Dr. Viviana Porcari, Consultant Child and Adolescent Psychiatrist

Eating disorders involve extreme disturbances in eating behaviors—following rigid diets, bingeing on food in secret, throwing up after meals, obsessively counting calories. But eating disorders are more complicated than just unhealthy dietary habits. 

If you notice the warning signs of an eating disorder in your child, it’s important to speak up. You may be afraid that you’re mistaken, or that you’ll say the wrong thing, or you might alienate the person. However, it’s important that you don’t let these worries stop you from voicing your concerns.

People with eating disorders are often afraid to ask for help. Some are struggling just as much as you are to find a way to start a conversation about their problem, while others have such low self-esteem they simply don’t feel that they deserve any help. Whatever the case, eating disorders will only get worse without treatment, and the physical and emotional damage can be severe.

The sooner you start to help your child, the better their chances of recovery. Having supportive relationships is vital to your child’s recovery. Your love and encouragement can make all the difference.

At their core, eating disorders involve distorted, self-critical attitudes about weight, food, and body image. It’s these negative thoughts and feelings that fuel the damaging behaviors.

Young people with eating disorders use food to deal with uncomfortable or painful emotions. Restricting food is used to feel in control. Overeating temporarily soothes sadness, anger, or loneliness. Purging is used to combat feelings of helplessness and self-loathing. Over time, people with eating disorders lose the ability to see themselves objectively and obsessions over food and weight come to dominate everything else in life. Their road to recovery begins by identifying the underlying issues that drive their eating disorder and finding healthier ways to cope with emotional pain.

Warning Signs of Eating Disorders

Many people worry about their weight, what they eat, and how they look. This is especially true for teenagers and young adults, who face extra pressure to fit in and look attractive at a time when their bodies are changing. As a result, it can be challenging to tell the difference between an eating disorder and normal self-consciousness, weight concerns, or dieting. Further complicating matters, people with eating disorders will often go to great lengths to hide the problem. However, there are warning signs you can watch for. And as eating disorders progress, the red flags become easier to spot.

Restricting food or dieting

  • Making excuses to avoid meals or situations involving food (e.g. they had a big meal earlier, aren’t hungry, or have an upset stomach)
  • Eating only tiny portions or specific low-calorie foods, and often banning entire categories of food such as carbs and dietary fat, obsessively counting calories, reading food labels, and weighing portions
  • Developing restrictive food rituals such as eating foods in certain orders, rearranging food on a plate, excessive cutting or chewing.
  • Taking diet pills, prescription stimulants, or even illegal drugs such as amphetamines (speed, crystal, etc.)


Bingeing

  • Unexplained disappearance of large amounts of food in short periods of time
  • Lots of empty food packages and wrappers, often hidden at the bottom of the trash
  • Hoarding and hiding stashes of high-calorie foods such as junk food and sweets
  • Secrecy and isolation; may eat normally around others, only to binge late at night or in a private spot or their bedroom where they won’t be discovered or disturbed


Purging

  • Disappearing right after a meal or making frequent trips to the bathroom
  • Showering, bathing, or running water after eating to hide the sound of purging
  • Using excessive amounts of mouthwash, breath mints, or perfume to disguise the smell of vomiting
  • Taking laxatives, diuretics, or enemas
  • Periods of fasting or compulsive, intense exercising, especially after eating
  • Frequent complaints of sore throat, upset stomach, diarrhea, or constipation
  • Discolored teeth


Distorted body image and altered appearance

  • Extreme preoccupation with body or weight (e.g. constant weigh-ins, spending lots of time in front of the mirror inspecting and criticizing their body)
  • Significant weight loss, rapid weight gain, or constantly fluctuating weight
  • Frequent comments about feeling fat or overweight, or about a fear of gaining weight
  • Wearing baggy clothes or multiple layers in an attempt to hide weight

How to talk to your child about an eating disorder

The decision to make a change is rarely an easy one for someone with an eating disorder. If the eating disorder has left your child malnourished, it can distort the way they think—about their body, the world around them, even your motivations for trying to help. Bombarding them with dire warnings about the health consequences of their eating disorder or trying to bully them into eating normally probably won’t work. Eating disorders often fill an important role in the person’s life—a way to cope with unpleasant emotions—so their allure can be strong. Since you may be met with defensiveness or denial, you’ll need to tread carefully when broaching the subject with your loved one.

Pick a good time. Choose a time when you can speak to your child in private without distractions or constraints. You don’t want to have to stop in the middle of the conversation because of other obligations! It’s also important to have the conversation at a time of emotional calm. Don’t try to have this conversation right after a blow up.

Explain why you’re concerned. Be careful to avoid lecturing or criticizing, as this will only make your child defensive. Instead, refer to specific situations and behaviors you’ve noticed, and why they worry you. Your goal at this point is not to offer solutions, but to express your concerns about your child’s health, how you much you love them, and your desire to help.

Be prepared for denial and resistance. There’s a good chance your child may deny having an eating problem or become angry and defensive. If this happens, try to remain calm, focused, and respectful. Remember that this conversation likely feels very threatening to your child. Don’t take it personally.

Ask if they have reasons for wanting to change. Even if your child lacks the desire to change for herself, she may want to change for other reasons: to please someone they love, to return to school, for example. All that really matters is that they are willing to seek help.

Be patient and supportive. Don’t give up if your child shuts you down at first. It may take some time before they’re willing to open up and admit to having a problem. The important thing is opening up the lines of communication. If they are willing to talk, listen without judgment, no matter how out of touch they may sound. Make it clear that you care, that you believe in them, and that you’ll be there in whatever way they need whenever they’re ready.


What not to do

Avoid commenting on appearance or weight. People with eating disorders are already overly focused on their bodies. Even assurances that they’re not fat play into their preoccupation with being thin. Instead, steer the conversation to their feelings. Why are they afraid of being fat? What do they think they’ll achieve by being thin?

Avoid shaming and blaming. Steer clear of accusatory “you” statements like, “You just need to eat!” Or, “You’re hurting yourself for no reason.” Use “I” statements instead. For example: “I find it hard to watch you wasting away.” Or, “I’m scared when I hear you throwing up.”

Avoid giving simple solutions. For example, "All you have to do is accept yourself." Eating disorders are complex problems. If it were that easy, your child wouldn’t be suffering.


Avoid power struggles over food. Attempts to force your child to eat will only cause conflict and bad feelings and likely lead to more secrecy and lying. That doesn’t mean you can’t set limits or hold your child accountable for their behavior. But don’t act like the food police, constantly monitoring your child’s behavior.


Don’t blame yourself. Parents often feel they must take on responsibility for the eating disorder, which is something they truly have no control over. Once you can accept that the eating disorder is not anyone's fault, you can be freed to take action that is honest and not clouded by what you "should" or "could" have done.


What you can do


As a parent, there are many things you can do to support your child’s eating disorder recovery—even if they are still resisting treatment.

Set a positive example. You have more influence than you think. Instead of dieting, eat nutritious, balanced meals. Be mindful about how you talk about your body and your eating. Avoid self-critical remarks or negative comments about others’ appearance. Instead, focus on the qualities on the inside that really make a person attractive.

Make mealtimes fun. Try to eat together as a family as often as possible. Even if your child isn’t willing to eat the food you’ve prepared, encourage them to join you at the table. Use this time together to enjoy each other’s company, rather than talking about problems. Meals are also a good opportunity to show your child that food is something to be enjoyed rather than feared.

Encourage eating with natural consequences. While you can’t force healthy eating behaviors, you can encourage them by making the natural consequences of not eating unappealing. For example, if your child won’t eat, they can’t go to dance class or use their bike or moped, in their weakened state, it wouldn’t be safe. Emphasize that this isn’t a punishment, but simply a natural medical consequence.

Do whatever you can to promote self-esteem in your child in intellectual, athletic, and social endeavors. Give boys and girls the same opportunities and encouragement. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to disordered eating.


Treatments for eating disorders

The right treatment approach for each person depends on their specific symptoms, issues, and strengths, as well as the severity of the disorder. To be most effective, treatment for an eating disorder must address both the physical and psychological aspects of the problem. The goal is to treat any medical or nutritional needs, promote a healthy relationship with food, and teach constructive ways to cope with emotions and life challenges.

A team approach is often best. Those who may be involved in treatment include medical doctors, mental health professionals, and nutritionists. The participation and support of family members also makes a big difference in the success of eating disorder treatment.

Medical treatment. The first priority is to address and stabilize any serious health issues. Hospitalization or residential treatment may be necessary if your child is dangerously malnourished, suffering from medical complications, severely depressed or suicidal, or resistant to treatment. Outpatient treatment is an option when the patient is not in immediate medical danger.

Nutritional counseling. Dieticians or nutritionists can help your child design balanced meal plans, set dietary goals, and reach or maintain a healthy weight. Nutritional counseling may also involve education about proper nutrition.

Therapy. Therapy plays a crucial role in eating disorder treatment. Its goals are to identify the negative thoughts and feelings that are behind the disordered eating behaviors, and to replace them with healthier and less distorted attitudes. Another important goal is to teach your child how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive way.



Useful Resources


www.overcominganorexiaonline.com 

www.overcomingbulimiaonline.com

www.b-eat.co.uk


Let's Talk About about

Eating Disorders

​Extract from Helpguide.org

by Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal 


 Call on: 07983 325340

                    

Child Psychiatrist in London