Introduction
When it comes to our children, as parents we only want the best for them. We want to shield them from all the dangers of the world, and give them a life that was better than ours. However, we have to realize that we can’t keep them away from the dangers of the world. Since we can’t be with them 24/7, we don’t know everything that our children are going through.
At school, on the web and even around their peers, children can be constant victims of bullying. According to StopBullying.gov, children who are most at risk of being bullied are often viewed by their classmates as different. The Center for Disease Control says that amongst students in grades 6-12 in the U.S., 28% of them have experienced bullying, and for students in high school (grades 9-12) 20% of them have been bullied.
Typically, victims of bullying are often overweight or undeweight. In their struggle to gain acceptance by their peers, children will sometimes go to extreme measures in order to do it, which can mean developing eating disorders.
Here are some more statistics about eating disorders:
• More than 10 million women and 1 million men struggle with an eating disorder.
• More than 50% of teenaged girls and more than 30% of teenage boys have admitted to using unhealthy methods for controlling their weight such as smoking, skipping meals, vomiting and/or taking laxatives.
• In a college campus survey, 91% of women had attempted to control their weight through dieting, and 22% of them dieted “often” or “always.”
• Anorexia is the third most common chronic illness among adolescents.
• 95% of those who have eating disorders are between the ages of 12 and 25.
• 47% of girls in 5th-12th grade reported wanting to lose weight because of magazine pictures.
• 69% of girls in 5th-12th grade reported that magazine pictures influenced their idea of a perfect body shape.
• 42% of 1st-3rd grade girls want to be thinner.
We at Holiner Psychiatric Group created this e-guide as a reference for parents who may be worried that their child has developed an eating disorder. We’ll discuss the types of eating disorders and what signs you should look for if you think your child has developed an eating disorder. We’ll also give you tips on starting the conversation with your child and resources that you can use that can help further with the recovery process.
Types of Eating Disorders
We’re going to begin this guide by telling you about the different types of eating disorders: anorexia nervosa, bulimia, and binge
eating disorder. All of these affect the body in different ways, but they all are mental illnesses that could severely affect your child.
Anorexia Nervosa
What is Anorexia?
We’ll begin with the most well-known eating disorder, anorexia nervosa. Anorexia is an eating disorder in which a person restricts how much food they eat. Anorexics can also have unusual eating habits, becoming overly obsessive about being thin, with an irrational fear of gaining weight. Anorexia has the highest mortality rate among all psychological disorder. Because of the malnutrition that anorexiacauses, people suffering with it are at more risk for other health issues, such as heart conditions and organ failure. The chances of suicide are also at a much higher rate for people who are battling anorexia.
Symptoms, Risks, and Effects
When it comes to anorexia, and other mental health
disorders, there isn’t a single definitive cause of them. While they can be passed on through genetics, there are also other environmental factors that can cause them. Some risk factors to look for in your child’s life are:
• They seem unduly worried about or pay more attention to their weight and shape
• They were diagnosed with an anxiety disorder
• They have a negative self-image
• If, during infancy or early childhood, they had eating problems
• They start having certain social or cultural ideas about health and beauty that seem over the top
• They are trying to be perfect or overly-focused on rules
Anorexia often begins in early adolescence or young adulthood, when there may be a lot of pressure to fit in and meet society’s “requirements” of the perfect body type. Teens will often feel the social pressures of keeping up and fitting in with – looking like, acting like, being perceived like – the other “cool” kids. This can include keeping their weight at a certain threshold. Some symptoms you should look for if you think you child is anorexic are:
• Deliberate self-starvation with weight loss
• Intense, persistent fear of gaining weight
• Refusal to eat or highly-restrictive eating
• Continuous dieting
• Excessive facial/body hair because of inadequate protein in the diet
• Compulsive exercise
• Abnormal weight loss
• Sensitivity to cold
• Absent or irregular menstruation
• Hair loss
If untreated , anorexia can lead to more drastic symptoms, sicknesses, and ultimately death. Anorexia that goes unnoticed can lead to symptoms such as:
• Thinning of the bones (osteopenia or osteoporosis)
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Mild anemia and muscle wasting and weakness
• Severe constipation
• Low blood pressure, slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multi-organ failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility
To diagnose the severity of anorexia nervosa, the DSM V recommends that physicians measure the patient’s Body Mass Index (BMI). Here’s the scale that is used – the lower the BMI, the more severe the case of anorexia.
• Mild: BMI >17
• Moderate: BMI 16-16.99
• Severe: BMI 15-15.99
• Extreme: BMI <15
Bulimia Nervosa
What is Bulimia?
Next on the list is bulimia nervosa, more commonly referred to as just bulimia. The difference between bulimia and anorexia is that bulimics don’t starve themselves, in fact, they do the exact opposite. According to the Mayo Clinic, bulimia can be a potentially life-threatening disorder. Bulimia is an eating disorder that involves both binge-eating and purging oneself of the food.
A person with bulimia eats a large quantity of food in a very short amount of time – bingeing. If you want to find out more about binge eating, you can skip to the next section where we go into further details about binge eating. After the food binge, they then will purge themselves of the food by either forcing themselves to vomit, using laxatives, excessively exercising immediately afterward, or any combination of these actions. Like people with anorexia, people with bulimia have the same intense fear of gaining weight. Some will also use bulimia to maintain their current weight.
Symptoms, Risks, and Effects
Just like anorexia, there isn’t one direct cause of bulimia. Because bulimia is very similar to binge eating, often they can be confused with one another. Some signs to look for in your child are:
• They seem more worried about, or pay more attention to their weight and shape
• They seem to have a lack of self-control when eating – eating well beyond the point of being full
• They have a negative self-image
• Secret eating – it seems they are eating a lot after everyone is asleep or always eats in private
• If your child eats a lot of food, but their weight and physical activity hasn’t changed much, it could be bulimia.
• He or she makes frequent trips to the bathroom after meals to vomit. You may also hear running water in the background to hide the vomiting sound.
• Your child may also buy laxatives and diuretics to help with the purging of food.
Repeated purging over a period of time can have detrimental effects on your child’s health. With the constant vomiting, they’re putting their bodies at risk of dehydration. Vomiting and using laxatives and diuretics can cause an imbalance of electrolytes in the body, which can cause low potassium levels in the body. According to Helpguide.org, low potassium levels can trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. These are some other dangerous effects and symptoms to watch for:
• Weight gain
• Abdominal pain, bloating
• Swelling of the hands and feet
• Chronic sore throat, hoarseness
• Broken blood vessels in the eyes
• Swollen cheeks and salivary glands
• Weakness and dizziness
• Tooth decay and mouth sores
• Acid reflux or ulcers
• Ruptured stomach or esophagus
• Loss of menstrual periods
• Chronic constipation from laxative abuse
Binge Eating
What is Binge Eating?
The Mayo Clinic defines binge eating as an eating disorder where an unusually large amount of food is consumed frequently couple with a feeling of not being able to stop eating. Unlike bulimia, there isn’t any purging involved with binge eating.
Binge eaters will use food to cope with negative emotions and stress. Often, after a session of binge eating, your child will feel worse than before. They’ll try to hide their binge eating by eating in secret or by going out to binge eat. Of the major eating disorders, binge eating is the most common in the United States, with around 3.5% of women and 2% of men diagnosed with it. Among adolescents in America, about 1.6% are diagnosed with binge eating disorder.
Symptoms, Risks, and Effects
Overeating in itself isn’t a bad or dangerous thing. We all tend to eat more than we should during big holidays like Thanksgiving and Christmas and regret it afterwards. However, binge eaters take over eating to the extreme. If you’re worried that your child may be binge eating here are some signs to look for from the National Institute of Diabetes and Digestive and Kidney Disease.
• Your child eats a large amount of food in a short period of time (for example, within 2 hours).
• Your child feels a lack of control over their eating. For example, they may feel that they cannot stop eating or control what or how much they are eating.
• They eat much more quickly than usual
• They eat until uncomfortably full
• They eat large amounts of food even when not really hungry
• They eat alone
• They feel disgusted, depressed, or guilty after overeating
Unlike anorexia and bulimia, binge eating isn’t used for weight loss. Often sudden weight gain can occur, which can be looked at as another warning sign for binge eating. Just like anorexia and bulimia, there isn’t a direct cause of binge eating. The cause of binge eating likely involves imbalances in the brain, which can be caused by things such as stress and depression. Binge eating can also be passed down genetically. If your child is suffering from BED, chances are they could also be suffering from other mental health disorders such as:
• Anxiety
• Depression
• Personality disorders
With binge eating, your child may also become upset with themselves, leading down a path of even more depression. WomensHealth.gov lists just a few of the health effects that can happen if your child’s binge eating disorder goes untreated:
• Type 2 diabetes
• High blood pressure
• High cholesterol
• Gallbladder disease
• Heart disease
• Certain types of cancer
Other Specified Feeding or Eating Disorders (OSFED)
What if your child’s eating habits, or lack thereof, aren’t as drastic as the main three eating disorders, but you can still see symptoms you are concerned about? What used to be known as Eating Disorders Not Otherwise Specified (EDNOS) in the DSM-IV are now known as Other Specified Feeding or Eating Disorder (OSFED). These are disorders that cause significant distress or impairment but don’t meet the criteria for another eating disorder.There is no a clear-cut line between each eating disorder, and often people who suffer in that grey area are misdiagnosed, mistreated, or not treated at all. According to the National Association of Anorexia Nervosa and Associated Disorders, there are 5 subtypes to OSFED. They are:
1 . Atypical Anorexia Nervosa 2 . Atypical Bulimia Nervosa 3 . Binge Eating Disorder
4. . Purging Disorder
5. . Night Eating Syndrome
For the first 3 on the list, we won’t go into too much detail about them since we’ve discussed them earlier in the guide.
For atypical Anorexia, your child could be exhibiting the same restrictive behaviors that typical anorexics show, however they don’t meet the low weight criteria. For an atypical case of Bulimia Nervosa, your child may meet the criteria for bulimia but suffers at a lower frequency and/or limited duration. So, perhaps they don’t purge after every meal, but when a major stressor occurs (i.e. cheer tryouts, prom, sport tryouts, etc.), they begin to exhibit the signs of bulimia.
Purging Disorder
Purging disorder is similar to bulimia and anorexia, the difference being that the purging act doesn’t come from an episode of binge eating. Without the excessive overeating, your child could be purging calories from a normal dinner by vomiting, excessive exercise and using laxatives improperly. Research has shown that purging disorder could be as common as both anorexia and bulimia. Some signs that you should view as cautionary flags are:
• Running to the bathroom all the time after meals
• Regular use of laxatives
• Overly obsessed with their appearance and body size
Purging disorder shares some of the same medical risks as bulimia and anorexia, and those are:
• Dehydration
• Anemia
• Imbalanced Electrolytes
• Hypertension
• Arrhythmia
• Broken blood vessels in eyes due to constant vomiting
• Esophagus damage
• And many others
Night Eating Syndrome
Night Eating Syndrome , or NES , is when individuals have recurrent episodes of eating late at night. Sometimes your child will wake up in the middle of the night to eat, or might eat even more after dinner. Don’t mistake this for your child wanting a late night snack – this is more along the lines of your child wanting a late night dinner after having dinner! NES also includes an awareness and recollection of the eating, so not a case of sleep-eating. According to a diagnostic proposed in the International Journal of Eating Disorders , the criteria to be diagnosed with NES are as follows:
• Include evening hyperphagia (consumption of 25% or more of the total daily calories after the evening meal) and/or nocturnal awakening and ingestion of food two or more times per week.
• The person must have awareness of the night eating to differentiate it from the parasomnia sleep-related eating disorder (SRED).
Three of five associated symptoms must also be present:
• Lack of morning hunger
• Urges to eat in the evening/at night
• Belief that one must eat in order to fall back to sleep at night
• Depressed mood
• Difficulty sleeping
For Parents:
How to Start the Conversation about Eating Disorders
You want your child to be able to talk to you about anything and everything that is going on in their lives, but we know that won’t always happen. So, if you start seeing signs that your child may have an eating disorder, how do you approach them about it?
The first thing is to do is to get past the initial fear of saying something wrong or thinking that you’ll alienate your child. As a parent, it ’s your duty to care for your child’s well-being, and that includes having uncomfortable or confrontational conversations. Often, your child’s eating disorder can be a cry for help, and just like you, they’re also struggling to ask for help and start the conversation.
When having the conversation, schedule a time where both of you can talk with no distractions and pressures from outside sources. The last thing you want to do is make your child feel rushed or attacked in a large group setting.
Don’t use accusatory statements during the conversation. Even in a private setting, they can still feel attacked if you’re using statements such, “ You’re spending too much time in the gym,” and “ You’re skipping too many meals.” Instead, the National Eating Disorder Association recommends that you focus on the behaviors that you’ve seen, which can also go beyond just their eating habits, by using ‘I’ statements. By using this type of speech, you’re better able to portray the concern that you have for their well-being. “I’ve noticed a change in how much you eat.”
Mirror-Mirror.org offers some more tips and things to keep in mind when approaching your child about their eating disorder:
• “Avoid approaching them when food is present, because they will more than likely already be stressed. Your first approach should be at a non-mealtime situation.”
• “Do not take on the role of a therapist – but do encourage them to seek one out, and keep checking in on the progress of this if they agree to do so.”
Getting Help
Finding the Therapists and Psychiatrists in Your Area
Now that you’ve had the conversation with your child and they are ready to get help for their disorder, the next big step is finding a local psychiatrist to formally diagnose them and find out if there are any other mental disorders that could be afflicting your child. Once you find your preferred psychiatrist, they’ll give a formal diagnosis along with the level of care that is needed.
There are 5 levels of care that can be implemented, depending on the severity of diagnosis. The earlier you can notice behavioral changes in your child, the better. The levels are:
• Outpatient – In this type of program the sufferer lives at home and travels into a treatment center to attend treatment sessions.
• Intensive Outpatient Program – In this scenario
sufferer still lives at home but spends all or many of his or her mealtimes at the treatment center.
• Partial Hospitalization – In this type of program the
sufferer divides his or her time between hospitalization and home life.
• Residential – This is full time living in a specialized
residence that will involve all meals and snacks being supervised.
• Inpatient Hospitalization – The sufferer is hospitalized. All of his or her time is spent in treatment and this may involve therapy but is primarily focused on getting the patient the nutrition that he or she needs.
However, treatment from the physical effects of the eating disorder is just the first step in the recovery process. If the mental effects that caused your child’s eating disorder aren’t addressed, then they’ll be at risk to relapse into their eating disorder.
It is essential to find a therapist who can help your child work through the triggers that caused them to turn to their eating disorder and teach them the skills to either avoid these triggers or handle them without returning to their eating disorder. Along with individual therapy sessions that are between the therapist and your child, there are also group therapy sessions where your child will be among other individuals who are recovering from the same struggles as your child. Group therapy sessions are good because they can show your child that they are not alone in their struggles, and they can also support each other in developing healthier habits to cope with their problems.
You’ll also need to help them reestablish healthy eating habits at home and when your child isn’t at home. Finding a dietitian who specializes in helping people recover from eating disorders is very important.
Resources
Websites, Books, and Other Information for Teens and Parents about Eating Disorders
Websites
• http://www.anad.org/get-information/about-eating-disor- ders/eating-disorders-statistics/
• http://www.stopbullying.gov/news/media/facts/#listing
• http://www.stopbullying.gov/at-risk/factors/index.html
• http://www.mentalhealth.gov/what-to-look-for/eating-disor- ders/anorexia/index.html
• http://www.nimh.nih.gov/health/topics/eating-disorders/in- dex.shtml
• http://www.helpguide.org/articles/eating-disorders/buli- mia-nervosa.htm
• http://www.niddk.nih.gov/health-information/health-topics/ weight-control/binge_eating/ Pages/binge-eating-disorder. aspx
• http://womenshealth.gov/publications/our-publications/ fact-sheet/binge-eating-disorder.html
• http://www.anad.org/get-information/about-eating-disor- ders/eatingdisorders-not-otherwise-specified/
• https://www.nationaleatingdisorders.org/sites/default/files/ Toolkits/ Parent Toolkit.pdf
• http://www.mirror-mirror.org/purging-disorder.htm
• http://www.mirror-mirror.org/help.htm
Books
• Collins, M.E. (1991). Body figure perceptions and prefer-
ences among pre-adolescent children. International Journal of Eating Disorders, 199-208.
• Mellin, L., McNutt, S., Hu, Y., Schreiber, G.B., Crawford, P.,
& Obarzanek, E. (1991). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at en- rollment: The NHLBI growth and health study. Journal of
Adolescent Health, 23-37.
• Surviving an Eating Disorder: Perspectives and Strategies for Family and Friends by Michelle Siegel, Ph.D., Judith
Brisman, Ph.D., and Margot Weinshel, Ph.D. – Harper & Row Publishers, NY, 1988
Other Information
• Prevention of Eating Problems with Elementary Children, Michael Levine, USA Today, July 1998.
• Substance Abuse and Mental Health Services Adminis-
tration (SAMHSA), The Center for Mental Health Services (CMHS), offices of the U.S. Department of Health and Hu- man Services.