Is My Teenager Developing an Eating Disorder? Early Warning Signs for Parents
By Ben Segal
Research published by the Butterfly Foundation in February 2024 suggests that approximately 1.1 million Australians live with an eating disorder, with 27% aged 19 years or younger. Whilst there is growing awareness about teenage eating disorder risk amongst families, it is important that parents are equipped to identify early warning signs so that symptoms can be addressed before they escalate.
Early Signs Beyond Weight Loss
Typically, teenagers will exhibit several warning signs as an eating disorder develops and becomes more established. Typical behavioural changes involve eating fewer snacks, more irregular eating, incorporating additional 'low-fat' food variants into their diet, increasing exercise, and spending more time monitoring their body through mirrors. As the eating disorder strengthens, teenagers may also begin to eliminate whole food groups from their diet and skip entire meals. Other warning signs may include secrecy around eating, episodes of eating accompanied by a sense of loss of control, self-induced vomiting, or increasing distress and guilt following meals.
Common eating disorder thoughts that teenagers may talk about include rationalisations around:
Skipping meals or snacks ("It's fine to skip dinner since I had cake earlier").
Avoiding social eating ("Everyone will judge me for being fat and eating too much").
Compulsively exercising to reduce weight or change body shape ("If I go to the gym, I can burn all the calories I ate at breakfast").
Other Eating Disorders to Look Out For
Whilst restrictive eating is often associated with eating disorders, teenagers may also experience other eating disorders, including bulimia nervosa (BN) and binge eating disorder (BED).
Bulimia nervosa (BN) involves recurrent episodes of binge eating, where a person experiences a loss of control over their eating, followed by behaviours intended to compensate for eating. These may include self-induced vomiting, fasting or excessive exercise.
Binge eating disorder (BED) involves recurrent episodes of binge eating accompanied by a sense of loss of control, often followed by guilt, shame or distress. Unlike bulimia nervosa, binge eating disorder does not involve regular compensatory behaviours.
Both conditions can occur in teenagers of any body size, and changes in weight or appearance may not be obvious.
Why Eating Disorders Can Develop in Teenagers of Any Body Size
Eating disorders can affect teenagers of any body size. Whilst anorexia nervosa includes a significantly low-weight diagnostic criterion, other eating disorders, including atypical anorexia nervosa, can occur in people who are not underweight.
Current research indicates that teenagers can be at risk of significant medical complications associated with inadequate nutrition, rapid weight loss and other eating disorder behaviours, regardless of their body size.
How to Distinguish Common Adolescent Changes from Concerning Patterns
Asking several of the following questions will help you identify whether your teenager is experiencing early eating disorder warning signs or going through common adolescent changes:
Has my child's weight or physique changed significantly in a short period of time?
Is my child noticeably eating less adequately or regularly than they used to?
Is my child judging themself because of their weight or body shape?
Is my child socially withdrawing from family and friends, or refusing to eat socially?
Is my child experiencing significant distress when I or others express concerns about their food, eating, or thoughts regarding body shape or weight?
Is my child becoming secretive about eating, or showing signs of binge eating or behaviours intended to compensate for eating?
If the answer to any of these questions is yes, your child may be experiencing early warning signs of an eating disorder. These signs do not necessarily indicate an eating disorder, but may warrant further assessment, particularly if they are persistent or escalating.
How to Have Conversations Without Blame or Confrontation
Teenagers with eating disorders often judge themselves and experience guilt, shame, and embarrassment about their difficulties with food, eating, body shape, and weight. Using effective communication tools when discussing your concerns can reduce the risk of your child feeling that they are being blamed or judged for struggling, which can result in family conflict and greater difficulty accessing support.
By using eating disorder-informed communication strategies like externalisation, you can help your child feel supported rather than blamed, which may reduce distress and make getting them the assistance they need easier. Externalisation involves clearly communicating to your child that eating disorder-related changes in their behaviour, thoughts, and emotional experience are influenced by the eating disorder, rather than being a reflection of their personality or character. Emphasising that your child's difficulties are not their fault, and that you understand the resulting distress is associated with mental health struggles, may help them participate in discussions and reduce the risk of further distress.
Examples of externalisation include:
"It's not your fault you're having difficulty with eating, it's the eating disorder."
"Dinner was really hard today, but I wonder if the eating disorder made it feel overwhelming."
"I know the eating disorder is making you anxious about your body and being judged by friends."
It is also important to recognise that not every emotion or behaviour is caused by the eating disorder, and teenagers should continue to feel heard and understood.
When to Seek Medical Assessment and Psychological Support
Several symptoms can serve as indicators that a teenager may be experiencing the effects of inadequate nutrition, sometimes referred to as starvation syndrome. Starvation syndrome refers to the physical and psychological consequences of prolonged inadequate energy intake. This can occur in teenagers of any body size, particularly where there has been significant dietary restriction or rapid weight loss. Other eating disorder behaviours, such as self-induced vomiting and compulsive exercise, can also contribute to serious medical complications.
Starvation syndrome symptoms may include:
Physical impacts:
Dizziness and blackouts
Constant feelings of cold
Hair loss
Reduced heart rate and blood pressure
Fatigue
Decreased strength
Emotional impacts:
Anxiety
Irritability
Depression
Thinking impacts:
Rigidity of thought
Decreased concentration
Constant rumination about food
Social impacts:
Decreased self-esteem
Stress in friendships and family dynamics
Isolation
If you notice these symptoms or are concerned about your teenager's eating behaviours, it is important to arrange an assessment with their GP. Eating disorders can cause serious medical complications even when a teenager does not appear underweight.
Symptoms such as fainting, chest pain, marked weakness or rapid physical deterioration require urgent medical assessment.
Early psychological support can also help address eating disorder thoughts and behaviours before they become more established.
How Family-Based Treatment Can Help
Teenagers struggling with an eating disorder are fighting an uphill battle from the beginning because they are still in the middle of their physical development, intensifying the negative impacts of starvation syndrome.
Additionally, eating disorders can differ from other mental health experiences, such as anxiety and depression, in that some eating disorder behaviours offer perceived benefits to teenagers affected by them.
These perceived benefits include feeling more emotionally regulated after controlling food intake, feeling less self-judgement, and experiencing a sense of accomplishment after reducing meal adequacy, purging, or finishing compulsive exercise.
As a result, teenagers may struggle to make changes to their eating disorder behaviours, particularly when they experience these behaviours as helpful or reassuring. Family support can therefore play an important role in recovery.
Family-Based Treatment (FBT) is a leading evidence-based first-line intervention for adolescents with anorexia nervosa. FBT addresses the paralysing effect eating disorders often have on teenagers by empowering parents to directly support their children.
This helps teenagers transition out of starvation syndrome, with their parents directly assisting them in working towards nutritional rehabilitation and weight restoration where needed, whilst preventing eating disorder behaviours from getting in the way of recovery.
As treatment progresses, responsibility for eating is gradually returned to the teenager in a developmentally appropriate way.
Family-based approaches may also be used for adolescents experiencing other eating disorders, including bulimia nervosa, with treatment adapted to the young person's presentation.
What About Enhanced Cognitive Behaviour Therapy (CBT-E)?
Enhanced Cognitive Behaviour Therapy (CBT-E) is another evidence-based psychological treatment for eating disorders that can be adapted for adolescents.
CBT-E focuses on helping teenagers understand and change the thoughts and behaviours maintaining their eating disorder. This may include addressing dietary restriction, binge eating, compensatory behaviours, and concerns about weight and body shape.
Treatment also supports teenagers to establish regular eating patterns, develop more helpful ways of managing difficult emotions, and reduce the influence of eating disorder thoughts on their everyday lives.
Whilst FBT is often recommended as a first-line treatment for adolescent anorexia nervosa, CBT-E may be an appropriate alternative depending on the teenager's individual needs, eating disorder presentation and family circumstances. Parents and carers can continue to play an important supportive role throughout treatment, regardless of the approach used.
Seeking Support
If you are concerned that your teenager may be developing an eating disorder, seeking support early can make a meaningful difference.
At Blueprint Psychology, our psychologists provide evidence-based eating disorder assessment and treatment, including Family-Based Treatment (FBT) and Enhanced Cognitive Behaviour Therapy (CBT-E). We work collaboratively with teenagers, families and other health professionals to support recovery and develop treatment plans suited to each young person's needs.
Resources
Reference: Deloitte Access Economics. (2024). Paying the Price: The Economic and Social Impact of Eating Disorders in Australia. Report commissioned by the Butterfly Foundation.
