Identifying and understanding the signs of Anorexia in teens (your teen) is an important first step to getting help. Parents tell us that the world of eating disorders in teens can feel overwhelming. It’s likely that you’ve heard the term Anorexia but the details may be unclear. So today, we will take a look at the history, symptoms, diagnosis and dietitian’s role in this increasingly common eating disorder.
Anorexia Nervosa (AN) is the oldest and one of the most recognized eating disorders in history. The term “anorexia” stems from the Greek language and has been used for 140 years to describe an individual “without appetite”. (You can read more about the history of anorexia here).
This meta-analysis confirms that eating disorders have the highest mortality rate of any mental illness. For adolescent girls, the mortality rate of Anorexia Nervosa is 12 times greater than all other causes of death combined (here). Thankfully through years of research, the medical community has now established effective treatments for AN in children and teens. Please don’t let these statistics cause panic! We share these simply to highlight the seriousness of this condition but want to remind you that recovery is possible for so many kids.
Diagnosing Anorexia Nervosa
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (otherwise known as the DSM-5) is the guidebook doctors, psychiatrists and psychologists use to formally diagnose eating disorders.
The diagnostic criteria for Anorexia Nervosa in the DSM-5 includes:
- Restriction of energy intake (calories) relative to requirements, leading to a significant low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected).
- Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.
- Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight.
Once diagnosed, Anorexia Nervosa is further classified into restricting type and binge- purging type.
- Restricting type is defined as an individual who has not regularly engaged in binge-eating or purging during the last three months.
- Binge-purging type is defined as an individual who has regularly engaged in binge-eating or purging within the last three months.
What are the Symptoms of Anorexia?
Anorexia in teens can present differently. As a parent, it is helpful to know what the signs are to keep an eye out for any abnormal behaviours around food and their body. Here are some of the red flags to watch for in your teenager:
- Refusing to eat certain foods, food groups or types of food.
- Avoiding food related activities and events, such as birthday parties or lunches with friends.
- Complaining about body weight, shape or size. Making comments such as “I feel fat” or “I hate my body” are common.
- Food rituals such as cutting foods into very small pieces, excessive chewing and playing with food.
- Significant weight loss **although this is not always the case**
- Throwing out food and/or skipping meals when unsupervised
- Choosing only “healthy foods” or having rules about food
- Drinking large amounts of coffee or carbonated beverages
- Counting calories, weighing or measuring food
- Cooking or baking for others but refusing to eat the food
- Exercising excessively despite illness, injury or fatigue
- Wearing several layers of clothing to stay warm or hide weight changes
- Complaining of abdominal cramping, bloating or constipation
This is a starting place, but it is by no means a complete list. If your teen is demonstrating any behaviours that make you feel concerned, reach out right away. Research consistently demonstrates that early and effective intervention increases the likelihood of full recovery.
Let’s press pause for a moment before we move on to address the misconception that all teens who have Anorexia are at a very low weight. This is definitely not true. This is no specific “look” to Anorexia and you can’t determine if an individual has an eating disorder based on their body size. Anorexia can impact people of all body weights, shapes and sizes.
What Causes Anorexia?
There is no single person, event or parenting choice that causes Anorexia Nervosa. Eating disorders are complex mental health conditions that result from a number of cultural, social, environmental and genetic factors.
Culturally, we live in a society that obsesses over thin bodies. Teens are constantly bombarded with messages on social media about weight loss and dieting. Fad diets and exercise challenges can easily lead teens astray. These confusing messages coupled with unrealistic images of photo-shopped bodies make it easy for teens to feel inadequate.
From a social perspective, eating disorders can be a coping mechanism to manage feelings of stress, anxiety or perfectionism. When other aspects of life are feeling out of control, teens may begin to control food as a way to handle big emotions.
In terms of genetics, twin studies have found specific genes which are associated with an increased risk of developing an eating disorder. Anecdotally, children with perfectionistic personalities, people pleasing tendencies and low self-esteem can be more vulnerable to developing an eating disorder.
How Can a Dietitian Help?
An eating disorder informed Registered Dietitian will guide your family to the support and resources that you need. At Blueprint Nutrition, our dietitians work alongside family doctors, pediatricians and counsellors to provide holistic care.
In most situations, we use the model of care called “Family Based Treatment” or FBT. FBT is the gold standard for eating disorder care in teens. The dietitian role in this model involves empowering families to re-nourish their child through thoughtfully planned family meals (which we are here to help with!). Dietitians can also help navigate the gastro-intestinal symptoms (hello constipation and diarrhea!) that often arise in recovery. While the majority of our work is done with parents, we also work directly with teens in the later stages of recovery to promote independent eating and a return to normal life.
If you found this article on Anorexia is teens helpful, be sure to check out our other posts on our Eating Disorder Blog.
