Signs of Disordered Eating in Children and Teens
Written by the Columbia Center for Eating Disorders: Loren Gianini, PhD and Barbara Smolek, MPA. Adolescence is a time of experimentation, rebellion and growing independence. It’s not unusual for emerging adults to experiment with different lifestyles; after all, the transition to (and then from) college often provides a picturesque backdrop for personal reinvention.
There are multiple common areas of experimentation including the trying on of different school majors or career foci, political beliefs or activist agendas, and friendships or intimate relationships. Health-related domains, including alcohol and drug use, eating and exercise patterns, and sexual behaviors, are also common arenas of exploration. For most adolescents and young adults, health-related experiments may be short lived, or found to improve overall function (for example, learning that it’s important to eat well and get a good night’s rest before a big game). For a susceptible few, however, experimentation around health-related behaviors begins a slippery slope that can be detrimental to physical and mental health.
What should you do if your daughter tells you that she’s routinely skipping lunch at the dining hall or avoiding keeping snacks on hand in her dorm room, but insists “it’s not a big deal because all my friends do too”? Should you be worried if every time you check your child’s social media feed, you notice that she’s posing to look thinner? How about if your credit card bills indicate that your child is frequently buying large amounts of food, of if he has started to describe eating more than usual when feeling stressed about midterms? What is a helpful reaction if your child returns home from college for break and has either gained or lost a significant amount of weight?
In short: What are the signs your child might be struggling with disordered eating, and what can you do?
Here are some reminders about behaviors that may indicate your child may be struggling with eating issues and some tips on how to tease out “normal” young adult behavior from signs of a potential problem:
- Trust Your Gut
If you notice a change in your child’s eating behavior and are concerned, trust that feeling, even if your child’s physician says that his or her weight is in the healthy range (Many individuals with eating disorders are actually not underweight.). For example, you may notice that your child, who has always been a picky eater, is now making excuses not to eat with the family at home, feeling stressed out by dining at restaurants, pushing food around on the plate, and covering their plate with a napkin before clearing it. If you’re wondering how to address your concerns with your child (of any age), read here how to ‘call it as you see it.’
- Eating Problems: Not Simply an Intake Issue
If your child seems to go above and beyond the training regimen recommended by their sports team, take note. This could mean trying to get in extra practice before or after school, or trying to train through an injury or illness, even though their coach has recommended they take some time to recover. Has your child’s friends expressed concern? And, if your child exercises in order to compensate for food they’ve eaten, rather than for fun or for health, or seems bound to a rigid fitness routine even when home on a school break, this may also be cause for alarm.
- Digital Dilemmas
Are you noticing your child using social media in ways that focus exclusively on appearance? Are they competing in the “thigh gap” challenge, or wanting to pose to show as little of themselves as possible? These challenges are unhealthy, unrealistic, and undermine a healthy self-image. Teach them – explicitly, and by your own example – how to manage normal body image concerns in the digital age. Remind them of those in the media who stand up to Photoshop and choose instead to show realistic images that accurately reflect the acceptability of a range of body types. Teens and young adults are old enough to engage in a meaningful conversation about how their relationship with technology impacts their focus, friendships, and feelings about themselves.
- Finding the Fine Line with Food Rules
Has your child recently decided to go gluten-free, even though they do not have celiac disease, or to become a vegetarian, and as a result is eating far less at meals or parties? Experimentation in moderation with new approaches to food, like vegetarianism, can be supported, so long as your child is still eating a broad variety of foods, i.e., not just eating vegetables. People who struggle with disordered eating may adopt rigid food rules which give them an excuse to exclude large groups of foods from their diets. They may say they are trying to be frugal and not spend money on food, or might report that they’re “just” dieting in advance of spring break to “look good in a bathing suit”. A healthy approach to eating includes flexibility, choosing from a wide variety of foods, and it’s important to remember that many teens and young adults in high school and college are still in the process of reaching a stable weight, particularly if they experience changes in activity level (e.g., starting or stopping athletic involvement).
- Food and Mood
Does your child seem moody and withdrawn? While it may be common for a teen to want to spend more time with friends than family, the notion that teens withdraw from the world or are constantly irritable is really a myth. Low mood is not specific to individuals with eating disorders; however, if someone has an eating disorder it often comes hand in hand with mood changes, or outright depression. There are many ways that mood and anxiety levels can track with increases or decreases in intake. In one scenario, a teen or young adult might respond to anger and sadness following a fight with a friend by retreating to their room with a pizza and a carton of ice cream. In another context, such as a heavy semester workload or career decisions, the experience of heightened anxiety may play out in under- or overeating. Research suggests that if eating behavior is tightly bound up with fluctuations in mood and anxiety, it is worth taking note. You may be able to help your child develop other, healthier ways to handle life’s inevitable stresses without turning to or away from food.
If you see a troubling shift in your child’s behavior, including but not limited to those listed above, say something. Be mindful to express your concern (rather than your frustration).
If your child is still living at home, you can approach this as you would any other kind of medical issue. If your child had a cold, you might monitor the symptoms for a while and then seek consultation from a doctor if the symptoms did not improve, or worsened. You can monitor what’s happening by talking to teachers and school counselors who can share observations of your child when they are not with you. Pay attention to the attitudes and behaviors of your child’s peer group.
For college students who are living on campus, you can certainly take note of both appearance and behavior when they are home for breaks and reach out to them if you are concerned by what you observe. If you are connected with your child via social media platforms, you might also be able to indirectly monitor their wellbeing based on what they are posting. Investigate what student health resources may be available to students through their university, and speak with them about accessing those resources if you feel they might benefit from getting help from a professional. You might also refer them to some of our back-to-school tips and suggestions for college athletes.
For emerging adults, do what you can to empower them to make their own decisions in service of optimal health and functioning. Encourage them to learn about treatment resources local to their area or through their employer’s employee assistance program. If the behaviors of concern persist or worsen, you can offer to speak together with an expert who can provide an objective assessment. This might be your child’s physician, or a mental health provider who is an eating disorders specialist. Remember, families play a vital role in helping those with eating problems (even those in adulthood), and research indicates that early intervention is key.
An earlier version of this post appeared in The Feed on January 4, 2017.
About the Author: Dr. Gianini is a clinical and research psychologist at the Columbia Center for Eating Disorders. Her current research aims to examine food-related decision-making across the weight spectrum. Be sure to check Columbia Center for Eating Disorder's blog as well.