Facts About Eating Disorders
- What is an eating disorder?
- What causes eating disorders?
- How can I recognize an eating disorder in a teenager?
- What happens if an eating disorder isn’t treated?
- What can I do?
- Is there a cure?
- Books and other resources
What Is an Eating Disorder?
Eating disorders take several forms: anorexia nervosa, bulimia nervosa, and binge eating disorder. A young person with anorexia follows a severely restricted diet that results in weight loss. Bulimia is characterized by food binges, followed by purging through self-induced vomiting, exercise, laxatives, or fasting. This often leads to weight fluctuations—sometimes large, sometimes small.
Both anorexia and bulimia are about eight times more common in females than in males. Young people work hard to keep their struggles with food secret, so it’s hard to know just how many suffer from eating disorders. Between 1% and 13% of American high school and college-age women are estimated to be anorexic or bulimic.
An eating disorder arises when a person develops a distorted relationship with food, but it involves much more than simple dieting or feeling too full.
Sometimes the problem begins with a weight-loss diet, but then something goes wrong. Once 5 pounds have been lost, the weight goal is lowered another 5 or 10 pounds. Or perhaps the original goal is never quite reached, and instead the teenager's weight goes up and down in a seesaw pattern. Sometimes no actual diet is involved; the teen simply believes that they are much too fat and experiences a relentless drive to be thinner.
Eventually, the pursuit of thinness becomes an obsession that assumes more importance than anything else in the young person's life.
Food Isn't the Real Problem
Both anorexia and bulimia arise from a complex web of factors. There's no single, simple cause. The relentless focus on calories, diets, secret eating, exercise, and purging are only the outward signs of emotional confusion.
Conflict with friends and family and societal messages can all contribute to this problem. An individual with an eating disorder usually has a poor self-image and low self-esteem—no matter how “perfect” he or she may appear to others. On the social level, teens and even younger kids get the message that “thin and muscular is in” and that “anything goes” in the struggle to achieve this image.
It is often difficult for the person with an eating disorder to admit that they need help. That's why it may be up to friends, family members, and respected coaches, or teachers to guide the young person to the help they need.
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What Causes Eating Disorders?
In our society, thin is definitely in. It doesn’t take long for kids to get the message. Research shows that by the age of 7, many children have decided that it isn’t okay to be fat.
The pressure to be slender is especially intense for girls and young women in their teens. Two thirds of girls between the ages of 10 and 15 have tried dieting. Cultural messages about thinness are directed almost entirely toward women, and puberty is a time when young people are confronted with a rapidly changing body.
Despite the preoccupation and struggle with eating, the central issue in any eating disorder is never the food itself. It’s control. At a time when the teenager's body and feelings are changing in ways the teen can barely understand, the young dieter discovers that there's one thing they can control—their weight.
The eating disorder therefore often begins as a problem-solving approach to the difficulties of adolescence. Ironically, though, dieting soon becomes a tyrant the teenager is helpless to control. They have then lost to the eating disorder the one thing they have been desperately struggling to preserve—control.
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How Can I Recognize an Eating Disorder in a Teenager?
Young people go to great lengths to deny and conceal their painful struggles with food. Here are some signs that may help you recognize an eating disorder in someone you know:
- Excessive weight loss. Anorexia is diagnosed when the teenager is 15% below expected weight (whether because of loss of weight or failure to gain with growth).
- Frequent weight fluctuations. Although people with bulimia usually maintain near-normal body weight, their roller coaster dieting may show up in erratic weight gains and losses.
- Unusual eating habits, such as taking tiny bites to stretch out eating time or compulsively arranging food on the plate.
- Stops eating meals with the family; i.e., too busy or eating elsewhere.
- Secretive behavior, especially with respect to eating and bathroom use. A teenager who habitually runs water, plays the radio, or flushes the toilet repeatedly while using the bathroom may be masking the sounds of vomiting.
- Use of laxatives or diet pills.
- Food disappearing on a regular basis.
- Excessive and often obsessive exercise.
- Dull hair and hair loss, splitting or softening nails.
- An absence of menstrual periods related to loss of body fat.
- Dental cavities and gum disease, caused by malnutrition and vomiting.
- Extreme sensitivity to cold, caused by loss of fat and muscle.
- Fine body hair on arms and legs. This is the body's attempt to keep warm.
- Low self-esteem.
- Distorted body image. No matter how thin they get, people with anorexia still believe they are too fat.
- Irritability, depression, or talk of suicide.
- Drug or alcohol abuse. Sometimes, teenagers with eating disorders will turn to substance abuse to relieve feelings of fear, shame, and depression.
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What Happens If an Eating Disorder Isn't Treated?
Without intervention, the consequences of anorexia nervosa can be tragic. Prolonged dieting and weight loss leads to severe malnutrition. The body tries to stay alive by going into a hibernation-like state, with organ functions slowing down to barely survivable levels. Almost every organ system is affected: brain, heart, liver, kidneys, bone marrow, skin, and reproduction. The heart muscle gets smaller, leading to poor circulation; and the heart rate slows, putting one at risk for potentially fatal heart attacks. Brain tissue is lost, some of it permanently. Girls stop having periods, and the lack of estrogen can lead to significant osteoporosis—weak bones—which develops in 50% of patients with anorexia.
Bulimia nervosa also causes serious health problems. Frequent purging causes electrolytes, especially potassium, to get dangerously low, leading to potentially fatal heart attacks. Repeated vomiting can result in rupturing the esophagus or breaking blood vessels, presenting an emergency that can be life threatening.
The psychological complications of an eating disorder, though sometimes slower to surface, can be just as devastating as the physical problems. Rejection by peers and family conflict may be both the cause and the effect of the person with anorexia's self-destructive eating patterns. Schoolwork and relationships suffer, leaving the teenager isolated and even more determined to take control of their life by controlling their eating. Emotionally, the person with an eating disorder becomes isolated and deeply depressed. Self-esteem spirals downward as the disorder gains control over one's life. This can get to a point at which teenagers consider suicide, which is the leading cause of death in people who suffer from eating disorders.
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What Can I Do?
As a parent:
From as early as possible, let your child make decisions appropriate for their age. This helps the child create a sense of control over his or her own life. Teach your children skills for dealing with stress and pain.
Understand that eating problems reflect deeper, emotional issues. Don't criticize or tease your child about minor weight gains, and avoid power struggles over food.
Finally, remember that no one is to blame. Discuss your concerns openly, then seek professional help.
As a friend:
Don't comment on your friend's eating behavior or size. Even if your friend gains weight, don't praise him or her for it. What your friend will hear is, “You’re fat again.”
Remember that you can’t solve the problem. You aren’t responsible for saving your friend.
Encourage your friend to talk to a parent, teacher, or counselor. If they don’t, tell an adult close to your friend about your concerns.
As a school nurse, counselor, teacher, or coach:
Discuss your concerns with the adolescent first, and suggest that the adolescent talk with their parents.
Expect denial of any problem. You may have to talk with parents, but always let the adolescent know that you will be doing this and why.
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Is There A Cure?
Both anorexia and bulimia can be treated successfully. Most damaging effects can be reversed if the condition is recognized and treated early enough. Without intervention, though, an eating disorder will not simply clear itself up. It may continue into adulthood, causing irreversible physical and psychological damage.
The individual's relationship with food may never again be completely anxiety-free, but the person with anorexia or bulimia can learn to control their eating patterns and find healthy ways to manage stress and pain.
There is no quick fix. The most successful treatment seems to draw on a number of approaches, both medical and psychological.
Although much can be accomplished in outpatient treatment, in many cases, hospitalization may be necessary to treat physical and psychological problems and to bring the abnormal eating patterns under control. In either setting, individual psychotherapy can be a key to understanding self-destructive behaviors and to developing healthier ways of dealing with stress.
Family therapy is extremely important for teens with eating disorders. Because they live in a family context, teenagers need desperately to feel that their family is supporting them. The family in turn needs support as parents and siblings try to cope with the way anorexia and bulimia affect their lives.
Group therapy is another form of help that provides crucial peer support. Nutrition counseling, behavior modification, and medication are other resources that prove helpful.
Help Is Available
The important thing to remember is that the person with anorexia or bulimia needs professional help. The individual is caught in a cycle of obsessive behavior that they cannot break alone, even with all the willpower in the world.
If you think someone in your family may be struggling with an eating disorder, speak with your teen's physician or call an eating disorders program that specializes in treating teenagers. Teens have different problems and pressures than adults do, and treatment approaches should address these special concerns.
With prompt treatment and support from friends and family, the person with anorexia or bulimia can learn that food is neither a best friend nor a worst enemy. Perhaps most importantly, the individual can begin to rebuild the central friendship in their life: a healthy relationship with themselves.
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