Could this be bulimia?

Jennifer had noticed a recent change in her daughter Kylie since she had turned 13. Kylie was once a rambunctious child, who loved rough-and-tumble games with her two big brothers and was seldom afraid to speak her mind. But lately, Kylie had become more withdrawn and touchy. Jennifer noticed that she was less and less interested in interacting with her brothers, and she did not bounce back from their little-sister taunts and teases as easily as she once had.

Kylie was reading a lot of articles online about dieting and fasting, and once, Jennifer had even found a package insert for over-the-counter diet pills in Kylie’s bedroom trash can. Kylie was also spending less time with her childhood friends and more time staying home watching sitcom reruns on TV.

Jennifer was concerned, but she felt that Kylie was pushing her away. Should Jennifer follow conventional wisdom that advises parents to give teens space and respect their desire for more independence? Or should Jennifer pay closer attention to Kylie’s day-to-day behaviors, especially related to eating and dieting?

If you know the facts about an eating disorder called bulimia nervosa, then you know that Jennifer should calmly and quietly pay closer attention to Kylie’s behavior around eating and dieting. Studies indicate that by their first year of college, 4.5 to 18 percent of women and 0.4 percent of men have a history of bulimia.

In the United States, five to 10 million adolescent girls and women struggle with eating disorders and borderline eating conditions. According to The Center For Mental Health Services, 90 percent of those who have eating disorders are women between the ages of 12 and 25.

Boys and young men are also at risk for eating disorders. And eating disorders in boys and men, even if less frequent, may be on the rise. Especially at risk, studies say, are boys on competitive sports teams, where members are under pressure to meet specific weights or stay physically fit, and also boys who are hypersensitive about physical appearance.

Bulimic behavior means binge eating and then attempting to rid the body of the food by purging (forcing yourself to throw up), by taking laxatives or diuretics, by fasting, or by compulsively exercising. Children who are overly concerned about their weight may take diet pills, smoke cigarettes, drink excessive amounts of diet soda, take stimulants, or try anything else that promises appetite suppression or rapid weight loss.

If you are wondering if your child is overly focused on body image and weight, and might be at risk for bulimia nervosa, watch for these seven signals:

Large amounts of foods consumed in short amounts of time. Food disappears suddenly from your kitchen or pantry. Packaging and wrappers appear in indoor or outdoor trash and recycling containers without your awareness that food was eaten. You find food packaging or wrappers in funny places, such as in bedroom closets or hidden under or behind furniture after you’ve noticed food missing.

Purging behaviors. Your child retreats to a remote bathroom right after meals. You discover diet pills in your daughter’s purse or diuretics in your son’s sports bag. You find evidence of vomiting in the bathroom although no one in the house is sick. You notice bloodshot eyes or broken blood vessels in your child’s face shortly after mealtime.

A fascination with fasting. You notice your child not eating for a day or even days at a time, possibly engaging in extreme behaviors like drinking large amounts of water or diet soda to suppress appetite. Your child exhibits dizziness or light-headedness from not eating.

Compulsive exercising. Your child often exercises right after eating, perhaps even early in the morning or late at night. You notice that periods of intense exercise come in fits and spurts rather than maintained sensibly over time. You notice a connection between the reward of food and the punishment of exercise afterwards.

Secretiveness around eating and food. You may find multiple candy bar wrappers in an outdoor trash container. You might hear your daughter awake at night rooting around in the kitchen cabinets. You notice that an ice cream container that was almost full yesterday in now almost empty.

Overeating. You suspect your child is eating emotionally or anxiously. He has a group of buddies who like to all “pig out” together after intense sports competitions. You wonder how your child seems to be eating so much without gaining weight. You notice a pattern of bursts of overeating that did not exist before.

Mood changes and addictive behaviors. Does your child seem anxious, depressed, or excessively moody lately? Sometimes eating disorders and mood disorders go hand-and-hand, and those who suffer from eating disorders may also be at higher risk for addictions. If a typically cheery child suddenly turns sour and becomes distant and depressed along with several of these other signs, get ready to offer help.

There is often nothing visible on the surface that will tip you off to an eating disorder, so you may need to become a detective to determine whether or not your child is suffering from one. A bulimic child may work hard to keep up appearances. She may fall into a normal category of weight for her age, take care with her appearance, and put a smile on her face to cover up behaviors she does not want you to notice. But pay attention, because by the time you notice concrete physical signs, like discolored teeth or calluses on fingers, the disorder will already be in advanced stages.

The best thing that can happen for a child with an eating disorder is early intervention and treatment, which is why it’s important to try and catch patterns of bulimic behavior as soon as possible. Remember that eating disorders are painful and cause the sufferer to feel acute shame. If your child needs help, you want to be ready to provide it calmly and supportively without making a big fuss or taking the situation personally.

Do not try to treat eating disorders at home. Seek professional help. Do some homework and set up professional resources before you approach your child, so you can be ready to offer a course of helpful action. Contact your family doctor ahead of time, and get the name of specialists in your area. Keep in mind that the best choice for a child feeling vulnerable and ashamed may be to seek out a treatment professional of the same gender with a gentle manner.

Think of an eating disorder as a cry for help rather than a permanent condition. With early intervention and treatment, and love and support from family and friends, Kylie has a good chance of making a full recovery. Then she and Jennifer and the whole family can feel close once again.

Author and freelance journalist Christina Katz would like to live in a world without eating disorders, so she wrote this article to help parents notice signals they might otherwise miss. Her latest book is “The Art of Making Time for Yourself, A Collection of Advice for Moms.”