Symptoms of Eating Disorders in Children and Teens

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Eating disorders, such as anorexia nervosa and bulimia nervosa, are serious chronic conditions that are often underdiagnosed and not properly treated. These illnesses can be dangerous, so it is important for us to recognize signs and symptoms of disordered eating in order to get our kids the help they need for recovery.

On this week’s On Call for All Kids, Sarah Sobalvarro, Ph.D., a licensed pediatric psychologist at Johns Hopkins All Children’s Hospital who works closely with the Adolescent and Young Adult Clinic, is here to share some important information on this topic.

What is an eating disorder?

Eating disorders are complex medical illnesses that have serious physical, mental and psychosocial consequences as well as association with high mortality rates. Eating disorders involve an unhealthy relationship with food and cause significant interference with daily functioning. Some examples of eating disorders include anorexia nervosa, atypical anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant restrictive food intake disorder (also known as ARFID).

What is atypical anorexia nervosa?

Atypical anorexia nervosa is a common eating disorder that is often overlooked or underdiagnosed because patients with atypical anorexia are in the normal weight range. Atypical anorexia is categorized by all of the same symptoms and risks as classic anorexia nervosa and is just as dangerous so we want to monitor individuals across the weight spectrum for disordered eating.

Eating disorders are considered both mental health disorders and medical illnesses. Therefore, someone suffering from an eating disorder should seek help from a medical professional and a mental health professional who specializes in treating eating disorders. It is also recommended to have a dietitian closely involved when a child or teen is struggling with an eating disorder.

What are some of the signs and symptoms of an eating disorder?

In anorexia nervosa or atypical anorexia nervosa, some of the most common signs are frequent comments about weight/appearance, skipping meals, eating small portions, refusal to eat high-sugar, high-fat foods, overall restrictive food intake and excessive exercise. Severe weight loss, fear of gaining weight and severe body image disturbances are also warning signs of anorexia.

What is bulimia nervosa?

Bulimia nervosa is categorized by a pattern of binge eating followed by the use of a compensatory behavior, such as purging, fasting, laxative or diuretic use, and excessive exercise to prevent weight gain. 

What is binge eating disorder?

Binge eating disorder involves eating larger than normal portions of food in one sitting and inability to stop oneself from eating excessively large portions.

What is ARFID?

ARFID is an eating disorder categorized by significant aversion to food based on sensory characteristics (texture), lack of interest in eating, or concern about aversive consequences of eating such as stomach pain, vomiting or choking.

Other signs to look out for across eating disorders include hiding/sneaking food, calorie tracking and refusal to participate in social events involving food. As you can see, there are several different signs of eating disorders that indicate an individual may need an assessment by a professional.

What can happen if a child/teen starts to engage in disordered eating behaviors?

There are several medical and mental health consequences that can occur when children or teens start engaging in disordered eating behaviors. Medical concerns include rapid weight change, low heart rate, hormone changes, electrolyte shifting, fatigue, breathing problems, hair loss, blood pressure changes, heart rhythm abnormalities, fainting and even death. Mental health concerns that often occur in individuals with eating disorders include social isolation, loneliness, significant anxiety, withdrawal, depression and suicidal ideation.

What should you do if you or someone you know is suffering from an eating disorder?

Take these concerns seriously. Eating disorders can be a very sensitive topic, but reaching out to a trusted adult or professional is one of the most important steps toward recovery. Discussing it with your doctor or therapist will help you receive the right care, evaluation, diagnosis and treatment plan.

What should parents do at home to support their child or teen with an eating disorder?

Great question! It is important to remember that eating disorders are both medical and mental health disorders so it is incredibly difficult for children/teens to recover on their own. They need treatment and consistent support from their families. This means parents should not be afraid to closely monitor their child or teen’s eating behaviors. Parents should be ensuring their child is eating a variety of foods and obtaining adequate nutrition each day.

Parents may have to use clever strategies to make sure their child is compliant with eating and not engaging in disordered eating behaviors. Remember to balance empathy and authoritativeness. As a parent it can be tempting to back off because arguments may happen around mealtime or because we feel the child/teen does not want help, but don’t give in to the eating disorder.

Remember that your child did not choose to have an eating disorder. Your role as a parent or caregiver is to help your child fight the eating disorder. Parents and family are a critical component of recovery and should be closely involved in their child’s treatment.