June 19

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Eating Disorders: Signs, Symptoms, and Tips for Managing ED


Weight obsession affects millions of teenagers today, especially girls.

Gen Z faces an onslaught of body image messages from peers, social media influencers, mass media, and even clothing store mannequins that depict an “ideal” version of what the ideal body should look like. 

So, it’s no wonder that according to a 2009 Youth Risk Behavior Survey, 33 percent of adolescent girls believed that they were overweight. A staggering 56 percent were actively attempting to lose weight!

In 2020, researchers at University College London found that significantly higher numbers of Gen Z adolescents in the UK are dieting to lose weight, and are likely to overestimate their own weight. They also found that girls who are trying to lose weight are also more likely to experience depressive symptoms than in previous years.

What does this all mean for teens who are at risk for developing an eating disorder?

As a teen, when you look at diet and exercise as a way to lose weight rather than as a way to stay healthy, you have a higher risk of developing an eating disorder (ED). And just like mental illness, anyone can be affected by an eating disorder. 

Most people develop eating disorders between the ages of 12 to 25. The National Association of Anorexia Nervosa and Associated Disorders estimates that just under 1 in 10 of the U.S. population will deal with some sort of eating disorder during their lifetime. 

Girls experience eating disorders at a much higher rate — 90 percent of cases happen among girls. However, this doesn’t mean that teenage boys don’t also have body image issues. Many boys strive for the perfect body by dieting or exercising compulsively.

Eating disorders can cause a significant decline in your quality of life. If you’re concerned that you or a loved one may have an eating disorder, it’s important to understand the consequences of eating disorders, the most common eating disorders, what contributes to eating disorders, signs and symptoms, and the best strategies for prevention.


What is an eating disorder?

Eating disorders are persistent pathological eating behaviors that negatively impact health, emotions and your ability to function normally. 

The American Psychiatric Association defines eating disorders as:

Behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological and social function.

Eating disorders often happen at the same time as other disorders, like anxiety, OCD, and alcohol and drug abuse problems. 


Can an eating disorder hurt my health?

Let’s acknowledge the elephant in the room: There is an abundance of pro-anorexia (pro-ana) content on websites and social media, some of which depicts ED as a choice or a lifestyle. However, by framing anorexia as a lifestyle, it diminishes the dangers and severity of ED. 

It’s dangerous to think of entering an ED “lifestyle” as an “easy way” to lose weight. ED is serious, and can even be fatal if left untreated. For example, a girl with anorexia nervosa can lose her period, which causes early bone loss and can lead to painful fractures. A boy with bulimia may develop an irritated or torn esophagus, damaged teeth, and even heart failure.

Eating disorders are also linked to other serious health problems, such as kidney disease and heart disease. Each of these health problems requires specific tests and treatment.


What are some common eating disorders?

The most common ED are anorexia nervosa, bulimia nervosa and binge-eating disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), there are five categories of eating disorders. 

Anorexia nervosa

Someone with anorexia severely restricts the amount of food they eat, and may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain. When you have anorexia, you often equate thinness with self-worth.

The DSM-V diagnostic criteria for anorexia nervosa include:

  • Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected)
  • Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.
  • Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight.
  • Restricting type: In the last 3 months, has not regularly engaged in binge-eating or purging.
  • Binge-eating/purging type: In the last 3 months, has regularly engaged in binge-eating or purging.

Bulimia nervosa

Someone with bulimia has repeated episodes of bingeing — eating large amounts of food without a sense of control — followed by compulsive purging behaviors, such as vomiting or the use of laxatives to rid the body of food. 

The DSM-V diagnostic criteria for bulimia nervosa include:

  • Recurrent episodes of binge eating, as characterized by both:
    • Eating, within any 2-hour period, an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances.
    • A feeling that one cannot stop eating or control what or how much one is eating.
  • Recurrent inappropriate compensatory behaviors in order to prevent weight gain such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for 3 months.
  • Self-evaluation is unjustifiability influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.
  • Purging type: During the current episode, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
  • Nonpurging type: During the current episode, the person has used inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.

Binge eating disorder

Someone with binge eating disorder experiences multiple episodes of uncontrolled overeating without any purging behaviors.

The DSM-V diagnostic criteria for binge-eating disorder include:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    • The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
  • Binge-eating episodes are associated with three (or more) of the following:
    • Eating much more rapidly than normal
    • Eating until feeling uncomfortably full
    • Eating large amounts of food when not feeling physically hungry
    • Eating alone because of being embarrassed by how much one is eating
    • Feeling disgusted with oneself, depressed, or very guilty after overeating
  • Marked distress regarding binge eating.
  • The binge eating occurs, on average, at least 1 day a week for 3 months (DSM-5 frequency and duration criteria)
  • The binge eating episodes are not associated with the regular use of inappropriate compensatory behavior (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.

Avoidant restrictive food intake disorder (ARFID)

Like anorexia, avoidant restrictive food intake disorder (ARFID) is an eating disorder that involves intense restrictions on the amount of food and types of foods you eat. Conversely, someone with ARFID isn’t worried about losing weight.

Rather, someone with ARFID is highly restrictive in what they eat, to the point that they struggle to reach the required nutritional amounts for basic functioning.

The DSM-V diagnostic criteria for ARFID include:

  • An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
    • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
    • Significant nutritional deficiency.
    • Dependence on enteral feeding or oral nutritional supplements.
    • Marked interference with psychosocial functioning.
  • The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

Other specified feeding or eating disorder (OSFED)

OSFED is considered a “catch-all” category for a litany of less common ED, such as:

  • Orthorexia, wherein a person becomes obsessed with “healthy eating.” Orthorexia causes people to identify specific food or food groups as “proper,” “healthy,” or “pure.” Eventually, certain foods or entire groups are removed from the person’s diet; they might also begin to obsess over the ingredients in their foods, spending hours each day planning meals. This often begins to interfere with the person’s social life, precluding activities where there might be “bad” foods.
  • Rumination disorder, which involves regurgitating food through spitting out, chewing, and swallowing again. Normally, they do not experience stress or disgust when regurgitating, nor do they appear to make an effort to vomit (as seen in bulimia nervosa). Rumination disorder is often a reaction to an irrational fear of illness caused by eating, although its causes are less well-understood than other eating disorders. 
  • Chewing and spitting disorder, which involves chewing a food and spitting it out instead of swallowing it. The intent of chewing and spitting is to enjoy food’s flavor without ingesting calories. Chewing and spitting is similar to bingeing because it involves larger than intended quantities of high-calorie foods. It also shares elements of restrictive eating because the food is not actually consumed.

What causes eating disorders?

There is rarely one isolated event or single situation that causes an eating disorder. Most researchers believe that there are a few different factors that can make you more vulnerable to developing an ED.

Biology

If you have a sibling or parent with an eating disorder, you’re more likely to develop one yourself.

Psychological and emotional issues

If you also suffer from anxiety or depression, you’re at a higher risk of developing an ED.

Environmental

American culture emphasizes thin and slender frames as an ideal beauty standard.

Extracurriculars

If you take part in an extracurricular activity, such as ballet, figure skating, diving, or gymnastics, you may develop an ED in the name of improving performance.

Trauma

If you’re a child of divorce or have been a victim of emotional abuse or neglect, physical abuse, or sexual abuse, your history may trigger and perpetuate an ED.

Bullying

The anonymity of social media has made it much easier to bully people anonymously. Teens who have been bullied or cyberbullied may deal with their pain through restricting food or emotional eating.

Peer pressure

If you’re part of a group who values thinness, you may develop self-consciousness around your weight — and succumb to the pressure to lose weight in order to fit in with your friends.

Athletic achievement

If you play in a team sport, you’re well-aware of the pressure to perform well. Certain sports, like wrestling, cycling, and cross-country running, emphasize weight and muscularity — which can contribute to the development of an eating disorder.

What are some signs & symptoms of the major eating disorders?

Depending on the type of eating disorder, your signs and symptoms may look different. Examine your eating patterns and beliefs around food. Here are some signs to look out for:


You struggle to eat in front of others.

Eating disorders make it difficult to enjoy food in a healthy way. This can mean that you have a hard time eating in public, or perhaps you feel like you need to hide the food that you’re eating.


You develop rituals based around eating. 

One of the biggest issues for those struggling with an eating disorder is that they feel a need for control over the way they eat. It’s healthy to have a routine around meals, like always starting dinner with a salad. It’s a problem when you’re unable to eat without going through a specific routine, like cutting your food into tiny pieces to delay the eating process.


You’re losing and gaining weight rapidly. 

With disordered eating, it’s hard for the body to retain the nutrients it needs to maintain a healthy weight. In turn, the fluctuation in weight can be incredibly triggering for people who are already dissatisfied with how their body looks.


You’re experiencing body dysmorphia. 

Body dysmorphia involves an obsession with a perceived flaw in appearance. Although it’s not present in all types, body dysmorphia is often a key trigger in leading to the development of disordered eating.


You’re constantly eliminating food groups or experimenting with new trendy diets. 

Although some people need to avoid certain foods for health reasons, it’s healthy to have more variety in the types of food you consume. When you’re constantly removing entire food groups, like carbs, that is one warning sign for 


You struggle to stay warm, even when it’s hot outside. 

Some body fat is good. It exists to help keep our bodies warm. When there’s inadequate nutrition for fat cells, it’s common for people to feel a deep cold that they can’t shake.


You have persistent stomach pain. 

Lack of adequate nutrition negatively affects the gastrointestinal system. Common symptoms include cramps, acid reflux, and constipation.


Additional red flags:

  • Extreme weight change
  • Frequently skipping meals or refusing to eat
  • Excessive focus on food
  • Unusual eating habits (such as eating thousands of calories at one meal, skipping meals, eating secretly, secretly storing food)
  • Persistent worry or complaining about being fat
  • Frequent weigh-ins on the scale
  • Frequent checking in the mirror for perceived flaws
  • Using laxatives, diuretics or enemas after eating when they're not needed
  • Irregular menstrual cycles
  • Forcing yourself to vomit or exercising too much to keep from gaining weight after bingeing
  • Repeated episodes of eating abnormally large amounts of food in one sitting
  • Expressing depression, disgust or guilt about eating habits
  • Overeating when you’re stressed out (and feeling out of control)
  • Equating your self-worth with your body image
  • Sleeping too much or too little
  • Constipation
  • Skin rash or dry skin
  • Dental cavities, erosion of tooth enamel
  • Losing hair or developing brittle nails
  • An obsession with exercise
  • Avoiding social situations that involve eating in public or around others
  • Continually dieting, even if your BMI is within normal range
  • Overusing diet pills or laxatives
  • Wearing baggy clothing to hide body shape
  • Using the bathroom directly after every meal


How are eating disorders treated?

Although there is no easy treatment for eating disorders, you can recover from an ED.

In the lesser stages of severity, your treatment options include:


Talking to a mental health professional who specializes in ED. 

A mental health professional can help you identify and replace self-destructive thinking patterns and behaviors.


Talking to a Registered Dietitian about realistic healthy eating habits. 

Your diet and exercise regimen are tools to boost your physical health, mental health, and energy levels.


Getting social support.

Tell your friends and family about your ED struggles, and ask them to hold you accountable during breakfast, lunch, and dinner.


Practicing media mindfulness.

The media messages that you see on TV, in movies, and on social media can lead you to believe there is a narrow ideal of physical beauty. Challenge these ideals, and challenge yourself to widen your perception of beauty.


Practicing emotional mindfulness.

Eating or controlling your food intake are not a good way to deal with stress. Instead, talk to your friends, family, or a counselor about problems he or she might be facing. Make conscious choices about your lifestyle and design a life that works for your unique needs.


Practice body positivity.

Find the parts of your body and self that you do love and are proud of. Understand that different body shapes are uniquely beautiful. 


Focusing on non-physical traits and accomplishments. 

You have goals outside of your physical appearance — focus on those. Did you make a delicious breakfast? Celebrate that. Did you take your dog for a long walk today? Celebrate that. Are you a curious, generous, and funny human being? Celebrate that! Focus on the small wins, and they will eventually replace your physical concerns.


How to Get Help

If you think you need help, reach out to a trusted adult now. Your pediatrician will examine any changes in your BMI or weight percentiles, and may ask about your eating habits, exercise routine, and body image. They may refer you to a mental health counselor or therapist.

Early intervention can help speed your recovery. When you start your treatment, it may take several months to feel better. It’ll likely take some time to undo long-held beliefs about food, your relationship with it, and your body image. With time, you'll be able to recover from disordered eating.


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