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How Eating Disorders Affect Teens

How To Detect Eating Disorder in your child

Kirsten Wheaton, 27, from New York, N.Y., was 14 when she started restricting her food intake. The developing teen noticed changes in her body. The normal growth of her hips and thighs left her feeling helpless and unhappy. Six months later, Wheaton was diagnosed with bulimia.

Eating disorders, defined as a disorder in the normal eating routine, affect as many as 10 million females and one million males in the United States, according to the National Eating Disorders Association. Another startling statistic: 81 percent of 10-year-olds are afraid of being fat. And 42 percent of first through third graders want to be thinner. Eating disorders affect not only a person's eating habits, but her emotions and attitudes toward food and weight issues.

Mandy Golman, the coordinator of "Girls in Motion," a mentoring fitness program paired with conversation about healthy eating, body image and the dangers of dieting at Southern Methodist University in Dallas, Texas, says there is no simple answer to the rise of eating disorders in children. But she feels that it is an external solution to inner turmoil. "Depression is often associated with eating disorders [and] sometimes hard to say which came first – an eating disorder can certainly cause depression and the reverse is also true," says Golman.

"I was depressed for about a year before I developed an eating disorder," says Wheaton. "I cried a lot and became secretive at home. Some of this may have been normal teenage adjustment, although in retrospect, it was probably more profound."

Thin Is Too In

Society, the media and views on what is the "right' and "wrong" way to look also play a big role. "Young girls today are presented with an unrealistic body type, one that less than 5 percent of the population could achieve," says Golman. "Our society has a preoccupation with thinness and beauty. Girls today are given the message: It is important to be beautiful and thin above all else."

Ronnie Litz Julien, a registered dietitian and vice president of the Julien Nutrition Institute in Miami, Fla., agrees. "The peer pressure of being thin in this country is a complete obsession, and young people are being drawn into this at an earlier age," she says. "Consider the models, the television and music celebrities and merely their friends' body weights are all factors in a potential eating disorder."

Eating disorders have been seen in children as young as 8. According to the National Association of Anorexia Nervosa and Associated Disorders, 10 percent report onset at 10 years or younger, and 33 percent report onset between ages 11 to 15. Females are most affected by eating disorders, but boys are not immune, and their rates are rising. "Cultural images of buff bodies being portrayed as the ideal man, anabolic steroid use and GI Joes with unrealistically muscled physiques create similar pressures for boys," says Dr. Abby Aronowitz, a psychologist and author of Your Final Diet (Single Star Press, 2003).

For as long as Wheaton can remember, she'd had a tendency to eat compulsively. "If there was food available that tasted good, I ate, regardless of whether or not I was hungry," she says. "I had a hard time recognizing satiety. When I first began to develop a diagnosable eating disorder, however, I restricted my food for the first few months. I wasn't able to maintain an anorexic pattern of eating for long, and so I started to alternate periods of starvation with periods of intense overeating." Eventually Wheaton began binging and purging.

Golman says the pattern Wheaton described is very typical. "Many people with eating disorders begin with restriction but can't keep it up so end up in the binge-purge cycle," she says.

Defining Eating Disorders

Anorexia nervosa is probably the most well known, and in simple terms, is self-starvation. "People who have anorexia refuse to eat even though they are weak, hungry and way too thin," says Golman.

For children, the definition regards a failure to maintain the steady weight gain expected for their age or actual weight loss combined with over-concern with weight and shape, says Dr. Aronowitz. "Often doctors check to see if the patient weighs 85 percent or less than that which is considered typical for someone of similar build, age and height," she says.

There is usually an intense fear of gaining weight, self-perceptions of being fatter than they actually are and low self-esteem connected to feeling fat. "They do not see their illness as a problem, often refuse treatment and typically receive praise from others for 'being so thin' or 'being so good,'" says Dr. Aronowitz.

Parents should watch their child and look for warning signs. According to Golman these signs include the following:

  • Preoccupation with food, calories and dieting
  • Anxiety about being fat, which does not diminish as weight is lost
  • Withdrawal from family and friends
  • Depression
  • Evidence of self-induced vomiting and/or laxative use
  • Excessive, rigid exercise regimen

"Depending on its severity, numerous medical problems may occur such as dehydration, electrolyte imbalance, hypothermia, poor peripheral circulation and even circulatory failure [or] cardiac arrhythmias among others, says Dr. Aronowitz. "Most severe cases must be hospitalized, since this is a life-threatening condition," she says.

Bulimia is characterized by binge eating and purging to get rid of the food consumed. Large amounts of food are eaten in a short time, expelled by vomiting, excessive exercise and laxative or diuretic abuse, says Julien.

Dr. Aronowitz says there is typically a feeling of being out of control during the binge, and being in control with the purge. "Secrecy frequently surrounds this disorder, since purging is considered their 'friend' and helper, which prevents them from gaining weight," she says. "Many [bulimics] maintain normal or above normal body weight, and often successfully hide their problem from others for years. Binges and purges can range from once or twice a week to several times a day."

Golman says to keep a watch for the following signs:

  • Weight changes
  • Evidence of vomiting
  • Evidence of laxative/diuretic abuse
  • Frequent trips to bathroom following meals
  • Obsessive thought of food and weight
  • Excessive exercise
  • Secret eating/hoarding of food evidenced by missing food

After a while, more serious and frightening signs can start to occur, says Julien, and include vomiting up blood, calluses on their knuckles from sticking their fingers down their throat, "horrific" dental erosion and tears in the esophagus.

Binge eating is another eating disorder classified as binging without purging. The newly classified disorder affects millions of Americans. "These people tend to be overweight or obese, and tend to be compulsive overeaters," says Ronnie Julien. "The only warning signs here are rapid weight gain, large amounts of food missing at home in a short period of time and seeing the child eating enormous amounts of food, either at a particular meal or throughout the day."

Mandy Golman says that people with binge eating disorder eat alone out of embarrassment at the quantity of food and have feelings of disgust, depression or guilt after overeating. "This disorder differs from anorexia and bulimia because people with binge eating disorder usually do not purge afterward," she says. "Treatment includes individual psychotherapy and support groups. Antidepressants have also been found to be useful to people with binge eating disorder."

Observation is key for parents in uncovering any eating disorder. "Parents should ask themselves if their child is limiting their food intake or becoming obsessed with dieting, fitness magazines, calories, carbs, fat or exercise," says Dr. Aronowitz. "Is your child losing weight or claiming unreasonably that they are too fat? Is your child part of a family with a history of eating disorders – if so, they may be at risk. Check to see if your child is skipping meals or social situations revolving around food or wearing baggy clothes sometimes with several layers. Is there excessive time spent looking in the mirror, weighing themselves or 'feeling their fat'? Perfectionism, anxiety, low self-esteem, inability to express emotions and 'all or nothing thinking' are common symptoms."

Wheaton's parents discovered her disorder and confronted their daughter. "They noticed that I left the table and went upstairs to the bathroom immediately after every meal," says Wheaton. "They also noticed food disappearing from the kitchen; I binged on ice cream, cookies, pizza – anything soft. My face grew bloated and blotchy as a result of purging. I had broken blood vessels around my eyes and nose. The knuckles of my right hand were frequently raw."

Getting Help

Treatment is crucial once the disorder is uncovered. "The sooner the eating disorder is identified, hopefully by a physician or pediatrician, the better chances of recovery," says Julien.

For severe cases, it's best to find a treatment center or hospital "specializing in eating disorders where a complete program is offered, including nutritional counseling, medication, individual therapy, group and family therapy," says Dr. Aronowitz. "Less severe cases often require psychotherapy, clinical care, nutrition counseling [and] family support."

During psychotherapy, the child learns what triggers her reaction to food, how to control her eating disorder, stress management and coping techniques through cognitive behavioral therapy. "Medical intervention might be needed to stabilize symptoms like malnutrition, extreme weight loss, damage due to vomiting, etc., and if necessary, may provide medication to help control depression," says Dr. Aronowitz. "During nutrition counseling, children learn proper eating habits and are given an eating plan or menu. Family therapy can identify and remedy dysfunctional patterns to prevent relapse."

After confronting their daughter, Wheaton's parents put her in therapy immediately. Wheaton saw counselors and was hospitalized in the eating disorder wing of a psychiatric hospital for two months. She continued to see an eating disorder expert on an outpatient basis, but continued to binge and purge.

"To be honest, I wasn't ready to stop," says Wheaton. "When I finally realized that my life consisted of little else besides obsessing about food, I was able to slowly recover. But I'm sure I wouldn't have reached the breaking point without a patient and wise therapist who was trained in eating disorder treatment, and helped me to see the relationship between my eating disorder and my emotions."

Even with treatment, many patients struggle the rest of their lives. "It's a 'weak link' that will most likely surface during times of stress," says Dr. Aronowitz. "Research has found that one half of patients with anorexia nervosa recover and that up to 25 percent of patients are disabled severely by their disease. As many as 15 percent of the men and women, boys and girls, who are diagnosed as having anorexia nervosa will die from that disorder this year."

But many do recover fully. "It differs for everyone," says Golman. "It depends how long the eating disorder has been going on. The earlier the onset, the harder it is to treat. If caught early and with a comprehensive treatment approach, recovery from an eating disorder can be successful."

"I am very aware that I have a different relationship with food than someone who has never had an eating disorder," says Wheaton. "I'm careful to make good choices about what I eat because compulsive eating puts me in danger of relapse. I also try to stay honest about how I'm feeling."

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