Eating disorders in young people - a parent's guide
Dr Pippa Hugo, Child and Adolescent Psychiatrist and Lead Eating Disorder Consultant at Priory Hospital Roehampton, provides advice for parents who may be concerned their child has an eating disorder.
1. Eating disorders explained
If you suspect your child has an eating disorder, you might be scared to mention anything, worried you will make it worse. However, the sooner you talk with them about it, the better. Once they accept they have a problem, the faster and the more likely it is that your child will be able to make a lasting recovery. Recovery involves not just getting physically better but also regaining a healthy attitude towards eating, and improving confidence and self esteem.
There are two main types of eating disorders that commonly affect young people:
- Anorexia nervosa
- Bulimia nervosa
There are also ‘atypical’ eating disorders, like food addiction, for example. These do not fully match the criteria needed to be diagnosed as either anorexia or bulimia, but are still a cause for real concern. Many patients do not meet the full criteria but can still be very unwell.
What is it?
Anorexia nervosa is an eating disorder which focuses on starving the body, often causing the individual to become dangerously thin. It is associated with extreme food restriction and a real fear of gaining weight, together with an inaccurate self body image, which can also lead to body dysmorphia. Anorexia affects both genders, but is most common amongst young women between the ages of 14 and 25.
- Significant weight loss (or failure to grow as expected in children)
- Behavioural symptoms include limiting food and drink consumption, and engaging in excessive exercise
- Psychological symptoms include preoccupation with food and weight, and disturbance in body image with a fear of being at a normal weight
- Can be associated with depression, anxiety, self-harm and suicidal thoughts
- Physically may develop significant complications e.g. slow heart rate, low blood pressure, constipation
- Infertility and loss of menstrual periods
- Brittle bones (osteoporosis)
- Extreme fatigue and exhaustion due to starvation
- Chemical changes in the brain, making rational decisions and concentration difficult
- Social withdrawal and impairment in all aspects of development
What is it?
Bulimia nervosa is an eating disorder characterised by binge eating, whereby suffers can eat up to three or four times the normal amount of food. This is followed by dietary restriction, self-induced vomiting or taking laxatives to try and avoid putting on weight. Anyone can suffer from bulimia, but it is most common in young women aged between 15 and 25.
Bulimia is commonly associated with depression, anxiety, low self-esteem, loneliness and emotional distress.
- Behavioural symptoms include binge eating followed by self-induced vomiting or taking laxatives after meals
- Psychological symptoms include preoccupation with food and weight, judging oneself in terms of appearance, and an overwhelming feeling of guilt after binge eating
- Can be associated with depression and anxiety
- Problems with vital internal organs due to lack of essential minerals
- Gastrointestinal complications
- Damage to tooth enamel
- A painful throat and damaged vocal chords
- Swollen cheeks
Atypical eating disorder
What is it?
An atypical eating disorder is very similar to anorexia nervosa or bulimia nervosa, but does not meet the exact diagnostic measures of either eating disorder. For example, this may be because a sufferer’s weight or body mass index (BMI) does not meet the specific threshold for these disorders, or menstruation still occurs despite having a low body weight.
The symptoms and causes of atypical eating disorders may be very similar to anorexia and bulimia, but the overall clinical picture does not allow for the same diagnosis.
The symptoms may match those listed for bulimia nervosa and anorexia nervosa, but individuals will most probably not suffer from the full list of symptoms. Children and adolescents often suffer from more atypical forms of these disorders.
2. How common are eating disorders?
Eating disorders are serious mental health condition. Over 725,000 men and women in the UK are affected by eating disorders. Although anyone can develop an eating disorder, young women are most likely to suffer, particularly in their teenage years. It is important to remember that boys get eating disorders too – up to 10% of young people with eating disorders are male. Although they are serious conditions, eating disorders can be treated and recovery is possible. Eating disorders impact every area of a sufferer's life – physical, emotional and social. In addition, young people’s development is seriously affected and the impact on families is significant. The sooner that people receive treatment, the better chance they have of recovery and preventing the long-term impact on their lives.
3. Why do people get eating disorders?
There is no single reason why someone develops an eating disorder. There is no one gene responsible for eating disorders but it seems there is some biological vulnerability in people who develop these conditions. Many sufferers also tend to be anxious and perfectionists who struggle to manage strong emotions.
A world dominated by appearance
Teenagers live in a world dominated by appearance, and therefore can become more self-conscious around this time of life. Adolescence, with its many challenges, often provides the trigger for dieting which can lead to the development of an eating disorder. Causes can vary but include school changes, family problems, peer pressure and bullying.
People with an eating disorder tend to have very low self-esteem and will judge themselves very critically in terms of their weight and shape. They become obsessed with food, and their day-to-day lives are usually led by thoughts, feelings and behaviours that focus on food and eating. Sufferers use behaviours (sometimes life-threatening) as a way of coping with these difficult thoughts and feelings, including extreme dieting, vomiting, excessive exercise, and binge eating. Many people will feel very ashamed of their symptoms and can gradually distance themselves from friends and family.
Although they can sometimes recognise that what they are doing is unhealthy, because of the strong drive to manage food and weight, sufferers can find it difficult to stop. Eating disorders are associated with a high incidence of other mental health conditions such as anxiety and depression.
4. What to do when you suspect your child has an eating disorder
It can be really upsetting if you suspect that your child has an eating disorder. Parents are often concerned that they may be making too much of things and hope that if left, it will go away. However the disorder will not go away by itself, so although talking about it may be difficult, it is essential.
Encouraging your child to discuss any worries and insecurities they may have will be useful in understanding the reasons that may have led them to feel badly about themselves. Establishing an open discussion about how to cope with anxieties and difficulties will be an important first step.
Help with healthy eating habits
You should help to encourage a healthy attitude towards eating and watch out to see if your child continues with disordered eating habits. Do not wait too long before seeking advice if you are worried. It can be useful to discuss this with your child’s school as schools often notice the early signs of an eating disorder or may have heard from school friends who have concerns. Schools can also be useful partners in helping young people manage their eating during treatment (e.g. supervising meals, providing medical monitoring).
Trying to talk to someone that you suspect has an eating disorder can be a scary thought. Sometimes young people with eating disorders can be relieved that their problem has been noticed as they too can be frightened. Not uncommonly though they will avoid any discussion about what they are doing and deny that there is a problem. It can be a difficult tightrope to walk between trying to support a child whilst also insisting they need help. At times it can feel that any reference to food leads to an argument.
The key is to communicate without being judgemental or argumentative. Think carefully about what to say beforehand, speak calmly and be careful not to criticise or get angry or emotional. Even though the problem may be denied, given some time the young person may be able to acknowledge they have some difficulties and talk about these when they are ready.
5. Treatment options available
The GP is the first person to contact to discuss your concerns with, even if your child is refusing to attend. Be strong and do your best to insist that your child agrees to a visit with the GP. The GP will advise on the appropriate treatment available and will be the person responsible for making any referrals.
Community team support
Most young people with definite eating disorders need outpatient treatment with a specialist team. Teams should be able to provide dietary advice, specialist psychotherapies and will work with paediatricians, the GP or school health to monitor the young person’s physical health. Regular monitoring of physical health is crucial, as individuals can become extremely physically unwell.
Specialist family therapy is most effective for eating disorders in young people, particularly anorexia nervosa. Other therapies e.g. supported self-help programmes and individual therapies such as cognitive behavioural therapy (CBT) may also be useful.
Approximately 10-20% of young people require more intensive day and inpatient treatment, because they are so physically unwell; this treatment, if necessary, can be forced against their will.
6. Love and support
People with eating disorders often become lonely and isolated but those who recover say the love and support from family and friends is vital in their recovery. It is important for those close to the person to receive their own support as they frequently feel helpless, confused, frustrated, and angry. Whilst families are not the cause of the eating disorder, they are crucial in the recovery.
Avoid talking about appearance
Think carefully about how to discuss things and what may be helpful and unhelpful, because comments can be misunderstood. Saying “you look well” or “you’re making progress” can sound as if you are saying “you are getting fat”. The person struggling will not feel any sense of achievement by managing to eat appropriately, instead they may feel extremely guilty, and a failure, so they are unlikely to take your comments as positive. It is probably better to steer clear of references to appearance. You should acknowledge what a challenge your child is facing whenever they are managing food in a positive way. There are times when, as a parent, you have to assume responsibility for making decisions around food to take away the guilt that your child experiences when making food choices. Helping your child to develop coping skills, continue normal aspects of life and to find things outside of the eating disorder will all contribute towards building self-esteem.
Don’t give up
Most importantly don’t give up. At times, things may seem hopeless but with time and appropriate help, it is possible for young people to recover.
7. Further information
B-eat is a helpful charity providing information, support groups and resources for people suffering with eating disorders and their families. They can be contacted through the website at www.b-eat.co.uk.
Priory spoke to two young people to hear their story of living with an eating disorder and how they were supported to get the help they needed.
“I kept it all to myself because I thought it was just a phase, but it continued to progress. I made myself sick the first time in the summer holidays, just because I felt guilty for eating a packet of crisps. It continued on and off for a few weeks, and then I got gradually worse to a point where I would weigh myself literally after every single mouthful of food. If I hadn't gained anything I would go back and eat more. When I hit the point where the scales would go up by one pound (which now sounds ridiculous), I would use that as justification to make myself sick. All I saw in the mirror was a fat girl (looking back on photos, I was definitely nowhere near fat). The food I was eating wasn't particularly unhealthy, but in my mind if it wasn't fruit or vegetables - it was bad.”
“My parents didn’t notice for a while. They could see that I was losing weight but didn’t realise how. I would make a bowl of weetabix in the morning with very little milk, mush it up together, and spoon most of it into the bin. I would then smear the rest of it around the bowl and leave it, so when my mum saw the bowl in the kitchen, it looked as if I had eaten.”