Eating disorders are insidious. They hide behind social media, dating, fitness-conscious workouts, and bathroom doors. By the time parents catch on, the challenge of catching up can be overwhelming…and consequential. It’s therefore important – imperative, really – that all parents become educated about the early signs of an eating disorder.
Indicators of eating disorders are often much easier to recognize in retrospect than in the present. Parents commonly look back and say things like, “if only I had realized ‘x’ when I first noticed ‘yz.’”
There are definitely more helpful and productive ways to channel your energy than lamenting all the “if onlys.” If you knew then what you know (or will know) now, you would have proceeded differently.
Give yourself some grace.
But educate – and continue educating – yourself and others in your sphere of influence. Grace and education today may very well save a life tomorrow.
One common challenge that parents lament is distinguishing between “normal teenage behavior” and eating disorder symptoms. Signs of an eating disorder in one child (e.g. weight loss) may not be the same in another child (e.g. weight loss due to undiagnosed Crohn’s Disease).
Another common challenge occurs when parents wonder why their child is showing signs of an eating disorder. Almost by default, they blame themselves.
The real issue often boils down to guilt. “What did I do or not do to cause this?”
Please hear me loud and clear: Your child’s eating disorder is not your fault. Eating disorders are caused by a combination of factors – biological, cultural, emotional, and social. And then the perfect storm results. You cannot single-handedly cause your child to develop an eating disorder.
To better understand your child’s path to an eating disorder, put yourself in her or his shoes.
The scenario might go something like this:
You’re 14. You’re convinced that the only way to build your self-worth is to lose weight. So much happening around you is beyond your control. Your perfectionism has earned you a lot of praise, but it feels as if it’s never enough. You still feel crappy about yourself.
Social media feeds tell you that the way to love your body and self is simple: Just lose weight, “be hot,” and you will get more “likes.” be more confident, and become really worthy of love. #guaranteed.
It’s all about how you look and the number of likes you get.
So you cut back on the amount you eat. You skip snacks and eat less at meals. You work out more.
People tell you how awesome you look. Changes in your appearance make you feel like the work is worth all the effort. (Having trouble concentrating and feeling lightheaded when you stand up are secondary to the perks.)
You decide that each day you have to eat less than you did the day before. It’s all you can think of. The rule is non-negotiable.
You’re convinced that if you just lose “x” more pounds, then you will be happy. But you are never too thin to feel fat. And fat, you believe, you are.
Eventually the biological drive for fuel prevails. You eat something from your forbidden foods list. Or you eat more than the rule you made allows.
You decide to make up for what you have eaten by not eating for the rest of the day or by exercising even more.
Maybe you even induce purging.
You compulsively body-check. And jump on the scale a few times a day “just to see” your weight, making sure you have peed before you do.
You suck in, pinch, and measure, always praying that you’re taking up less real estate today than you did yesterday.
Whatever the scale says determines how the rest of your day goes and how you feel about yourself.
The “restraint” is temporary. Eventually you eat. And then feel guilty. And then do it all again.
You’re now a hostage to eating disorder symptoms. You want – and simultaneously don’t want – to “be normal.”
You want someone to intervene, but you don’t want someone to call you out.
So, parents, what to do?
Step 1: Identify the Problem
There are early signs of an eating disorder that your child may be presenting.
You may be aware that something doesn’t feel quite right about your child’s behavior, but you’re reluctant to make “too big a deal” out of your concerns. After all, maybe your tween/teen is “just acting like a teenager.”
Or perhaps you think, “I don’t want to upset him by asking what he ate for lunch. He gets so defensive.”
Some signs of an eating disorder occur before the more obvious eating disorder symptoms. Others occur during the eating disorder. Still others intensify along with the eating disorder.
That’s a lot to tune into, let alone know how to respond to.
Below are what I call “The Big 5” – 5 classic, red-flag early warning signs of an eating disorder.
After these 5 major signs, I will list categories and detailed examples of how they present. But these are the biggies that you, as parents, should always be on alert for.
1. Weight Changes
It’s normal and a sign of good health for human beings to gain weight into their 20’s.
If your child doesn’t gain weight – especially during early adolescence – s/he may be in the early stages of an eating disorder.
Any weight loss, even unintentional, can trigger an eating disorder in at-risk children.
How your child responds to your or the doctor’s recommendation for weight gain may provide another sign of an eating disorder.
An increase in anxiety is common when developing and/or in the midst of an eating disorder. Anxiety can occur following weight loss or before any noticeable change in weight.
Depression, too, can be a precursor and/or outcome of an eating disorder.
3. Unusual Food Behaviors
People with eating disorders sometimes develop unusual behaviors around food. A few of the most common include: cutting food into tiny pieces, using a lot of hot sauce, and suddenly eliminating food for no valid reason.
It’s common for an interest in veganism to mark the start of an eating disorder.
A sudden interest in cooking (but not eating) is another example of an eating disorder-related food behavior. It’s common for people who are inadequately nourished to develop an interest in all things food – including shopping, preparing, and cooking.
4. Obsessive Behaviors
Eating disorders often take the form of a compulsion. If your child builds her day around exercise, she may have an exercise compulsion. This can be especially tough to determine if she is on an athletic team at school.
One revealing clue is her anxiety level. Does she freak out if something keeps her from her exercise routine? Does she exercise when injured, sick, or encouraged not to?
OCD is known to overlap with certain eating disorders.
5. Changes in Activity and Interests
Eating disorders are often secretive and isolating. People with eating disorder symptoms have little interest in the activities they used to enjoy. They may isolate themselves from peers and family, showing a preference instead for staying in their rooms, alone.
If these 5 major early warning signs sound too broad for you to confidently put your finger on, let’s dive into specific examples that might be easier to catch.
Below are detailed, categorized lists of early warning signs of an eating disorder. Note that you may not be privy to many of these signs, as not all are behavioral, and those that are may present only in secrecy.
Note also that many of these examples may fit under more than one of the Big 5. Compulsive behavior, for example, can show up in eating behavior, exercise, academics, and intrafamilial relationships.
By examining these signs in the context of unavoidable life components – eating, activity, health, thoughts, social life – you will have a heads-up on what to look for as your child goes through an “average” day.
Here are specific early warning signs, broken down into “lifestyle categories,” to be on alert for:
- dieting – can be disguised as “healthy eating,” “lifestyle changes,” veganism, or a specific diet, such as Paleo
- avoiding certain foods – foods often deemed ‘bad’ are sweets, snacks, and other foods that are “unhealthy”
- refusing to eat in front of other people
- sudden interest in “healthy,” “clean,” or “low-carb” diets
- rigidity about how much to eat, when to eat, and what to eat
- focusing on what other people eat, and deliberately eating less than everyone else
- insistence on knowing calorie content of the food before eating it
- sudden interest in cooking, watching food shows, reading recipes
- frequent baking and giving away the baked goods
- secretive eating
- having rules around time of eating (e.g. avoiding food until noon and after 7 pm)
- hostility if encouraged or “pressured” to eat something
- self-criticism for eating or not exercising
- fear of weight gain from a meal or type of food
- using the bathroom or showering right after meals
- cutting food into tiny pieces, mashing food, moving it around the plate to disguise the amount eaten. Maybe even hiding food in napkins or giving it to the dog on the downlow.
- intense, compulsive exercise
- refusal to cut back on exercise, even if injured or sick
- insistence on using a fitness tracker, calorie tracker, and/or other similar device/app
- sneaking exercise during the day or even in the middle of the night
- downplaying the distance or duration of exercise
- preference to stand and not sit
- unusual routines, such as having to use the same plate
- frequent daily weigh-ins on a scale
- wearing oversized, baggy clothing
- no longer growing as expected according to growth chart
- weight loss at any time as a child or teen
- injuries from overexercise
- sore throat if purging
- gastrointestinal problems, such as diarrhea, constipation, reflux
- feeling cold
- teeth damage
- rapid, extreme, unexplained weight loss
- denial of seriousness of symptoms
- preoccupation with “flaws” of the body, body parts, or aspects of the body
- constant need for reassurance about appearance
- distorted beliefs about food, weight, exercise
- inability to recognize distorted thinking
- difficulty concentrating
- belief of not being sick enough
- disinterest in and withdrawal from friends, family, activities
- unable to describe feelings
- refusal to spend time with friends if eating is involved
- low self-esteem
- shame about eating
- feeling stressed
- fixation on weight, body size, and shape
Parents, here are some questions to ask yourselves:
Does your child/tween/teen:
- seem to be losing or have lost control over how she eats?
- make herself sick?
- believe she’s fat, even when others don’t? Or believe she needs to lose weight in order to be happy?
- seem to be controlled by negative food thoughts and low self-worth?
- appear preoccupied with changing his body or weight?
- make family meals difficult because of behavior or comments about food, eating, or body image?
- isolate from family and friends?
- have unexplained weight changes?
Step 2: Then what?
Recognizing that in fact your child is developing/has developed an eating disorder is difficult to admit and accept.
You are not alone. Support for you and your child is just a call or click away.
For starters, you may want to contact your child’s pediatrician. Schedule an appointment for your child to have lab work done and vitals and weight taken. Find out about local resources.
Recommendations may include eating disorder treatment programs, eating disorder specialists (e.g. registered dietitian, psychologist), and/or family treatment.
Finding treatment and support can be daunting. Connecting to resources that offer support is often identified as one of the most helpful things a parent can do.
Reaching out like that helps the parent, the suffering child, and the entire family.
Here are some helpful resources:
- National Eating Disorders Association – family resources
- An international support organization for parents and caregivers – F.E.A.S.T.
- Multi-service Eating Disorder Association – MEDA
Parents, your role in identifying early signs of an eating disorder is key.
You also have a huge role to fulfill in recognizing when it’s time to seek help.
Trust your gut. YOU are also central in your child’s recovery.
Effective help is out there. The sooner treatment begins, the better the prospect of a successful recovery.
Without proper diagnosis or treatment, prognosis nosedives.
But, with proper treatment, full recovery is absolutely possible.
Dr Elayne Daniels is a psychologist specializing in eating disorders, body image, and High Sensitivity. For more information, contact her here.