What to know about eating disorders in teenagers

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In the early stages of an eating disorder, symptoms can be easy to miss. Many people have skipped the occasional meal or do not like certain foods.

As an eating disorder progresses, teens may hide their symptoms from others. For example, they may wear loose clothing or lie about having eaten. Symptoms can also vary depending on the type of eating disorder a person has.

Parents and caregivers may notice changes in a teenager’s weight or behavior surrounding food and mealtimes. Below are specific symptoms for various eating disorders:

Anorexia nervosa

Anorexia nervosa, or anorexia, has two subtypes: restrictive and binge-purge. Both subtypes involve people placing extreme restrictions on the kinds and quantities of foods they consume.

Someone with the binge-purge subtype also has episodes where they rapidly consume large amounts of food and then purge it from the body, for instance, by vomiting or using laxatives or diuretics.

Anorexia symptoms include:

• intense fear of increasing weight
• highly restricted eating
• denial or distorted view of their body
• refusal to gain weight or maintain a moderate weight
• self-esteem connected to body shape and weight
• muscle and bone density loss
• anemia
• brittle nails and hair
• dry, yellow skin
• growth of fine body hair, known as lanugo
• constipation

Bulimia nervosa

Bulimia nervosa, or bulimia, is characterized by compulsive eating followed by compensatory behaviors. Examples include vomiting, excessive exercise, and laxative use.

Symptoms include:

• chronic throat pain or inflammation
• swollen salivary glands
• dental issues such as pain, worn enamel, and tooth decay
• dehydration
• acid reflux
• gastrointestinal issues
• electrolyte imbalance, potentially leading to heart attack or stroke

Binge-eating disorder

Binge-eating disorder features recurring episodes of eating a large amount of food, beyond what someone needs to satisfy their hunger. After each episode, the person does not take measures such as purging or excessive exercise.

Of all the eating disorders doctors have identified in the United States, binge-eating disorder is the most common.

Symptoms include:

• regularly eating a large amount of food in a small amount of time
• eating past the point of fullness
• eating quickly
• frequently trying to diet
• experiencing shame relating to eating
• eating while no one else is watching

Avoidant restrictive food intake disorder (ARFID)

A person living with ARFID restricts their food intake for reasons that do not involve body image or fear of gaining weight. Instead, they may not like the smell, taste, or texture of many foods, or they may worry about consequences such as choking.

Symptoms include:

• extremely fussy eating
• lack of appetite
• disinterest in food
• feeling ill at mealtimes
• fear of choking
• weight loss
• gastrointestinal issues with no known cause
• limited range of acceptable foods

Like anorexia, ARFID can lead to medical symptoms because of nutrient deficiencies. This includes changes in heart rate, decreased bone density, and lethargy.

The causes of eating disorders are complex. However, a combination of factors can increase a person’s chance of developing an eating disorder, including:

• Biological factors: There is some evidence that genetics play a role in eating disorder development. Serotonin may also affect the development of eating disorders due to its role in mood regulation and appetite.
• Socio-cultural factors: Media and cultural values promoting thinness may contribute to eating disorder development in teenagers.
• Developmental factors: Disturbances to typical childhood development may increase the risk of someone developing an eating disorder.
• Behavioral factors: Some types of behaviors may lead to eating disorders. For example, a 2020 study suggests that the development of eating disorders can result from dieting.
• Psychological factors: The American Psychiatric Association states that eating disorders often co-occur with mental health conditions such as mood disorders and obsessive-compulsive disorder (OCD).

Complete recovery from an eating disorder is easier if treatment begins early. The longer someone lives with an eating disorder, the greater the chance they may experience medical complications or adverse mental health effects.

Eating disorder treatment is often multifaceted and may include:

• Psychotherapy: Therapy can be individual, group, or family-based. Cognitive behavioral therapy (CBT) is a first-line treatment for eating disorders. However, family therapy may also help teenagers with eating disorders.
• Medication: When eating disorders co-occur with conditions such as depression or mood disorders, medications to treat those issues can help. Doctors may also prescribe medication such as fluoxetine (Prozac) for some eating disorders.
• Nutrition counseling: Nutrition therapy helps a person change their relationship with food so they can stabilize their body weight and nutrient blood levels.
• Medical care: Some teens may require hospitalization to stabilize any acute issues relating to malnutrition, as well as to prevent long-term negative impacts by providing feeding support.

A teenager’s treatment plan may depend on the type of eating disorder they have. Aftercare is also important to prevent remission.

Parents and caregivers should seek medical assistance for their teen as soon as they suspect they may have an eating disorder. Early diagnosis and treatment are vital to reduce the risk of complications and further health conditions.

A doctor may also be able to put a caregiver in touch with mental health professionals to help a teenager with mental health conditions alongside an eating disorder.

In addition to getting an eating disorder assessment from a trained medical professional, there are strategies parents can employ at home to help their teen. They can:

• provide nutritious meals and snacks
• discuss the importance of monitoring the body’s hunger and fullness signals
• practice nonjudgmental communication and active listening
• model self-love and acceptance
• value health over appearance
• avoid criticizing people’s body types
• involve their teen in grocery shopping and meal selection and preparation

Eating disorders can be dangerous without treatment because of the adverse effects of malnutrition. The sooner caregivers get help for their teens, the easier it is to stabilize body weight and regain health.

The causes of eating disorders are complex and varied. Sometimes, they co-occur with mental health conditions such as depression or OCD.

Treatment strategies include therapy, medication, medical support, and nutrition counseling.