Anorexia in Teens

How do I know if my teen is struggling with Anorexia Nervosa?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), which is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders, the following criteria must be met to have a diagnosis of Anorexia Nervosa:

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

It is important to note that even if the DSM-5 criteria for Anorexia Nervosa is not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

What symptoms suggest that my teen is struggling with Anorexia?

• A distorted body image
• Skipping most meals
• Unusual eating habits (such as eating thousands of calories at one meal or skipping meals)
• Frequent weighing
• Extreme weight change
• Insomnia
• Constipation
• Skin rashor dry skin
• Dental cavities
• Erosion of tooth enamel
• Loss of hairor nail quality
• Hyperactivity and high interest in exercise

Teens with eating disorders are often in denial that anything is wrong. They may be moody, anxious, depressed. They may withdraw from friends, and become overly sensitive to criticism. Parents are often not aware of these symptoms because the teen keeps them hidden.

How did my teen develop Anorexia?

There has been a rise in the number of teens struggling with an eating disorder due to the pandemic. Covid-19 has caused an increase in uncertainty and anxiety. As a result, vulnerable adolescents have turned to restricting and over-exercising as a way to cope with this.

Like the pandemic, there is often a triggering event that sets in motion the eating disorder, but there are normally underlying factors that make a teen vulnerable to anorexia.

Precipitating events:

FAMILY HISTORY AND GENETICS

Genes are thought to play a big part in increasing one’s likelihood of developing an eating disorder. This means adolescents and teenagers are at an increased risk if they have a close relative who has suffered from an eating disorder, and/or addictions.

ANXIETY DISORDERS

Research shows a significant subset of youth with eating disorders also meet criteria for an anxiety-related disorder (i.e. – generalized anxiety disorder, obsessive-compulsive disorder, social phobia, etc.).

LIFE CHANGES AND TRANSITIONS

Certain life changes and events can cause emotional distress and feelings of instability. Major life changes include moving, loss or death of a loved one, relationship deterioration, etc.

TRAUMA

Adolescents and teenagers who have experienced abuse (emotional, physical, or sexual) are more likely to suffer from an eating disorder. Research indicates a strong correlation between past trauma and eating disorders.

HISTORY OF DIETING

In this day and age, weight loss is frequently met with positive reinforcement. Many youth are motivated by these affirmations around dieting. sometimes becoming excessive, which can (often very quickly) lead to the development of an eating disorder.

EXTRACURRICULAR ACTIVITIES

Young people who are involved in certain extracurricular activities or sports (e.g., activities driven by appearance – athletes, actors, dancers, models) are at an increased risk for suffering from an eating disorder. While competitive sports can be wonderful for a teenager’s health and confidence, they also often put huge emphasis on physical shape (body shape and size). This can cause individuals to become body-focused, and unfortunately for some, this can progress into an eating disorder.

EATING DISORDERS & DIABETES

Recent studies have cited type-one (insulin-dependent) diabetes as a risk factor for eating disorders. In fact, one study showed approximately one-quarter of women diagnosed with type-one diabetes will develop an eating disorder.

BODY DISSATISFACTION

It is not uncommon (especially in adolescence) for people to dislike their physical appearance. While it is understandable why some with high levels of body dissatisfaction develop eating disorders, those with eating disorders actually end up reporting even higher levels of body dissatisfaction. The eating disorder can increase a teen’s dissatisfaction with their body and appearance.

Every teenager is different, and therefore the underlying causes for a a young person, who has developed Anorexia may differ. Parents and loved ones, who are aware of the possible warning signs of eating disorders can be helpful in identifying a problem and seeking early intervention for their teen.

What are the risk to my teen?

Anorexia can be very dangerous. Every 62 minutes, at least one person dies as a result of an eating disorder. The high death rate associated with anorexia is what makes eating disorders the deadliest of all mental illnesses. A review of nearly 50 years of research confirms that anorexia nervosa has the highest mortality rate of any psychiatric disorder.

Anorexia statistics for teen girls and young women are especially alarming: For females between 15 and 24 years old who suffer from anorexia nervosa, the mortality rate associated with the illness is 12 times higher than the death rate of all other causes of death.

Anorexia has both long-lasting and life-threatening effects on physical health. Consequently, this eating disorder can permanently damage the body. The negative health impact of anorexia on teens and adults can include the following:

• Fainting, fatigue, and weakness
• Low blood pressure and abnormally slow heart rate, increasing the risk for heart disease and heart failure
• Muscle loss
• Severe dehydration, which can lead to kidney failure
• Brain shrinkage due to lack of nutrition, leading to decreased cognitive function
• Permanent loss of bone density: Nearly 90 percent of women with anorexia have osteopenia and 40 percent have osteoporosis
• Infertility, due to compromising of the hormonal system.

How can I help my teen who is struggling with Anorexia Nervosa?

Assemble a treatment team

Because eating disorders have serious emotional, medical, and nutritional consequences, it’s important to have a team of professionals that can address every aspect of your problem. As you search, focus on finding the right fit—professionals who make the teen feel comfortable, accepted, and safe.

To find an eating disorder treatment specialist in your area:

• Ask your primary care doctor for a referral.
• Check with your local hospitals or medical centers.
• Ask the school counselor or nurse.

Address Heath Problems

Eating disorders can be deadly—and not just if the teen is drastically underweight. The teen’s health may be in danger, even if they only occasionally fast, or purge, so it’s important to get a full medical evaluation. If the evaluation reveals health problems, they should take priority. Nothing is more important than the teen’s well-being.

Make a long-term treatment plan

Once the teen’s health problems are under control, the teen and their treatment team can work on a long-term recovery plan. Your treatment plan may include:

Individual or group therapy. Therapy can help the teen explore the issues underlying the eating disorder, improve their self-esteem, and learn healthy ways of responding to stress and emotional pain. Different therapists have different methods, so it is important to discuss with them the teen’s goals in working towards recovery.

Family Therapy

Family therapy can help the teen and their family members explore how the eating disorder is affecting their relationships—and how various family dynamics may be contributing to the problem or impeding recovery. Together, you’ll work to improve communication, respect, and support.

Nutritional Counseling 
The goal of a nutritionist or dietician is to help the teen to incorporate healthy eating behaviors into your everyday life. A nutritionist can’t change the teen’s habits overnight, but over a period of time the teen can learn to develop a healthier relationship with food.

Medical Monitoring 
Often, treatment will include regular monitoring by a medical doctor to make sure the teen’s health is not in danger. This may include regular weigh-ins, blood tests, and other health screenings.

Residential Treatment 
In rare cases, the teen may need more support than can be provided on an outpatient basis. Residential treatment programs offer around-the-clock care and monitoring to get you back on track. The goal is to get the teen stable enough to continue treatment at home.

If your teen has an eating disorder, early intervention can prevent the health risks associated with a teen’s eating disorder so the sooner the symptoms are recognized, the better the outcome. The sooner you do something the better. By getting help early, your teen can prevent the health risks associated with eating disorders.

These questions may be helpful to ask your teen’s GP or Professional Team:

• What should I do if I suspect my teen has an eating disorder?
• My teen doesn’t like to eat in front of anyone. Should I worry?
• My teen is always dieting, and I’m concerned. What can I do?
• How can I tell if my teen is at a healthy weight?
• What is Body Dysmorphic Disorder?
• Will vitamins help fill the nutrition gap for my teen?

Also, it’s very important to be sure your teen feels loved and supported by family and friends during treatment for an eating disorder. Feeling secure and accepted can help form a strong foundation so your teen can begin to learn new, healthier habits.

Anita Sommers

Systemic Psychotherapist

Seeking further support? Access our live webinars specifically addressing the concerns of parents and carers here:

https://theeatingdisorderpsychologist.com/courses-for-parents-and-carers/