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Disordered Eating or Eating Disorder? What to Watch for, When to Worry

Published on: December 28, 2012

eating disorderDo you have a teen who’s on a new health kick? Is she watching what she’s eating, cutting calories, limiting carbs? Or maybe you have a tween who has suddenly become a vegan, has started a “cleanse” or lately, peruses the Web by Googling “How do I lose weight?”

Is it time to worry? Maybe.

Most parents I meet with are frustrated with themselves because, months back, they had a sneaking suspicion that something was up. They noticed their child was eating differently, but did nothing about it until they were staring down a big, bad problem.

Katie, a 14-year-old, started to restrict her eating around Thanksgiving of her freshman year of high school. It wasn’t until February that her mother, Dana, realized something was amiss. Katie began to pay a lot more attention to her appearance. She complained that her new friends were thinner than she was.

Katie’s eating habits drifted. Dana would pass Katie a Luna bar as she dashed out the door in the morning. The possibility that Katie was not eating the Luna bar — or lunch — did not cross Dana’s mind at first. Dana saw Katie eating in the evening when the family had meals together and this was reassuring. But Dana also noted that Katie was avoiding gluten and carbs.

By January, Dana realized Katie was looking thinner. By the time Dana took Katie to see her pediatrician, Katie had lost 15 pounds.

It was difficult for Dana to catch Katie’s eating problem as it developed. Katie’s behaviors and feelings about her body might be considered typical for a teen. But it was the intensity of these behaviors and the length of time they wore on that spelled trouble. What began as disordered eating had evolved into an eating disorder.

What to watch for

What we think of as “disordered eating” includes binge eating (eating a large amount of food while feeling like you’re out of control), excessive dieting, fasting and other extreme weight control behaviors, such as making yourself vomit, the use of diet pills, or the use of laxatives or diuretics for weight loss. Disordered eating may be the preview to the main event or it may be a phase. It’s hard to know for sure.

These behaviors can be hard to spot. Kids hide them from adults. Parents often discover binge eating by finding food wrappers in their child’s bedroom or in the garbage can. And teens purchase diet pills or laxatives/diuretics without their parents’ knowledge.

If your teen exhibits disordered eating habits and is overly concerned with her body shape or weight (for instance, pinching body parts to check fatness, excessively looking in the mirror, weighing herself daily), it’s important to find out more. She may be sliding down a slippery slope into an eating disorder.

Not a phase

While disordered eating can be a phase, an eating disorder is not. An eating disorder is a serious psychiatric disorder that has the power to derail a child’s life.

Anorexia nervosa has the highest mortality rate of any mental illness, and bulimia nervosa can have serious health consequences as well. Eating disorders include anorexia nervosa, bulimia nervosa, and an eating disorder not otherwise specified (EDNOS, for short).

Kids with eating disorders focus on weight or body shape and show a pattern of problematic, disordered eating. While anorexia (characterized by low weight and restrictive eating) and bulimia (characterized by binge eating and habits such as vomiting or compulsive exercising) are the most familiar, parents should be on the lookout for slightly different forms of these disorders.

EDNOS is a catch-all term to include people with eating disorders who don’t meet all the criteria for anorexia or bulimia. For teens, EDNOS might take the form of binge eating and purging a few times a month or constant dieting, even if it doesn’t lead to weight loss. EDNOS is the most prevalent eating disorder in teens. In one recent study, 60 percent of kids being seen at an eating disorders clinic had EDNOS, compared with 20 percent with anorexia and 20 percent with bulimia.

Even though EDNOS may sound like it’s a “mild” form of anorexia or bulimia, research studies have shown that it can be just as dangerous for a teen’s physical and mental health.

Although most people think an eating disorder is a “girl’s problem,” boys are not immune. While some boys might intensely wish for a muscular, lean shape, others may just fear fatness and aim for weight loss. Idealized images of what men “should” look like can lead boys to engage in problematic behaviors, including excessive exercise and extreme food restriction, with some boys seeking out supposed muscle-building products — both over-the-counter and illegal substances.

Treatment options

Ultimately, an eating disorder is a mental health issue with physical health effects, and it requires treatment.

If you’ve noticed disordered eating, let your teen know you are concerned. Set up an evaluation with a mental health professional who specializes in eating disorders and use this as an opportunity to understand more about your teen’s eating and mental health. Early action with eating disorders leads to better results.

Treatments most likely to help your teen include cognitive behavioral therapy (CBT) for adolescents with bulimia (and bulimia-related EDNOS), and family-based treatment (also called the Maudsley approach) for anorexia.

CBT helps teens break the cycle of their disordered eating patterns and challenge the “thought traps” that perpetuate the eating disorder (for instance, the assumption that thinness equals happiness). The Maudsley approach enlists the strengths of a family to help an underweight teen eat well enough to reverse their self-starvation. The goal: to avoid hospitalization and set the teen back on a healthy developmental track.

Additional approaches to eating disorders may also be helpful. Most treatments include family involvement on some level. From sneaking suspicions to treatment, moms and dads are a crucial resource in keeping a “health kick” healthy.

Angela Celio Doyle, Ph.D., is a clinical psychologist and mother of two. She codirects the Eating & Weight Disorders Center of Seattle.

Prevent eating disorders

To help stop disordered eating before it starts, begin by prioritizing family meals. The opportunity to sit down with one’s family to eat provides a prime venue for parents to more casually check in with their teens about daily issues, moods, whereabouts, and to model healthy eating habits for their kids. Research has shown that having family meals at least five days a week (this could be any meal!) can prevent problematic behavior, including eating disorders, sexual activity, violence, school problems, and the use of alcohol, cigarettes and marijuana.

Signs of an eating disorder

The signs of an eating disorder can be so hidden that even a teen’s
pediatrician can miss the early red flags. What are some warning signs
of an eating disorder in your teen?

Eating behaviors:

  • Rigid dieting
  • Excuses for not eating
  • Inflexible thinking about foods as “good” or “bad”
  • Preoccupation with food, nutritional values of foods or cooking
  • Large amounts of food missing or empty containers found
  • Trips to the bathroom during a meal or immediately after eating
  • Skipped meals

Body weight/shape-related concerns:

  • Excessive focus on body weight/shape
  • Very negative body image
  • Frequent weighing
  • Wearing clothes that are too loose
  • Checking appearance frequently
  • Exercising at inappropriate times or in a driven way


  • More withdrawn from friends or family
  • Irritability
  • Sadness or depression

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