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The Informed Parent

Teens and Eating Disorders

by Sandra Smith, Ph.D.
Published on Jan. 01, 2000

The ideal of the “slender body” is apparent if one considers simply the increase in the number of books and magazines that deal with weight loss/control. Teens are especially vulnerable to striving toward the “ideal” as they struggle with issues of self-definition and acceptance.

Girls outnumber boys by 10 to 1 in their presentation of eating disorder symptoms. This can place the boy with an eating disorder at risk for not receiving appropriate medical and psychological treatment. Although this article will use the feminine gender, it is important to bear in mind that the teenage boy may also develop an eating disorder.

The World Of The Anorexic Or Bulemic Teen: What The Informed Parent Should Look For:

Teens with a propensity toward an eating disorder tend to associate being overweight with a variety of extremely negative attributes, including laziness, dirtiness, stupidity or worthlessness. They experience constant, nagging thoughts about their weight, and often state that they only feel good about themselves when they are "empty", or when they lose weight. They often describe feeling literally stupid about experiencing their own hunger.

Recognizing the methods teens may use in an attempt to lose weight may help the informed parent to determine if his teen is at risk. The methods most often used by teens to quell their appetites, while appeasing the demands of their eating disorders, will most often include some or all of the following:

  1. Eating low calorie and low fat food almost exclusively.
  2. Drinking non-caloric fluids, e.g., diet drinks and water, almost exclusively.
  3. Eating very slowly.
  4. Talking themselves out of their hunger, e.g., "I can't be hungry again; I had that salad just a few hours ago."
  5. Eating--but then engaging in a compensatory activity, including vomiting, use of laxatives or diuretics, or excessive exercise.
  6. Narrowing of the range of food choices: the teen with an eating disorder often finds herself restricted to an increasingly narrow band of foods she is willing to allow herself. Sometimes the teenager will eat exactly the same foods each day, with a pronounced fear that to deviate would most certainly mean a weight gain.
  7. A focus which may border on obsession with "numbers" surrounding food and weight, e.g., the number of calories or fat grams consumed per meal or per day, and/or the numbers on the scale. These rules often become extremely strict, because the teen is terrified that otherwise she will lose control completely. For the teen with an eating disorder, reliance on these numbers, no matter how seemingly arbitrary to us, can feel very much like a life or death situation.
  8. An increasing restriction in social activities. Teens with eating disorders begin to isolate themselves during meals. They are apprehensive about being observed as they eat little, or about the possibility of others' comments toward their food choices and consumption. They are anxious about being seen eating at all; some teens with eating disorders view the act of eating itself as a shameful activity. In conjunction with an increasingly restricted social life, you may observe your teen to become very absorbed in other activities, e.g., solitary exercise, studying for grades and even meal planning and eating. Unfortunately, the social isolation which often accompanies an eating disorder begets social anxiety and promotes further isolation.

How A Diagnosis Is Made

The essential diagnostic feature for individuals diagnosed as having either Anorexia Nervosa or Bulimia Nervosa, according to the Diagnostic and Statistical Manual (DSM-IV), is "being unduly influenced by body weight".

In Anorexia Nervosa, the criteria for diagnosis of the disorder includes a refusal to maintain adequate weight. This criterion is not present in Bulimia Nervosa.

In both the binge eating/purging type of Anorexia Nervosa and Bulimia Nervosa, binge eating is present. Binge eating by definition includes both consuming a large quantity of food, and feeling out of control.

In July we shall continue the subject of eating disorders. What should an assessment of my teen include? 

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