What Causes Eating Disorders in Teens? What to Do to Help Them

The ABC of Eating Disorders

Have you heard about a teen who refuses to stay at a normal body weight? Or a teen that had a sudden urge to eat just to later be purged with laxatives?

Eating disorders are serious and complex mental illnesses that affects teens more than you think. These illnesses include extreme disturbances in how food is perceived, also in eating, weights and even shape of the body.

The most common eating disorders affecting teens include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder (ARFID). They often start in the teen and young adult years. But they can occur at any age.

Statistics Tell the Story

The National Eating Disorders Association (NEDA)  reported many telling statistics from a variety of US studies that clearly paint the picture, including:

Overall:

• 9% of the US population, or 28.8 million Americans will have an eating disorder in their lifetime
• The overall lifetime prevalence of eating disorders is estimated to be 8.60% among females and 4.07% among males

Teens: 

• 62.3% of teenage girls and 28.8% of teenage boys report trying to lose weight
• 58.6% of girls and 28.2% of boys are actively dieting
• 68.4% of girls and 51% of boys exercise with the goal of losing weight or to avoid gaining weight

Different Types of Eating Disorders

There is a range of eating disorders that can affect teens. 

Anorexia Nervosa

Anorexia nervosa is a condition where an adolescent may avoid food, severely restrict food, or eat very small quantities of only certain foods. They are very strict about what and how much they will eat. They may think about food or calories almost all the time.

They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight. To lose weight, some people with anorexia fast or exercise too much. Others may use laxatives, diuretics (water pills), or enemas.

There are two types of anorexia nervosa: “restrictive” and “binge-purge”. 

People with the restrictive type:

• eat very little on purpose, leading to a very low body weight
• have an intense fear of weight gain and fear looking fat
• have a distorted body image and see themselves as fat even when they are very thin

Those with the binge-purge type:

• Also greatly restrict the amount and type of food they consume
• In addition, they have binge-eating and purging episodes. They eat large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what they ate
• Are very conscious of their weight

Compared with other mental health disorders, anorexia nervosa has an extremely high death rate, usually from medical complications of starvation. And suicide is the second leading cause of death for those with with anorexia nervosa.

Bulimia Nervosa

This typically is seen in teens of normal weight. Teens with bulimia nervosa may be slightly underweight, normal weight, or over overweight.They often feel a lack of control over these episodes. 

Binge-eating disorder

This  is the most common eating disorder in the U.S. Teens with this condition lose control over their eating with recurring episodes of eating unusually large amounts of food often faster than usual. This is not followed by purging, excessive exercise, or fasting. As a result, teens with binge-eating disorder often are overweight or obese. 

Avoidant restrictive food intake disorder (ARFID)

Most commonly seen in middle childhood, teens with ARFID limit the volume and/or variety of foods they consume. Unlike other eating disorders, selective eating is motivated by a lack of interest in eating or food, sensory sensitivity (e.g., strong reactions to taste, texture, smell of foods), and/or a fear of choking or vomiting.

What Makes Teen Eating Disorders so Dangerous?

Physical Risks

Eating disorders have many serious dangerous physical and mental health effects. Some of the main ones include:

Anorexia Physical:

• Extreme thinness (emaciation)
• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia and muscle wasting and weakness
• Brittle hair and nails
• Severe constipation
• Slow or irregular heartbeats
• Low blood pressure
• Slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multiorgan failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Feeling weak, dizzy, or faint
• Constipation and bloating
• Irregular periods
• Weak bones
• Delayed puberty and slow growth
• Infertility

Bulimia Physical:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging of fluids
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

ARFID Physical:

• Dramatic weight loss
• Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause

Mortality:

• Every 52 minutes 1 person dies as a direct consequence of an eating disorder
• Eating disorders are second only to opiates in deaths from any psychiatric illness

Mental Health Risks

(NEDA)  reported other statistics on co-occurring mental health and substance abuse conditions:

Mental Health:

• Up to 23% of individuals with Binge Eating Disorder had attempted suicide
• Virtually all (94%) reported lifetime mental health symptoms: 
  • 70% mood disorders
  • 68% substance use disorders
  • 59% anxiety disorders
  • 49% borderline personality disorder
  • 32% posttraumatic stress disorder

Substance Abuse:

• 50% of individuals with an eating disorder use alcohol or illicit drugs, compared to approximately 9% in the general population
• 1 in 5 individuals with an eating disorder will develop a substance use disorder at some point in their lifetime

Causes of Eating Disorders in Teens

Eating Disorders are complex and the causes are still being studied and not well known. A variety of factors give rise to the development of an eating disorder.

• Biological: Genetics and neurobiological (brain chemical imbalances). Serotonin may affect the development of eating disorders due to its role in mood regulation and appetite
• Psychological: Personality traits such as perfectionism, emotion regulation, stress and trauma in the family, and other existing mental health conditions. Co-occurring disorders such as mood disorders and obsessive-compulsive disorder (OCD) often exist
• Social and cultural: Family and peer influences, appearance standards, and discrimination. Media and cultural values promoting thinness may be key factors for teens
• Developmental: Disturbances to typical childhood development may increase the risk of someone developing an eating disorder
• Behavioral: Some types of behaviors such as dieting may lead to eating disorders

How to Identify an Eating Disorder in a Teen

Look for behavioral, emotional and physical signs, including:

Behavioral Signs:

• Skipping meals or snacks or making excuses for not eating
• Having a very limited diet that hasn’t been prescribed by a trained medical professional
• Too much focus on food or healthy eating, especially if it means not participating in usual events, such as sports banquets, eating birthday cake or dining out
• Making own meals rather than eating what the family eats
• Withdrawing from usual social activities
• Frequent and ongoing worry or complaints about being unhealthy or overweight and talk of losing weight
• Frequent checking in the mirror for what are thought to be flaws
• Repeatedly eating large amounts of foods
• Using dietary supplements, laxatives or herbal products for weight loss
• Exercising much more than the average person. This includes not taking rest days or days off for injury or illness or refusing to attend social events or other life events because of wanting to exercise
• Calluses on the knuckles from reaching fingers into the mouth to cause vomiting
• Problems with loss of tooth enamel that may be a sign of repeated vomiting
• Leaving during meals or right after a meal to use the toilet
• Skipping most meals
• Unusual eating habits (such as eating thousands of calories at one meal or skipping meals)
• Frequent weighing

Emotional Signs:

• May feel upset or guilty after binge eating
• Talk of depression, disgust, shame or guilt about eating habits
• Anxiety or fears about gaining weight
• Eating in secret
• A distorted body image
• Depressed mood

Physical Signs:

• Extreme weight change
• Insomnia
• Constipation
• Skin rash or dry skin
• Dental cavities
• Erosion of tooth enamel
• Loss of hair or nail quality
• Hyperactivity and high interest in exercise

How Are Eating Disorders in Teens Treated?

Diagnosis

It’s essential to see your doctor(s) to get a thorough diagnosis for your teen which typically includes:

• A physical exam: Your healthcare provider will likely examine you to rule out other medical causes for your teen’s eating issues. The provider also may order lab tests
• A mental health evaluation: A mental health professional asks about your teen’s  thoughts, feelings, and eating habits and behaviors. They also may be asked to answer a series of questions to help with the diagnosis
• Other studies:. Other medical tests may be done to check for any complications related to your teen’s eating issues

Treatment

Eating disorders require a team approach with your doctor, mental health professionals and a registered dietician experienced with treating eating disorders.

Treatment varies with the type of eating disorder, but includes:

• Learning about healthy nutrition
• Learning how to develop healthy eating habits
• Guidance in reaching a healthy weight if you’re underweight
• Behavioral therapy, sometimes called talk therapy
• Medicine, if needed
• If your life is at risk, you may need to go into a hospital right away

Medicine can’t cure an eating disorder as none have been demonstrated to help with weight gain or to treat anorexia. For bulimia or binge-eating disorder, some medicines may help manage urges to binge or purge or help manage an extreme focus on food and diet.

Some behavioral therapies can help treating disorders, including

• Family-based treatment (FBT): Usually an outpatient treatment for children and teenagers with anorexia.and possibly for bulimia and other problem eating behaviors. The family is involved in making sure that the child or other family member follows healthy-eating patterns and maintains a healthy weight
• Cognitive behavioral therapy (CBT): CBT is commonly used in eating disorder treatment, especially for bulimia, binge-eating disorder and some other problem eating behaviors. A type of CBT called enhanced CBT is used most often. You learn how to monitor and improve your eating habits and moods, develop problem-solving skills, and explore healthy ways to cope with stressful situations

If required, your health care provider may recommend you stay in the hospital for a time. Some clinics specialize in treating people with eating disorders. A day program may also help accommodate your teen’s schedules.