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Eating Disorders

Eating disorders are serious behavior problems that can include severe overeating or not consuming enough food to stay healthy. They also involve extreme concern about the person’s shape or weight.

Eating disorders are hard to diagnose and effectively treat. However, the growing number of children and adolescents with eating disorders, especially in the last decade, makes it especially important for parents, caregivers and pediatricians to be familiar with the problem signs so they can get help for the child. Here’s information from the National Institutes of Health to help parents recognize the problem in their children and address it. 

Eating Disorders and Adolescence 

Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood (or even later in life). Much of the unhealthy emphasis on dieting and weight loss can be traced to the significant increase in childhood obesity. Healthcare providers are also seeing weight-related issues in younger children. 

Eating disorders are potentially life-threatening and can lead to premature death if untreated. These illnesses represent the third most common chronic illness (after asthma and obesity) in adolescent females. Also, research shows that eating disorders affect brain function. According to the Academy for Eating Disorders, people with these disorders appear to have impaired memory, reduced visual-spatial ability, and problems with attention, verbal functioning and learning.

Males are less likely to be diagnosed since eating disorders are often considered a female disorder. Boys are more likely to have muscle dysmorphia, a type of disorder that is characterized by an extreme concern with becoming more muscular. Some see themselves as smaller than they really are and want to gain weight or bulk up. These boys are more likely to use steroids or other drugs to increase muscle mass.

Some parents may deny the existence of a problem, especially if the child denies an eating disorder. A feeling of shame on the part of the parent or the child can lead to an even deeper cycle of denial. People struggling with eating disorders are very skilled at hiding or explaining their behaviors, so it is important for parents to remain vigilant to signs and symptoms. 

What are the different types of eating disorders?

Anorexia nervosa is characterized by:

  • Extreme thinness (emaciation)
  • A relentless pursuit of thinness and an unwillingness to maintain a normal or healthy weight
  • Intense fear of gaining weight
  • Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
  • Lack of menstruation among girls and women
  • Extremely restricted eating

Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food and weight control become obsessions. People with anorexia nervosa typically weigh themselves repeatedly, portion food carefully and eat very small quantities of only certain foods. Some people with anorexia nervosa may also engage in binge eating followed by extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of laxatives, diuretics or enemas.

Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness.

Other symptoms may develop over time, including:

  • Thinning of the bones (osteopenia or osteoporosis)
  • Brittle hair and nails
  • Dry and yellowish skin
  • Growth of fine hair all over the body (lanugo)
  • Mild anemia and muscle wasting and weakness
  • Severe constipation
  • Low blood pressure, slowed breathing and pulse
  • Damage to the structure and function of the heart
  • Brain damage
  • Multiorgan failure
  • Drop in internal body temperature, causing a person to feel cold all the time
  • Lethargy, sluggishness, feeling tired all the time
  • Infertility

Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge eating is followed by behavior that compensates for the overeating, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge-eating-and-purging cycle happens anywhere from several times a week to several times a day.

Symptoms include:

  • Chronically inflamed and sore throat
  • Swollen salivary glands in the neck and jaw area
  • Worn tooth enamel; increasingly sensitive and decaying teeth as a result of exposure to stomach acid
  • Acid reflux disorder and other gastrointestinal problems
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration from purging of fluids
  • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals), which can lead to heart attack

With binge-eating disorder, a person loses control over his or her eating. Unlike bulimia nervosa, periods of binge eating are not followed by purging, excessive exercise or fasting. As a result, people with binge-eating disorder often are overweight or obese. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure. They also experience guilt, shame and distress about their binge eating, which can lead to more binge eating.

How are eating disorders treated?

Treating eating disorders requires a team approach that includes psychotherapy, family intervention, nutritional intervention and medical care, which may include medications. This team approach involves three main phases: 1) restoring weight lost because of severe dieting and purging; 2) treating psychological disturbances such as distortion of body image, low self-esteem, and family and interpersonal conflicts; and 3) achieving long-term remission and rehabilitation, or full recovery. These treatment phases can all be addressed at the same time.

Treatment plans often are tailored to individual needs. Some patients may also need to be hospitalized to treat problems caused by malnutrition or to ensure they eat enough if they are very underweight.

It is important to have a support system—including trusted friends, loved ones and health professionals—that can support your teen during the treatment process.

If you have concerns about your child’s eating behaviors, contact your doctor as soon as possible.