A 13-year-old girl walked hesitantly into my clinic, baggy clothes hanging off her small frame, dark circles under her eyes, and fingernails bitten down to the quick.

This was Victoria’s 1st visit to a psychologist accompanied by her parents despite her arguments that she didn’t need help. Her parents told me worriedly that Victoria’s weight had plummeted in the last few weeks, her mind seemed fixated on body shape and eating, and she was at risk of failing school.

Victoria was suffering from an eating disorder known as anorexia nervosa.

(The name has been changed for confidentiality reasons.)

Types of eating disorders in children and teens

Hearing that an eating disorder in adolescence is “just a phase” your teen will grow out of is a thing of the past. According to this study, an eating disorder is a serious mental illness that affects 8.4% of women and 2.2% of men worldwide. Eating disorders can affect people of all ages and cultures and have been diagnosed in people as young as 5 and as old as 80.

There are various eating disorders classified in the Diagnostic Statistical Manual 5th Edition (DSM- 5), a directory used for diagnosis by clinicians. These disorders include:

Anorexia nervosa – the restriction of food intake as a result of fear and a distorted view of being overweight

Bulimia nervosa – bouts of extreme overeating followed by self-induced vomiting or fasting

Binge-eating disorder – regular episodes of uncontrollable overeating resulting in feelings of shame

While they can vary, each eating disorder involves:

• An overvaluation of weight, shape, or appearance
• Distress about weight, shape, or appearance
• Eating and weight control behaviors

What are the causes of eating disorders?

A number of factors can increase the risk but don’t necessarily cause anorexia. A US survey of 57 individuals aged 18-47 that were diagnosed with an eating disorder reported that psychological and emotional problems were the most frequent causes of their disorder.

The other common risk factors identified in the research are;

• Perfectionism – needing to be “perfect” in all they do
• Family dieting and emphasis on achievement
• Ongoing critical comments from others about appearance
• Pressure to be thin due to occupation or recreational pursuits such as modeling, ballet, etc.
• Early puberty
• Childhood obesity
• Genetic component – eating disorders in the family

We now know that eating disorders are not just about food but about underlying emotional issues. This article will focus on anorexia nervosa.

What are the signs of anorexia in children and teens?

There are many signs that can alert us to an eating disorder potentially developing. In children and teens, there may be several signs or only a few. We can consider these anorexia nervosa symptoms as an invitation to provide support.

Physical

• Extreme weight loss – usually a rapid change in weight
• Swelling around the cheeks or damage to the teeth from vomiting
• Exhaustion
• Sensitivity to the cold
• Excess hair growing on the face or arms to keep them warm

Behavior

• Restricting food intake
• Any dieting when within the normal weight range
• Purging to vomit food or using laxatives
• Not eating at the table with family and friends
• Cutting out foods once enjoyed
• Lying about eating, exercise, or weight
• Over-exercising, even with injury

Psychological

• Believing weight loss to be a success
• Pre-occupation with food, body shape, or weight
• Constantly measuring or weighing self
• Anxiety, avoidance around eating times
• Labeling food as “good” or “bad” and counting calories
• Unhappy about body image
• Possible suicidal thoughts

Victoria explained that she wasn’t good enough and “had” to jog for hours every day, often missing school. She was drinking only coffee and avoiding going out to eat with her friends to ensure she would consume fewer than 800 calories per day. Victoria said that when she started to notice her friends’ bodies changing and her own, she became more anxious about “getting things right” at school and with her appearance. The more she couldn’t reach her goals of being “perfect,” the more her distress drove her to control her eating and exercise.

What anorexia nervosa treatments are effective?

Helping a young person with anorexia isn’t just about focusing on eating; it’s about responding to the distress underlying the eating disorder. Thankfully many people with anorexia do recover with early treatment.

A referral via your family doctor can lead you to a team of specialists who can focus on the following treatments:

• Restoring healthy weight first and foremost
• Family-based therapy where the family is encouraged to take control of feeding to prevent severe dieting, purging, and over-exercise
• Counseling support for the young person

Interestingly, no medications have been shown to be effective for anorexia.

How can I help my child or teen if they are showing signs of anorexia or another eating disorder?

Anorexia can be a difficult illness to treat. It is important that you, as a parent, adopt a kind and compassionate approach to your child or teen and focus on their distress rather than their eating.

Here are some steps you can take to help:

• Choose a place where you are both comfortable and where food is not the focus. Consider NOT sitting at the dinner table or in a food café.
• Try not to comment on your child’s weight, size, or body shape.
• Be ready for a defensive response. Your child/teen may have found a way to control their world that works for them, and it will be hard to give this up.
• Say that you are worried about them.
• Avoid discussing the cause of their problem (e.g., a breakup) or assigning blame.
• Reassure them that you love them and want to help.
• Don’t try to problem-solve (e.g., saying “Just eat!”)
• Offer to assist them in getting help from their doctor or an online support group.

If the anorexia is severe, the person may require hospital admission

Be aware of these signs of severe anorexia nervosa:

• Disorientation or not making sense
• Faint or too weak to walk
• Painful muscle spasms
• Complains of chest pain or trouble breathing
• Showing blood in their stool, urine, or vomit
• An irregular heartbeat

In severe cases, it’s important that medical support be provided first by attending the hospital, calling an ambulance, or visiting your local doctor.

Recovery from anorexia

Noticing signs that are outside of normal childhood or adolescent behavior early on significantly increases the rates of recovery. Sometimes, just being able to have a conversation with your child or teen about your concerns can be enough to begin the road to recovery.

Victoria was willing to consider treatment for her anorexia because she didn’t want to feel so anxious all the time and missed her friends. She came to therapy weekly to discuss the distress that was driving her eating disorder and slowly introduced more foods into her daily meals. It was a long journey, one that required time and effort from not only Victoria, her dietician, and psychologist but her parents as well.

After 3 years, Victoria was able to manage the distress that she experienced around eating and exercise and was on the road to graduating high school. She was adamant that she wouldn’t be here today to share her anorexia story if it weren’t for her parents’ persistence to seek help despite her anger towards them for doing so.