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Types of Eating Disorders

Signs and symptoms that alert parents to the problem of eating disorders



Everyone knows a toddler who eats only mac & cheese, chicken nuggets or pizza. But older kids who refuse to eat or even try foods based on color, smell, texture or temperature can go beyond pickiness to the point of something called selective eating disorder.

“It’s normal to be picky up to age 8,” says Stephanie Lee, LCSW, the clinical program manager of the Eating Disorders Program at Belmont Center for Comprehensive Treatment in Philadelphia. And it’s not unsafe to reject one specific food, she says. But after age 8, she advises closely monitoring severe pickiness, because rejecting entire food groups can possibly lead to malnutrition.

The Holiday Trap

“The holidays are an extremely stressful time of year for people with eating disorders because of all the social events with food,” says Karen Heinbach. Stresses of the season come from the social aspects, the prevalence of food and family conflict. People with eating disorders can distort what people tell them, continues Heinbach, even compliments from well-meaning family members. To someone with anorexia, “healthy” means “fat,” she says. Everyone seems to gorge around the holidays, and for anorexics and bulimics, so much food can be overwhelming. For those in recovery, therapists try to help find balance and moderation at this time of year. 

When Lauren, a mom from Wilmington, DE, brought her 16- year-old son Sean in for his annual physical last summer, she took a short list of foods he would eat. On the list: fruit, chicken tenders, French fries and plain pizza. No milk, no vegetables, no other meats. While Sean and his older brother both ate this way as youngsters, by the time Sean was 12 Lauren “knew in my heart it wasn’t just him being picky,” she says. When she asked him if he wanted help, he said he did.

Diagnosed with selective eating disorder, Sean has been seeing a therapist for several months and is taking “baby steps” toward recovery. “My role in this is to be his supporter, to be positive and nonjudgmental,” says Lauren. While it’s going to be a long process, “the goal is to eventually get him out of his comfort zone and be willing to try something else.”

Mind over appetite

While the most commonly known eating disorders — anorexia nervosa (a severe restriction of food intake) and bulimia (binging on large amounts of food, then purging) — are associated with an intense desire to be thin, they are actually psychiatric diagnoses with a very strong medical component. Wilmington-based licensed clinical social worker Darlene Jordan describes them as “more a mental illness than wanting to look good.”

According to Karen Heinbach, admissions coordinator at the Renfrew Center treatment facility in Mt. Laurel, NJ, eating disorders have the highest mortality rate of any mental health diagnosis. While most people think of eating disorders as a problem only for girls, they affect a growing number of males. A 2011 National Eating Disorders Association study found that the female-to-male ratio of positive screens for eating disorder symptoms was 3-to-1.

Most kids are teenagers when they are diagnosed with an eating disorder, but research shows that the problem can start as young as elementary school age. For girls, 11 to 13 is also a vulnerable age, says Jordan, because they’re preoccupied with their looks as their bodies start to change. Entrance to high school or college, or the loss of a friend or loved one, can also impel eating disorders, she says.

Behaviors & symptoms

There is no one cause of eating disorders. “They come from lots of factors and it’s different for everyone,” says Carrie Anderson, PsyD, licensed professional counselor at Mid-Atlantic Behavioral Health in Newark, DE. Eating disorders often go hand in hand with mental health issues like depression, OCD, anxiety and substance abuse. Dieting may not even be the goal, Lee explains; taking control or self-soothing are often the true culprit.

It can be difficult to detect an eating disorder before it spirals out of control because the telltale pointers are often conducted in secret. But there are signs. Look for body-conscious statements like “I’m fat” and a fear of weight gain, even when a child is not overweight.

Some teens develop rigid food rituals, says Heinbach, which may include:

  • Cutting food into tiny pieces
  • Rearranging food on a plate
  • Eating food in a specific order
  • Chewing excessively
  • Using excessive amounts of condiments

Other signs include:

  • Eating in secret
  • Withdrawal from activities that involve food
  • Dramatic weight gain or loss
  • Not eating foods they once enjoyed
  • Going to their room or the bathroom immediately after a meal
  • Foods disappearing suddenly, sometimes overnight
  • Excessively rigid exercise habits, or exercising despite exhaustion
  • Hiding body with baggy clothing
  • Constantly updating profiles in fitness apps that track food intake and calorie expenditures

If something doesn’t seem right, talk about it.

How to talk about it

Be mindful about what you say to your teenagers.

  • Model acceptance of your own body and self-confidence.
  • Focus on what your body can do for you rather than its flaws.
  • Focus more on good health.
  • Try not to talk about weight in terms of numbers.
  • Never, ever make negative comments about someone’s weight or size.

When you suspect an eating disorder, advises Heinbach, approach it as concern about your child’s happiness and well-being rather than as numbers (BMI, scale read- ings, dress size). It’s very hard to get someone with an eating disorder to admit she has a problem because of the shame that goes along with it, so be patient and persistent.

While the physical toll of eating disorders can prove fatal over time, correct treat- ment brightens the prognosis. “With treatment, recovery is definitely possible, but it will be a long-term process,” says Heinbach.

Key to recovery is having “a really solid treatment team with providers you trust,” including a counselor, a nutritionist and a psychiatrist on board. Often, it is necessary to treat the whole family rather than just the individual. Says Lee, “There are good outcomes when the family is involved in treatment.”

Suzanne Koup-Larsen is a contributing writer to MetroKids.

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