If you are worried about your teen and their relationship with food or their body, it is best to act fast. Often times it is not "just a phase" and if you are worried, there is a reason why you are worried. Getting your adolescent support sooner rather than later can help get them back on track quickly and will also avoid them developing a more pervasive negative relationship with food and/or body image. Eating disorders are not simply just wanting to be "thinner" or more superficial motivated reasons, they may present that way on the surface but the reality is eating disorders are a complicated mental health concern that impacts the whole body.
Although eating disorders impact people of all ages, they are most likely to develop in adolescence. Teens are going through great developmental and emotional changes through adolescence, which is why the phase is so challenging and exciting for everyone involved.
Here are 5 steps to take if you are concerned your teen has an eating disorder:
1. Research and Learn About Eating Disorders
Eating disorder are complex and mainstream information about eating disorders typically falls short in really providing accurate information. Most people do not understand eating disorders and tend to minimize the dangers of eating disorders. It is important to understand the seriousness of eating disorders and the medical and psychological complications. Eating disorders are one of the most fatal psychiatric disorders and it is important to be aware of that reality. It is valid to be concerned about your teen. One hallmark of eating disorders is that they are egosyntonic which means when people are engaging in eating disorder behaviors they typically feel better and when they are not engaging in behaviors, they feel worse. It is important to make sure that you are aware of the signs, symptoms and areas of concern so that you can react appropriately, even if you teen is acting like it is not a big deal and they do not want help. Often times, eating disorders may present like a superficial need to lose weight or to change one's body but there are complex processes occurring which can quickly become a serious obsession.
As Mental Health providers, we are trained to diagnosis and treat disorders based on certain criteria. However, even if an individual does not meet the full criteria of an eating disorder they can still benefit from therapy and intervention. Especially with teens, we want to help them build a positive relationship with food and body so that they do not have to struggle with these issues throughout their adulthood.
To better understand eating disorders, please see the following links:
Common misconceptions parents may have:
My child is not underweight, should I still be concerned? Yes. The reality is that most people with an eating disorder are not underweight. Someone can be malnourished and in a larger body. Body stigma is one of the main reasons that eating disorders are overlooked. Eating disorders are indiscriminate to gender, size, ethnicity, race and socioeconomic status.
I do see my child eating so its not like they do not eat. Should I still be concerned? Yes. It is extremely rare someone would have completely stopped eating. If an individual is eating less than then their nutritional needs or engaging in restriction then it can negatively impact their eating patterns, relationship with food/body and lead to medical concerns. In therapy we focus on healing the relationship with food/body and to gain insight into areas of distress around food/body. We want to help individuals lowered their anxiety around food intake, recognize their value outside of their body size/shape and be able to embrace their authentic self.
If your child is eating a minimal amount of food, completely refusing intake or showing signs of medical compromise, take them to the nearest ER immediately. If they are in the San Diego area, we recommend taking them to Rady Children's Hospital ER to be properly assessed and receive medical support immediately. If your concerns do not meet the criteria of an immediate medical emergency, then follow up with your child's pediatrician as soon as possible.
2. Ditch Diet Culture
First off, it is not your fault if your child is struggling with an eating disorder or showing signs of struggling with an eating disorder. This is a blame-free zone. We do however live in a diet-culture environment that places value on thinness and "healthy eating". We are impacted by these societal influences which perpetuate weight stigma. This is detrimental to all of us, and especially harmful to those who live in larger bodies. When someone in the home is struggling with an eating disorder they can be extremely aware of judgements around food and size/shape. In treatment, we aim to increase trust in the body and create more safety around food. This process is complicated due to the societal views around food/body size, the individuals own experiences around food/body image and the reality that person struggling is most likely going to have to eat more than what is comfortable and will most likely have changes in body size/shape. Therefore, it is crucial to take any judgement out of foods and size/shape. We want to create an environment where people to feel safe in their bodies no matter what size their body is. Reinforcing the idea there is a "right" and "wrong" way for your body to be can be very confusing and anxiety provoking for individuals struggling with disordered eating or in the recovery process.
To best support your loved one, it is crucial to take a look at your own personal thoughts and feelings around weight and food to guard against unintentionally reinforcing harmful beliefs.
Helpful resources:
Fat Talk by Virgina Sole-Smith
AntiDiet by Christy Harrison
3. Establish a Treatment Team
Eating Disorders are complex disorders and can be very difficult to treat. Eating Disorders are a mental health condition but they are also a medical condition. Eating disorder behaviors can impact almost every organ system in the body. Therefore, having a collaborative, multidisciplinary team is a must. Typically the team would consist of a physician, dietitian and therapist. Together the team can assess your teen and make individualized treatment recommendations. It is crucial to identify providers who have experience in eating disorders specifically and preferably those who are Certified Eating Disorder Specialists or supervised by one. Much of eating disorder work is nuanced and providers without experience in eating disorders may unintentionally reinforce disordered eating behaviors. Once you have located a provider (therapist or dietitian) that specializes in eating disorders, they typically have a network of other providers and can point you into the right direction of other specialist in the area they would recommend.
Here is a link to find a Certified Eating Disorder Specialist in your area.
A couple of quick note about eating disorder providers and treatment:
Often they are out of network with insurance. First, Eating disorder specialist typically have had extensive training in eating disorders specifically which has taken significant investment. Secondly, due to the complexity and severity eating disorders, your therapist is most likely going to work with you much more intensely then the average therapist. You are investing in your clinicians time and collaboration that happens often behind the scenes and outside of the therapeutic hour. Lastly, as providers, we want to provide treatment based on client needs and not based on artificially assigned insurance recommendations.
Parents are also looked at as a crucial part of the treatment team. You have an important role in helping to support your child's recovery. You are the ones that are available in the home and able to support the teen on a more consistent basis. It may mean helping provide support around meals, following up on appointments, helping strategize around utilizing positive coping skills, holding boundaries and natural consequences and just being a shoulder to cry on sometimes. Know that you are needed and you are irreplaceable in the recovery process. Your treatment team should be integrating you into the treatment process and if you are feeling unsure about your role, just ask. There should never be any secrets around your role in the recovery process.
4. Be Patient & Have Grace
Eating disorder treatment take times. Unfortunately there is no quick fix or easy way through the process. I often tell families that in treatment we are asking people to do the exact opposite of what they are comfortable doing, therefore, things look worse before they get better. Typically when someone has an eating disorder, their brain is telling them not to eat and we are going to tell them that they have to eat and not engage in any compensatory behaviors. This can typically increase anxiety and distress but we have to get them to increase nutritional intake to maintain medical stability and also to help improve cognitive functioning. This process of nutritional restoration can take quite a while and can be very frustrating and stressful for families. Additionally, No one wants to see their loved one in distress and the reason why you sought out treatment is to get your loved one out of distress. Body image concerns can often last for a very long time and are typically the last thing to improve throughout the treatment process. Therefore, distress around food and the body is expected and not always a sign the individual is not improving overall.
Treatment and recovery are also not linear. Bumps in the road are expected. If your child starts struggling after a period of doing well, trying to ground yourself and know this does not mean all the wins are lost. These set back are part of the process. Your child is most likely not acting out because they want to be difficult, they are just really struggling for one reason or another. Remember to hold grace for your teen and for yourself throughout the process.
Here are some resources for families to support you through this process:
FEAST - Parent support organization
When your Teen has an Eating Disorder by Lauren Mulheim
Brave Girl Eating by Harriet Brown
5. Take Care of Yourself
Lastly, make sure to take care of yourself. This process is stressful and your concerns are valid. Having a child with an eating disorders can be grueling emotionally, physically and even financially for families. It impacts everyone in the family and their relationships. Know that it is okay (and necessary) for you to take care of yourself. We often encourage parents to have their own therapy to support them through the process.
You may feel lost, exhausted, hopeful, scared- all the things and it makes sense. You need your own outlets to be able to stay grounded and allows you to continue to show up for your teen. You are not going to show up as your best self all of the time (none of us do even in the best circumstances). It is okay if you do not have all the answers. No one does. Your role is to parent. Be there, set appropriate boundaries and get extra help where you need help. Parenting is learned in the moment and you are probably not prepared to have a child with an eating disorder. You are probably going to say "all the wrong things" and that is okay. Just showing up is the most important thing but that takes you taking care of yourself. Get the support you need. Things can get better and recovery is possible.
You are doing the best that you can as is your teen. If you feel like you need more support but do not know what you need, reach out.
Things can get better and recovery is possible.