Eating disorders often begin with dissatisfaction in appearance and efforts to "eat healthier" or exercise more. Sometimes they begin when someone significantly increases their activity without increasing their intake, such as running cross country without an increase in nutrition. For some people, these behaviors can lead to changes in thought patterns and behaviors that develop into an eating disorder. The thoughts and behaviors become difficult to resist, and emotional and physical health begin to deteriorate.
Sometimes the problem begins with a weight-loss diet, but then something goes wrong. Once 5 pounds have been lost, the weight goal is lowered another 5 or 10 pounds. Or perhaps the original goal is never quite reached, and instead the individual’s weight goes up and down in a seesaw pattern. Sometimes no actual diet is involved; the person simply believes that they are too fat and experiences a relentless drive to be thinner. Eventually, the pursuit of thinness becomes an obsession that assumes more importance than anything else in the person's life.
The symptoms of anorexia nervosa include significant weight loss as part of a drive to be thin, fear of weight gain, loss of menstruation in females and body image distortion (not perceiving appearance accurately, such as the belief that one is fat, despite being very thin).
People with bulimia nervosa have episodes of binge eating at least several times a week, followed by purging through self-induced vomiting, exercise, laxatives or fasting. This often leads to large or small weight fluctuations.
How can I recognize an eating disorder in a child or teen?
Young people often go to great lengths to deny and conceal their painful struggles with food and weight.
Here are some signs that may help you recognize an eating disorder in someone you know:
- Excessive weight loss - Anorexia is diagnosed when someone is 15% below expected weight (whether because of loss of weight or failure to gain with growth).
- Weight fluctuations - Although people with bulimia usually maintain near-normal body weight, their roller coaster dieting may show up in erratic weight gains and losses.
- Unusual eating habits, such as taking tiny bites to stretch out eating time or compulsively arranging food on the plate
- The person stops eating meals with the family; they might make excuses that they are too busy or eating elsewhere.
- Secretive behavior, especially with respect to eating and bathroom use. A teenager who habitually runs water, plays the radio or flushes the toilet repeatedly while using the bathroom may be masking the sounds of vomiting.
- Use of laxatives or diet pills
- Food disappearing on a regular basis
- Excessive and often obsessive exercise
- Dull hair and hair loss, splitting or softening nails
- An absence of menstrual periods related to loss of body fat
- Dental cavities and gum disease, caused by malnutrition and vomiting
- Extreme sensitivity to cold, caused by loss of fat and muscle
- Fine body hair on arms and legs - this is the body's attempt to keep warm
- Low self-esteem
- Distorted body image - No matter how thin they get, people with eating disorders still believe they are too fat.
- Irritability, depression or talk of suicide
- Drug or alcohol abuse - Sometimes teenagers with eating disorders will turn to substance abuse to relieve feelings of fear, shame and depression.