If you have a teen (or tween) that you suspect may have an eating disorder, you likely have a lot of worries about them and just as many questions. Why won’t they just eat more? What will happen if they keep starving themselves like this? Where did that whole pack of Oreos in the pantry go? What are they doing in the bathroom after dinner? Don’t they realize how incredibly beautiful they already are?

Maybe you beg and plead with them, bribe them, or threaten them to eat but they still refuse. Nothing seems to work. Your child just gets angry with you and denies they have a problem. Meanwhile, you notice their formerly sunny personality disappearing as they become more and more obsessed with their weight, shape, and eating control.

Eating disorders can be very secretive, so it is no surprise if your teen doesn’t want to talk to you about it. However, the burden of an eating disorder can also be very heavy. Whether they want to or not, they may need professional support to overcome their problem.

What are the signs of an eating disorder?

The signs of an eating disorder may not be what you think. One misconception is that you have to be skinny to have an eating disorder. In reality, eating disorders affect people of all sizes. And frequent binge eating can lead to weight gain not loss. If you are worried that your son or daughter may have an eating problem, here are some things to look out for:

• Expressing insecurity or harsh self-criticism about their weight or shape (frequently saying they are fat or ugly)
• Skipping meals at home or saying they already ate somewhere else
• Saying they are full or have a stomachache after eating only a small amount of food
• Rigid eating habits and dietary rules (obsessively reading food labels and counting calories)
• Avoiding entire food groups like dairy, carbs, or meat
• Excessive exercise (more than an hour a day or extreme numbers of repetitions)
• Disappearing after meals (they may be using laxatives, forcing themselves to vomit, or exercising to try to compensate for the calories they consumed)
• Repetitively checking their shape in the mirror or their weight on the scale or, alternatively, avoiding mirrors and scales
• Stashing food in their bedroom (empty wrappers may be a sign of binge eating)
• Cooking big meals or baking desserts for others that they don’t eat
• Avoiding eating in public at restaurants, parties, or family get-togethers
• Wearing baggy clothes to hide weight loss
• Lack of interest in seeing friends or doing activities they used to enjoy
• Increased indecisiveness and trouble concentrating
• Feeling cold all the time
• Having dry skin, hair, and nails
• Callused knuckles or damaged tooth enamel (from frequent vomiting) 

What should I do if I suspect my teen has an eating disorder?

If you suspect your teen has an eating disorder, a complete physical exam from their pediatrician will be needed to assess their health and safety before anything else. Eating disorders can cause serious health complications affecting numerous organ systems in the body (cardiovascular, endrocrine/metabolic, hydroelectric, gastrointestinal, and neurological, for example). These complications can be life-threatening and should be taken seriously, but are usually reversible with treatment. Eating disorders, however, can cause irreversible damage to your child’s bones and teeth.

If your pediatrician thinks that your teen has an eating disorder, they may refer you to a behavioral health specialist that treats eating disorders, such as a psychologist like myself. Your teen may not want to go, and that’s okay. You can let that be the problem of the professional who is no doubt very used to meeting with patients who are (initially) resistant to talking to them. Once you’ve gotten your teen to the appointment, it will be the job of the professional to help them feel comfortable and to motivate them to engage in treatment.

For more information on eating disorders, www.nationaleatingdisorders.org is a great website that offers a helpline, screening tools, and lots of information for parents and patients alike. You can learn more about enhanced cognitive behavioral therapy I offer for teens and young adults with eating disorders here.  And of course, you are welcome to contact me to see how I can help.