Today I’m talking about the warning signs of eating disorders and tips for helping your child move toward healing and recovery.
Is your child a picky eater or are you dealing with something more serious? Dr. Nanika Coor explains four common eating disorders and how parents can help kids who are struggling with eating disturbances.
Project Parenthood is hosted by Dr. Nanika Coor. A transcript is available at Simplecast.
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One of your first and most important jobs as a parent is to feed your child well. But it’s not easy! Complicated relationships between food, family, eating, health, emotions, and attitudes about body shape and weight can derail healthy eating habits.
I’m not referring to eating too many sweets during holidays or picky eating in toddlerhood. I’m talking about serious conditions that take over someone’s life and the lives of those closest to them, and can also lead to life-threatening medical, psychiatric, and psychosocial outcomes. If you suspect that your child has an eating disorder, stick around—today I’m talking about the warning signs of eating disorders and tips for helping your child move toward healing and recovery.
Welcome back to Project Parenthood! I'm your host, Dr. Nanika Coor—clinical psychologist and respectful parenting therapist. Each week, I’ll help you repair and deepen your parent-child connection, increase self-compassion and cooperation from your kids, and cultivate joy, peace, and resilience in your relationship with them.
Eating disorders are serious mental illnesses that can affect people of all ages, genders, racial and ethnic groups, socioeconomic backgrounds, and body weights. It usually involves a preoccupation with food, body size, shape, and weight. Genetics, personality traits, and biological, psychological, behavioral, and social factors all contribute to the risk of developing an eating disorder. Approximately 30 million Americans will have an eating disorder in their lifetime.
Four common eating disorders in kids and teens are Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge-eating Disorder (BED), and Avoidant/restrictive food intake disorder (ARFID)
There are 2 types of AN; the restrictive type—when a person severely restricts the amount and type of food they eat—and the binge-purge type, which involves the same kind of severe food restriction along with episodes of binge-eating (consuming large amounts of food in a short period of time) followed by purging (vomiting, or using laxatives or diuretics to get rid of what they consumed). AN has the highest death rate of any mental illness. While dying as a result of the medical complications of starvation can occur, suicide is the leading cause of death in those with AN.
Some common warning signs of AN include but aren’t limited to drastic weight loss, and a preoccupation with and fear of the calorie and fat grams in food and gaining weight. They may refuse to eat foods they’ve previously enjoyed and not want to attend events that involve food. They may not want to eat what the family is eating and may take a very long time to eat at mealtimes. Your child might see themselves as “fat” although they are dangerously thin, and show unwillingness to or a denial of the need to gain weight.
This disorder is defined by recurrent cycles of extreme overeating, followed by excessive exercise, vomiting, fasting, and using laxatives or diuretics—or some combination of these strategies—to rid the body of what was consumed. There is a feeling of not having control over these cycles, which can happen anywhere from a few times a week to several times a day. Additionally, BN may be difficult to notice because the person hides their bingeing and purging and may not be drastically thin. Kids with BN can be underweight, normal weight, or overweight.
Common warning signs of BN include dental problems and teeth discoloration as well as calluses on the hands and fingers from self-induced vomiting. You might find evidence of large quantities of food having been eaten, like the disappearance of large quantities of food or lots of food wrappers and containers. You might notice the excessive use of mints or mouthwash to hide the smell of vomit, and frequent trips to the bathroom during or after meals.
This disorder is characterized by eating large amounts of food in short time spans and is often associated with a high level of distress. Those in a binge episode experience a lack of control and are unable to stop themselves from eating. A person may be secretive about overeating and only do so in private. BED doesn’t involve behaviors meant to compensate for overeating, like vomiting or over-exercising after a binge episode, and usually evokes feelings of shame, guilt, and disgust instead. These individuals tend to be overweight or obese.
A clinical diagnosis of BD will include eating large quantities of food, faster than usual, until past the point of fullness or even pain, do so at least once per week and for at least 3 months. You might see them having an irregular eating pattern, and notice binge eating episodes being more prevalent when they are highly distressed.
This disorder is characterized by an avoidance of or aversion to food and eating. Food restriction is not due to a distorted body image or a fear of weight gain. Rather, restriction is the result of extreme anxiety or a phobia about food and eating (like coughing, vomiting, or choking), a heightened sensitivity to the sensory aspects of food like texture, smell, sight, or taste, or they have a low appetite that results in a lack of interest in food. These folks don’t consume enough calories to develop and grow properly if they’re a child, or enough to maintain basic body function if they’re an adult.
In discerning developmentally normal “picky eating” from ARFID, you’d be looking for an extreme fear, aversion, or sensitivity to specific foods or the act of eating, or a general lack of interest in food and/or eating. They may eat only small amounts of food leading to nutritional deficiencies and significant weight loss, but people with ARFID can also be a normal weight.
It can be alarming, confusing, and anxiety-provoking when you suspect that your child is struggling with an eating disorder—and that makes sense! It’s important to remember that with outside professional help, along with your involvement as a parent, your child can make a lasting recovery.
Become an expert in your child’s specific type of eating disorder. Find first-hand accounts from those in recovery and read recent peer-reviewed articles. This will help you understand and better empathize with your child’s struggle.
Even if your child denies they have a problem, doesn’t think the problem is a “big deal,” or they’re too young to understand what the problem is, it’s important to confront the issue together. So start talking to your child about what you’re noticing. Encourage them to make small and manageable changes, and share your concerns about the long-term risks of going untreated, while giving them concrete first steps to getting treatment.
Make room for your child to share their own concerns, and commit to remaining calm no matter what they tell you about stressors they may be dealing with. Parental emotional dysregulation could be overwhelming for them at this point.
Finding a right-fit eating disorder therapist, clinic, or evaluator may take time, so don’t be discouraged if the first 1-3 providers don’t work out. Ask potential clinicians about their credentials, experience, how they work, and how they measure progress. The important thing is finding someone skilled that you and your child can grow to trust. Stay involved in your child’s treatment by attending sessions with them and staying in contact with their clinicians.
Remember that recovery isn’t linear and there is a long road ahead that may include setbacks and relapses. Recovery is an ongoing process that takes time and energy. Make sure you get therapeutic support to help manage your own stress and do what you need to do self-care-wise to maintain your parenting bandwidth as you support your child.
If these brief descriptions of common eating disorders resonate with you, and you’re concerned about yourself or your child, seek professional help. The earlier an eating disorder is detected, the better the chance for recovery.
What concerning eating patterns have you seen in your child? Tell me about it on Instagram @bkparents. You can also reach out to me directly at parenthood@quickanddirtytips.com, or leave a message at (646) 926-3243. And you can learn about my New York State-based private practice at www.brooklynparenttherapy.com. Catch you next week!
Hornberger, L. L., Lane, M. A., Lane, M., Breuner, C. C., Alderman, E. M., Grubb, L. K., ... & Baumberger, J. (2021). Identification and management of eating disorders in children and adolescents. Pediatrics, 147(1).