagnosis. The individual strictly adheres to certain practices of “eating healthy,” so much that it negatively impacts health, schoolwork, and social life. S/he restricts food in order to “to be healthy,” and not for fear of gaining weight in patients with anorexia nervosa. 

Muscle Dysmorphia

While this is not recognized in DSM5, some researchers believe that it is a manifestation of anorexia nervosa disorder, and is more common in males. Patients have similar rigid thoughts about food and body, but they desire a bigger and more muscular body. They are likely to focus on weightlifting, eating high protein foods, and use supplements or steroids. 

Common Challenges faced by Parents

Parents face challenges when supporting adolescents in recovery. 

Parental Overwhelm

Taking care of a child who has an eating disorder can be overwhelming. Your role as a parent didn’t stop when the additional responsibility of supporting your adolescents with an eating disorder got added to your plate. Ensure you do self-care and reach out to your support system and other parents who have been there. Asking for professional help when you need it models a healthy behavior for your adolescent. 

Tolerating a Teen’s distress

Helping your adolescent with their recovery means requiring your teen to repeatedly face the very situation that distresses them. You will find your comfort level of what needs to be done for your teen and when. Remember that your teen’s distress is temporary. 

Fear of Ruining your teen’s spirit

Prioritizing recovery in the long run brings long term gains, in the face of temporary discomfort. Remember that an untreated eating disorder may permanently cause irreversible physical and emotional consequences. 

Fear of Destroying your relationship with your teen

Keep your eyes on the prize and long-term goals. Relationships are damaged when parents and children remain chronically ill and don’t go into recovery. Once your adolescent is in recovery and becomes an adult, your child’s outlook on what you did for them will be positive and appreciative of parental support. 

Coping Strategies 

It is important as parents support their adolescents in their recovery that both parents and adolescents build distress tolerance. Below are some techniques that parents can try to help themselves and their children. Remember that the best way to teach your adolescent new skills is by modeling the behavior. 

Identifying and labeling feelings

Acknowledging and labeling a feeling makes it more manageable. You can model that behavior to your teen.  

Talking to someone 

Talking to another parent who has been in your same boat is a great source of support. Don’t keep your problems and thoughts to yourself and reach out to your community. 

Journaling

Writing can help you get thoughts off your chest. It doesn’t have to be long. You can start by doing it for a few minutes a day. 

Relaxation and Meditation

You can find several meditation exercises online and can do them as a family. 

Music

Listening to music helps calm the nervous system and promotes social engagement. 

Stress Balls

Using stress balls provides distraction and sensory input to the body to relax and release physical tension. 

Resources

www.newharbinger.com/40439 to find supplemental materials, including forms, worksheets. 

When Your Teen has an Eating Disorder

8 Keys to Recovery From An Eating Disorder

Dr. Abu Ata is a board certified psychiatrist and family medicine physician. She is in private practice and can be found at www.nesrinabuatamd.com or reached at drnesrinabuata@gmail.com. Dr. Abu Ata believes in providing holistic care that includes the mind, body and spirit in the context of personal growth, relationships with others and in community. Dr. Abu Ata is here to support you by providing a mindfully cultivated practice of presence and expertise. Her healing practice draws on her training in mindfulness, yoga, family medicine and integrative psychiatry to weave a unique tapestry that supports your needs on your YOU-nique journey.