Teens and Eating Disorders: Know the Risks and Recognize the Red Flags
For adolescents struggling with an eating disorder, early intervention is key
For Main Line area parent, Lisa*, it all began with a phone call from a friend, the mother of her daughter’s best friend. Her friend had become concerned about Lisa’s teenage daughter Emily,* who had spent a week with her family at the Jersey shore. As Lisa remembers it, her friend said in a cautionary tone, “I just want to say, watch Emily… because I noticed she’s not eating a lot and she’s running a ton.”
Lisa had noticed that her daughter, a rising high school senior and accomplished athlete, was running a lot that summer. But she didn’t give it a second thought. “She’s an athlete and I thought she was just staying in shape,” says Lisa. Her daughter had also been losing weight since her junior year but Lisa didn’t notice — until luckily, her friend recognized two very common symptoms of an eating disorder.
*Names have been changed to protect the family’s privacy.
What Are The Signs of an Eating Disorder?
Oftentimes, parents don’t immediately recognize their child’s disordered eating patterns, but it’s important to know the signs because the earlier someone gets help the easier it is to recover.
Gabrielle Morreale, LPC, Eating Disorder Specialist at Recovered and Restored Eating Disorder Center in Ambler, PA, says there are many warning signs but “a change in eating habits — that’s an obvious one.” She went on to list a few others: “eating less, an obsession with your body and exercising, withdrawal from friends, and isolation.”
Alexis Short, M.S., a primary therapist at the Radnor location of The Renfrew Center, a treatment center which specializes in eating disorder recovery, says, “You may notice that someone’s relationship with food and their body seem to be different or changing, that they avoid certain types of foods, are hiding food, going to the bathroom frequently during or after meals, are going on fad diets, experiencing weight changes, and are expressing more body dissatisfaction. These are all reasons that you might become concerned.”
After Lisa got her wake up call, she started watching her daughter much more closely and she realized, “Ok, she’s gotten really thin, really fast.” She says Emily never got dangerously thin, but she noticed a big weight drop. Lisa approached Emily about her suspicions immediately. “She gave me a little bit of a hard time,” says Lisa, “but almost from day one, she admitted that she thought she had an issue.”
What is an Eating Disorder?
Eating disorders are characterized by disturbances in thoughts, attitudes, and behaviors towards food, eating, and body weight or shape, and affect individuals of all ethnicities, socio-economic backgrounds, and genders.
According to Eating Disorder Hope, a web resource for individuals, families, and treatment providers, eating disorders typically emerge during adolescence and young adulthood. Although teenage girls and young women represent the largest percentage of those affected by eating disorders, teenage boys and men are affected, too, such as athletes, driven by pressures to have a fit body. And males who identify as gay or bisexual are 10 times more likely to develop disordered eating than straight men.
Gabrielle Morreale stresses the need to look beyond the stereotype. “It’s important to remember that eating disorders don’t have a look.” An example of a social stereotype around eating disorders is that “we think sufferers of eating disorders are White and emaciated, but only 6% are medically underweight.” Most people who are diagnosed with an eating disorder are not underweight but can still be nutritionally deficient and at risk for serious health consequences.
The American Psychiatric Association classifies eating disorders into 7 different types: Anorexia, Bulimia, Binge Eating Disorder, Avoidant/Restrictive Food Intake Disorder (ARFID), Other Specified Feeding or Eating Disorder (OSFED), Pica, and Rumination Disorder. Some other eating disorders, which are not formally recognized are Orthorexia and Body Dysmorphic Disorder (BDD).
It’s not uncommon however, for someone to have aspects of more than one type of eating disorder. Emily’s disorder was diagnosed as “calorie restriction, a form of anorexia,” says Lisa. It was “over-exercising and calorie restriction.”
What Causes an Eating Disorder?
While the issue manifests around eating—and not eating—the symptoms involve thoughts, emotions, and behaviors that have nothing to do with food. It usually serves as a coping mechanism for difficult or unpleasant emotions, or even painful experiences like trauma.
“Emotions like shame, anxiety, and depression are uncomfortable to experience,” says Alexis Short. “Disordered eating is used to avoid or change the emotional experience in some way.”
In her work she has often seen “a connection between trauma experiences and the development of an eating disorder, although trauma does not need to be present for an eating disorder to develop.”
Lisa says Emily’s eating disorder was tied to a string of serious injuries that occurred while playing high school sports. She was a promising athlete with her eye on a Division One scholarship until two torn ACLs and three concussions ended that prospect. It was a traumatic time for Emily and occurred just before the emergence of her eating disorder.
“Her whole life changed in her junior year when she suffered a major concussion,” says Lisa. Emily’s expectations went “from going to a D1 school with an athletic scholarship to never playing sports again. Because Emily couldn’t control her life and where she thought she was going, she had to control something.”
Dieting, Social Media and Eating Disorders
Another major risk factor for young people is the practice of dieting itself. The National Eating Disorders Association (NEDA) reports that in a large study of 14- and 15-year-olds, dieting was the most important predictor of developing an eating disorder. Those who dieted moderately were five times more likely to develop an eating disorder, and those who practiced extreme restriction were 18 times more likely to develop an eating disorder than those who did not diet.
Short sees a major connection “between disordered eating and the diet culture that exists in our society.”
Associated with diet culture is the influence of social media, which by its nature invites comparisons with others and, “places an emphasis on body image being connected to personal value,” says Short. For impressionable young people, the unrealistic beauty standards presented on social media combined with the constant messages of our diet culture, can lead to body dissatisfaction and unhealthy weight control behaviors.
Eating Disorder Treatment and Recovery
Emily’s treatment initially began with one-on-one counseling with a Main Line therapist who specialized in eating disorders and fortunately, “hit it off” with Emily, who continued seeing her therapist, with varying frequency, throughout the ups and downs of her eating disorder. When Emily hit “rock bottom” in her junior year of college, she was at her lowest weight and had to be hospitalized. At that point she came home from college and began daily outpatient treatment at The Renfrew Center in Radnor, for about four months. It was a turning point that “really helped her,” says Lisa.
Looking back at Emily’s journey, she says, “It was about a four-year struggle with an eating disorder.” But by the end of her college career she was firmly in recovery, maintaining her weight, and “in a good place. It took longer than any of us ever thought, but she pulled it together.”
Morreale has these words of advice for parents. “If anyone is struggling with anxiety around food and their body,” and is using “some type of compensatory behavior, let’s stop it in their tracks, because eating disorders are so dangerous.”
“If we can stop it early, they are more likely to have healing success,” she says. “There’s less to undo, there’s less to unlearn. If it’s something that’s been going on for five years, we can definitely help, but it’s just going to take a bit longer.”
Main Line Area Treatment for Eating Disorders
The local-area resources listed below come highly recommended by Main Line Parent Community members for the treatment of eating disorders.
The Renfrew Center
Specializing in the treatment of eating disorders since 1985, the Renfrew Center has locations in Philadelphia and Radnor, as well as multiple locations around the US. It offers residential, outpatient, and virtual programs using the “Unified Treatment Model for Eating Disorder.”
Recovered and Restored Eating Disorder Therapy Center
Located in Ambler, PA, and led by Gabrielle Morreale, LPC, the team at Recovered and Restored is a Health at Every Size (HAES) and Body-Positive provider that is passionate about helping teens and young women heal from their eating disorder. Offers both in-person and virtual therapy.
A holistic therapy practice located in Conshohocken and led by Leiza Stanley, LCSW, who specializes in eating disorders.
Susan E. Anderer, Psy. D.
Dr. Anderer is a licensed psychologist and certified school psychologist in Bryn Mawr, PA who specializes in the treatment of children. One of her areas of focus is eating disorders.
Belmont Behavioral Health Group
Belmont Behavioral Health System provides an array of mental health and addiction treatment services for children, teens, and adults with three locations in Philadelphia, including the Children’s Crisis Response Center.