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December 2012 / Bronx/​Riverdale Family / Brooklyn Family / Long Island Family / Manhattan Family / Queens Family / Staten Island Family

Eating disorders in teens

Longing to be lean

Eating disorders such as anorexia and bulimia seem to be in vogue today. Demi Lovato, Britney Spears, Nicole Richie, Mary-Kate Olsen, Paula Abdul, and Lady Gaga are among the many celebrities who suffered from them. Their disorders are glamorized on magazine covers and professionals wonder what effect stars’ disclosures have on our children.

In Psychology Today’s October 2011 issue, Dr. Judy Scheel distinguished between stars who disclose their ailments for mere publicity and those who share their private struggles to help fans better understand eating disorders. But no matter whether these celebrities are trying to help or not, Scheel tells me that vulnerable teens believe a disorder is no big deal if it helps them lose weight, look like their idols, and garner similar attention.

“In our pop-culture existence, teens think if they look a certain way they will feel good, preferring to share their idols’ symptoms and behavior, and focusing on someone else’s life, rather than tackling their own emotional issues,” Scheel explains.

Spotting an eating disorder

Concerned parents often have trouble differentiating between finicky eating and an eating disorder. Eating disorders are illnesses that seriously disrupt an everyday diet, most often characterized by severe distress about weight, according to the National Institute of Mental Health.

“Parents are going to miss the signs,” says Dr. Ira Sacker, former director of Eating Disorders at Brookdale University Hospital, who observes that parents’ busy lives make the signs almost impossible to spot.

“Eating disorders often start as weight loss diets,” writes Sacker in “Regaining Your Self–Understanding and Conquering The Eating Disorder Identity,” but change as body image and exercise become the focal point for girls’ anxiety and ultimately their identity. Some common signs include: eating very little or extreme dieting, having a distorted body image (incorrectly believing one is fat), lying about eating, excessive exercise, avoiding social situations where eating is involved, withdrawing from friends, excessive weight loss, a decline in grades, and a sudden penchant for baggy clothing.

Dr. Susan Bartell, author of “Girls-Only Weight Loss Guide,” tells me that eating disorders are sometimes misdiagnosed as attention deficit disorder or attention deficit hyperactivity disorder, mood swings, or are overlooked totally.

Still, Bartell notes that bulimics can hide their problem for years. According to “Dying to Be Thin,” which Sacker co-authored, “symptoms can develop little by little, day by day. And if you initially approved of the dieting or the exercising, then you may find it difficult to withdraw your approval, especially if your child seems pleased with his or her accomplishments.”

Bartell once treated a patient as young as 9, as eating disorders often start before high school.

Rebecca Allen, a 20 year old from Long Island who was treated for an eating disorder, tells me it started in seventh grade when there was a “dieting trend” amongst the girls. As a dancer, she spent hours in front of a mirror daily, which only exacerbated her situation.

One out of every five eating disorder sufferers die, according to Sacker. In fact, eating disorders have the highest mortality rate of any emotional disorder, he says. Impressionable adolescents with immortality complexes don’t recognize this, as they watch most of their idols recover. More than one patient confided in Sacker that she never realized how sick she was before treatment. And, recovery can take years.

Not just a food thing

Parents may incorrectly assume that an eating disorder is strictly food-related, and that monitoring a child’s intake can solve the problem, but that’s not the case.

“It’s the catalyst, not the cause,” says Scheel, who serves as director of Westchester’s Cedar Associates Eating Disorder Treatment Centers.

“Eating disorders are complicated,” Bartell tells me, and there’s never just one trigger, but many, including low self-esteem, poor self-image, and social issues. Sacker agrees, noting that even a fear of bullying can lead to an eating disorder, as adolescents can be critical of peers’ weight.

Scheel notes that both nurture and nature contribute, and stresses parents’ role in helping their child grow emotionally. Once this is done, a child is able “to weather the storm” by learning to cope with disappointments and negative feelings. In this way, young people are no longer dependent on others to tell them how they feel. She also explains “there is no eating disorder gene, but it is more common amongst those kids with a predisposition to anxiety and depression.”

A teen lying about how much food she eats is not a breach of trust, say experts. Sacker explains that an eating disorder patient will not see hiding her disorder as lying, but rather as not being understood, and parents’ accusations of mistrust will push her away more. Moreover, eating disorder patients truly believe they need to be thin or they’re nothing, adds Scheel.

“As an adolescent becomes more and more restrictive of her food intake, the brain starts to be starved of needed nutrients like fat and protein,” Scheel says.

“Being in a state of semi-starvation causes changes in the metabolism and brain chemistry that reinforce the restricting behavior by creating a natural high,” writes Sacker. This “dieting success” can be very satisfying and self-perpetuating.

Cover stories?

When my daughter entered 11th grade, seemingly half of her girlfriends turned vegan or vegetarian, and parents some wondered if these regimens were a gateway to an eating disorder.

Fortunately, parents need not necessarily panic if girls exhibit no other signs of a disorder. Veganism or vegetarianism can be healthy diet options for teens whose diets are balanced with sufficient vitamins and nutrients. But, for others, it can be the start of an eating disorder or orthorexia, which strikes healthy eaters who do not consume enough calories. Significantly, Sacker has treated many patients who have used veganism or vegetarianism to help conceal their extreme eating restrictions.

Parents’ words can reinforce dangerous behavior

Parents who always demand perfection think they are protecting their children against feeling vulnerable, but instead they are running the risk of contributing to a possible eating disorder.

“Young people really need help dealing with life’s disappointments, including not looking like a celebrity,” Scheel advises. “There’s beauty in imperfection.”

Allen warns against complimenting girls on how they look when they lose weight, lest they suffer from a disorder. “You are losing weight,” can be received as a compliment and motivation to lose more. Unfortunately, many girls already have strong peer reinforcement for their behavior, as friends undoubtedly tell them they look great and ask them how they did it. Additionally, comments normally considered criticism, like “you look too thin,” continue to reinforce the behavior, says Sacker. Bartell advises parents to refrain from criticizing or complimenting their daughter’s body, but instead talk about what she is eating.

Our world is an incubator for eating disorders

As girls’ bodies develop curves, their clothes tighten uncomfortably and the media bombards them with size zero airbrushed images, all of which can make them particularly vulnerable to eating disorders. In addition, girls’ preoccupation and anxiety about their bodies are magnified by the technology that is now a permanent fixture in their lives. The 24-seven internet and Facebook world permeates their lives everywhere, and photos, videos, and tweets can be unforgiving and relentless.

In addition, academic hyper-competition and over-scheduling, coupled with often unrealistic expectations, plague teens caught in limbo between childhood and adulthood. Some feel the only control they have is over their bodies.

And parents can be clueless, as Scheel notes, “we live in a quick-fix culture, which fosters the whitewashing of underlying problems, encouraging parents to buy things for their kids instead of allowing them to feel bad when they need to.”

How to help

Concerned parents should not hesitate to follow-up on reasonable suspicions for fear they are “invading their teen’s privacy” by checking if their child is purging or hiding food. Bartell equates a parent’s need for surveillance with that of drug or alcohol issues, as these disorders too can present a mortal danger.

She adds, “it our responsibility as parents to keep our kids healthy and safe.”

Sacker tells me that parents should not assume they are paranoid merely because eating disorders seem so commonplace now.

“If you are not a parent who is forearmed, then you are an ostrich with your head in the sand,” he advises. “Parents need to be cautious and aware.”

Still, micromanaging every morsel can backfire.

“If parents suspect an eating disorder, they should never assume they can handle it on their own by monitoring food. If they take that approach, then their child will go underground,” according to Bartell.

Instead, Sacker encourages parents to create an ongoing non-threatening dialogue with their teens.

“Parents need to understand their child’s interests, although not necessarily be part of them,” Sacker tells me. Moreover, he emphasizes the need for parents “to give up the guilt and the blame” in order to help.

The first step in treatment would be to locate an eating disorder specialist, preferably a medical doctor, to do a physical and mental evaluation, notes Sacker.

This decision may likely need to be made despite protestations from your child, Allen points out. If the patient is not medically stable, then inpatient treatment by a pediatrician, nutritionist, and a psychologist may be required. Although a parents’ first reflex might be to consult her trusted pediatrician, Sacker notes that pediatricians have varying levels of experience diagnosing and dealing with eating disorders. He reminds parents that they have to be prepared to ask their pediatrician about his background in these, if they are to rely on his advice or referrals.

Bartell also points out “the longer an eating disorder patient waits for treatment, the harder the recovery and cure.”

If one could say there is any benefit to having an eating disorder, Scheel would say it is that treatment can be instructive in helping patients and their families begin to concentrate on the real underlying problems.

Now that you know what to look for and what to do, pay attention to your kids and be aware of the signs. Parenting can be very challenging, but watching out for our children is just part of the job description.

Risa C. Doherty is a parent, attorney and award-winning freelance writer. Read more at www.risadoherty.com.

For more information contact the National Eating Disorders Association [(212) 576–6200; Helpline (800) 931–2237; www.nationaleatingdisorders.org]; Academy for Eating Disorders [(847) 498–4274; www.aedweb.org].

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