I was recently interviewed by Ser Familia Magazine for an article exploring disordered eating in teenagers. Here is a translation of the interview:
Is there a difference between an eating disorder and disordered eating?
Traditionally, eating disorder has been used for clinical cases such as bulimia and anorexia, and the term disordered eating was reserved for a distorted relation to food, such as the case of bingeing and chronic dieting.
In terms of legal and medical implications for practitioners, many countries have different guidelines for working with eating disorders.
However, as our understanding of this field increases, the lines between what constitutes a classic eating disorder and what is not becomes more blurred. For instance, bingeing is now considered an eating disorder.
The term EDNOS (Eating Disorders Not Otherwise Specified) has been coined to name the broad spectrum of issues around food that don’t necessarily fall into the classic eating disorder category, but which are nonetheless to be taken very seriously and require the help of a qualified practitioner. Also, the fact that a teenager has sub clinical symptoms does not mean that their ailment is less serious.
What are the most common eating issues during adolescence?
Parents might be surprised to hear that the first sign of an issue is to go on a diet. While eating disorders are not a diet gone wrong, dieting can indicate a distorted relationship to eating and nourishment. But many parents ignore this – somehow there is still a common perception that all eating disorders must be primarily linked to a dysfunctional family or childhood trauma, and that is not the case.
During adolescence we can observe many behaviors around food that require intervention. These are chronic dieting, bingeing (with or without purging), and of course anorexia and bulimia. Many years ago it was believed that the onset for anorexia was around 15 years old, but nowadays we are seeing children younger than 10 enter treatment for an eating disorder.
Which factors influence the development of an eating disorder in teenagers?
Again, one cannot underestimate the importance of dieting. Unfortunately, from the point of view of our current society, a diet can represent a rite of passage for a teenager, especially in the case of females: a diet is a way of letting the world know that we are no longer children, we have curves, and we can do the same behavior that millions of women around the world are doing.
It is interesting to note that parents are alarmed if their children drink alcohol, smoke or drive irresponsibly, but generally don’t intervene when they hear that their child wants to go on a diet. Sadly, many parents see dieting a positive behavior, especially if they believe that their children are getting “chubby”.
There are of course many other factors to consider, from environment to genetics to personality. We know that many teens who suffer from eating disorders tend to be highly intelligent, perfectionists and rather anxious, but this dos not mean that if your child doesn’t fall into these categories he/she is not at risk.
A child from ANY ethnic, religious or socioeconomic background can develop an eating disorder.
Is it true that eating disorders affect mostly women?
Generally speaking yes, though the number of affected males continues to climb. It is important to watch for signs in all teenagers, regardless of their sex or sexual orientation.
When confronted with an eating disorder, will we always see weight loss or weight gain? Are there any other symptoms or complications?
Not all eating disorders show a fluctuation of weight. Bulimia, for example, is perceived by many teens as a way to eat larger quantities of food without having to gain weight. The health condition of the teenager will deteriorate, but we won’t necessarily see a change in the number on the scale.
That is why it’s so important for parents to be vigilant: they know their children best and they are the first ones to see that there is something “off”, even though they might not be able to identify an eating disorder as such.
Depending on the issue at hand, there will be different complications: digestive issues, issues of absorption of nutrients, electrolyte imbalance, cardiac issues, fatigue, depression, obesity… the list goes on.
What are the signs that parents should look for? How should a parent react?
As said before, parents play a crucial role in noticing that there is something going on with their child. Besides weight fluctuation, which is an easy clue to identify, parents should pay attention to:
– Changes in mood (irritability or bad temper, which can be symptoms of hormonal imbalances, lack of lipids or malnutrition)
– Erratic behaviors, especially isolation: disordered eating thrives in isolation. If your child wants to eat alone, if he/she starts to spend more time in the bathroom, if there is less social contact than before, there may be something going on.
– And of course, pay attention to dieting!
Regarding how to react, confronting your child is not always the best option. They might get defensive, or start to hide their behavior from you. A first good step is to check with school (to see if they have noticed any changes as well) and with the pediatrician.
Sadly, not all pediatricians are trained to identify issues around nutrition and disordered eating. If you as a parent suspect that there is something wrong with your child and your pediatrician ignores or minimizes the issue, it is strongly advisable to look for support elsewhere (see resources) instead of hoping that your child “will grow out of this phase”.
How important is the environment for a teen with disordered eating? How important is the family?
Both are crucial, not only for the evolution of the disorder (for example, there is a lot of peer pressure to be thin) but also for its healing. The role of the family is especially important. When seeking professional help to work with your teenager, be prepared to involve the whole family in the process. And if the practitioner only wants to work with your child, (s)he should be able to give you ample reason for this, or you might have to look for another professional who specializes in these issues.
What is a standard treatment for disordered eating? How long does it take? And what can parents do after treatment to support their teen?
The type of treatment choice will depend on several factors, for instance: how old your child is, what type of eating disorder he/she presents, how severe it is, the health condition of the child, the family situation, etc. When dealing with anorexia weight gain is a must, but when treating bulimia weight issues are secondary. Each type of eating disorder presents its own set of challenges and characteristics.
Generally speaking, we can say that if the eating disorder is recent (that is, your child has only started to present these behaviors in the past few weeks/months) the probability of full recovery is higher. The best treatment options tend to involve a whole team of professionals: doctor, nutritionist, therapist for both teen and the family. Depending on the type of eating disorder and its severity, there will also be medication and/or hospitalization.
Finally, it is important to notice that recovery is not a linear process, but rather a cyclical one: there will be ups and downs along the way, and parents need to be prepared to be vigilant while still being loving and supportive of their teen. Because it happens oftentimes that the family is drained – it’s always important to remember that we are dealing with a teen that has a problem, and our goal should be to help the child, not to stigmatize or criticize him/her.
So the road to recovery might be long, but it is a road worth taking.
