Eating Disorders in Teens

Changes in your teenager’s eating habits may be a sign that they want to get healthier. But when your teen becomes rigid or secretive about their eating or makes negative body comments, take notice. 

Look for extremes, says Katrina Obleada, PhD, a pediatric psychologist at Lurie Children’s. Observe if they’ll eat only foods they deem healthy or if they become distressed if they miss a workout. These may be signs of a developing eating disorder. 

“Parents have really great instincts, and they know their child,” Dr. Obleada says. “Changes in eating habits become problematic when there’s no flexibility. If there’s any rigidity, that’s a clear sign something is going on.”

Here, Dr. Obleada explains what eating disorders are and what you can do if your teen develops eating disorder symptoms.

What are eating disorders?

Eating disorders are severe mental health conditions related to problems with eating. Teens with eating disorders may limit how much food they eat or not eat certain foods at all. Some teens may eat in secret or eat a lot of food at one time. Others may purge (intentionally vomit) after eating or use laxatives to empty their bowels.

Some teens who experience eating disorders have body image issues, but not all teens worry about how they look. There are different types of eating disorders, including:

• Anorexia nervosa: Teens with this condition may avoid eating altogether or eat tiny amounts of food (restrict). They may also use exercise or laxatives to try to lose weight.
• Avoidant restrictive food intake disorder (ARFID): Teens who have ARFID may limit the amount of food they eat or the kinds of food they eat. Their behavior isn’t typically about body image or weight. Instead, food-avoidant behavior relates to eating habits, such as a history of “picky” eating or negative feelings about food textures.
• Binge eating disorder: Teens who have binge eating disorder may eat a lot of food in a short amount of time. They often eat when they’re not hungry and often gain weight.
• Bulimia nervosa: Teens with this condition may eat a lot of food at once. After eating, they purge to eliminate the food they’ve consumed.

Who gets eating disorders?

Eating disorders are common. They can occur in people of any age or gender. Your teen may be at higher risk of developing an eating disorder if they:

• Don’t like the way their body looks
• Have a disciplined or high-achieving personality
• Have other family members or peers who create rigid rules around diet and exercise
• Spend a lot of time on social media and compare themselves to idealized images

When teens compare themselves to idealized body images, they may feel pressure to look a certain way, according to Dr. Obleada. Heavy social media use often adds to this pressure.

Signs Your Teen May Have an Eating Disorder

Disordered eating can cause many different symptoms, depending on the eating disorder type. Your teen may:

• Become upset about their own eating behavior or others expecting them to eat
• Be very underweight or gain a lot of weight
• Eat quickly or constantly, even when they’re not hungry
• Experience dehydration, dry mouth or changes to tooth enamel
• Feel tired or confused
• Have anxiety or depression
• No longer have regular menstrual periods

These eating disorder signs may mean it’s time to seek treatment. If you’re not sure where to start, “gently and lovingly share that you’ve noticed changes in the way they’re eating,” Dr. Obleada says. “The key is listening without judgment.”

Treatment for Eating Disorders

There is help if your teen shows signs of an eating disorder. Talk to your child’s primary care provider. Depending on their specific needs, your teen may benefit from evidence-based outpatient treatments such as: 

Family-Based Treatment

Family-based treatment (FBT) is the most common treatment for eating disorders in teens. Healthcare providers consider FBT the gold standard of treatment, Dr. Obleada says. A provider guides parents in supporting their teen while setting guidelines about eating. Providers use a phased approach to:

• Help parents or guardians take control of their teen’s eating
• Allow teens to make independent choices about eating after they’ve demonstrated compliance with eating guidelines and are eating in a healthy way
• Address anxiety, depression or family communication issues a teen may have

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) can help teens change how they think about eating and their bodies. Teens learn coping skills to help them change disordered eating behaviors. CBT also helps treat anxiety and depression.

Medication

Teens who experience anxiety and depression may benefit from treatment with antidepressant or anti-anxiety medications. 

When might my teen need inpatient care?

When teens experience medical complications that result from malnutrition, they need inpatient care. This care helps restore their nutrition and treat complications such as:

• Body mass index (BMI) that is too low
• Low blood pressure
• Imbalances in certain essential minerals (electrolytes)
• Irregular heartbeat or decreased heart rate
• Seizures

“When we see significant weight loss and a refusal to eat or drink fluids, a teen needs inpatient care,” Dr. Obleada says. “Heart palpitations, low blood pressure or loss of menstrual periods for a significant amount of time are clear signs that a teen may need hospitalization.

Can I protect my child from developing an eating disorder?

Eating disorders develop for different reasons. While you can’t stop your child from developing these conditions, there are some “protective factors” you can influence, according to Dr. Obleada. You can:

• Be a body image role model: If you’ve struggled with your own body image, work on self-acceptance. Encourage positive body talk in your home.
• Set a healthy example around food and exercise: Try not to talk about feeling bad or guilty when you eat certain foods. And don’t beat yourself up for missing a day’s workout.
• Talk to your teen about what they’re feeling: If your teen makes negative comments about their body, talk with them about what they’re saying. Use what you know about your child to respond. For example, remind an athlete who complains about their “big thighs” that their powerful legs help them score goals for their team.

If you’re worried your teen may have an eating disorder, talk to their pediatrician. “Trust your instincts,” Dr. Obleada says. “I want parents to feel empowered to advocate for their child.” And if you see signs of an eating disorder, push for a referral to a specialist, she says.
For more resources, visit The National Eating Disorders Association (NEDA) and F.E.A.S.T., an organization for parents and caregivers of loved ones affected by eating disorders.

Learn more about the Eating Disorder Program at Lurie Children’s.

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