It can be a challenge for parents to determine whether or not their child has a healthy relationship with food. The fact that three out of four American women report symptoms of disordered eating signifies the prevalence of unhealthy eating behaviors in American society (University of North Carolina Chapel Hill). The danger is that such eating issues have become so common they are too often seen as “normal.” And it isn’t just adult women; the U.S. Department of Health and Human Services reports that half of 9-10-year-old girls are dieting, most of them unaware of the risks. Studies show that as many as 35% of “normal” dieters progress into unhealthy, or pathological dieting behaviors, while 20-30% of those go on to develop a full blown eating disorder (Shisslak 213). These numbers are especially frightening when weighed with the fact that, of all mental illnesses, eating disorders have the highest mortality rates (Sullivan), and anorexia is the third most common chronic illness among adolescents (Public Health Service).
Even in the early stages of onset, children, teens, and young adults suffering from bulimia or anorexia are adept at hiding or explaining away their unusual behaviors. Many aren’t even aware that they have a disordered relationship with food, and physical changes that would indicate an eating disorder, such as continuous weight loss, may be more difficult for a parent to recognize when they see their child on a daily basis. Pathological dieters tend to be defensive about their eating and exercise habits. This might cause some parents to shy away from stirring up conflict with their children, fearful that questions or accusations could add stress to an already strained relationship. In some cases, when a disorder is passed from a parent to a child, the parent may unconsciously be reinforcing the child’s disordered behaviors. For these and many other reasons, even when parents and family members do recognize some potential signs of trouble, they tend not to act quickly enough in staging an intervention.
While, taken individually, some of the signs on this list may not indicate an eating disorder, it is far better to err on the side of precaution when the risk of an eating disorder is present, to prevent the disorder from escalating. A few of these behaviors might also be signs of some other physical or psychological condition that should be checked by a doctor.
Your child disappears into the rest room or bedroom after every meal.
This behavior can be a sign of purging, or eliminating food from the body soon after eating. A bulimic may induce vomiting by sticking a finger in the back of the throat, activating the gag reflex. When the disorder becomes more advanced, a bulimic may be able to vomit at will, without using a finger or any other means to activate the gag reflex. In the most dangerous, advanced stages, a bulimic might find it difficult to keep food in the stomach.
Vomiting is the most well-known form of purging, but there are other kinds of purging that can indicate an eating disorder, including the use of laxatives. Chewing food and then spitting it out into a trash can or into a toilet is also considered a purging behavior and is a clear sign that a person is in the early stages of an eating disorder. Parents might look for traces of vomit or food on or around the toilet, or check for chewed up food hidden in kitchen or bathroom trash cans. Those who chew and spit may spit food into napkins or hide it under larger items in the trash. Purging behaviors are usually seen in conjunction with the second sign:
Food goes missing and yet your child shows no signs of serious weight gain.
Prior to purging, bulimics and those suffering from mixed-symptom eating disorders regularly binge, eating and vomiting up (or chewing and spitting out) sometimes massive amounts of food in one sitting. The foods that are typically consumed during a binge are “forbidden” foods, the types of foods that a person with an eating disorder would normally avoid, such as cake, cookies, chips, fast food or other junk foods. Though the person suffering from the disorder may appear to be of normal weight, or may even appear to be underweight, she or he can consume shocking amounts of food during a binge.
A bulimic often plans a binge in advance, collecting and hiding food until they can binge at a time when they are unlikely to be caught by a family member or roommate. Binge foods do not have to be restricted to bad or junk foods, however. Anorexics might binge on foods that are low in calories, such as vegetables or light popcorn. A binge is defined by the amount of food eaten and the time in which it takes to eat it, and it is usually characterized by a single-mindedness in regard to eating: the person is starving, desperate to eat, and the binge brings some temporary, if illusory, relief.
Your child expresses feelings of guilt associated with food, and engages in self-punishing or obsessive exercise.
While most people feel some regret after overeating, recurring behavior patterns and thought cycles that indicate obsessiveness about food, calories, or exercise are a clear sign of disordered eating. Anorexics and bulimics might engage in repetitive physical activities, with the goal of burning calories, sometimes wearing wrist and ankle weights while going through normal, daily routines, or frequently doing sit-ups, leg lifts, or other exercises at inappropriate times. The desire to punish oneself in the gym after a binge is a sign of a disordered relationship with food.
You child has established strict rules about where, what, and when she/he will eat.
Anorexia progresses through an increasingly strict set of rules that the anorexic creates in regard to what, when, and even where the anorexic will eat. These rules include lists of foods the anorexic considers to be bad or “unsafe” (foods that may be high in calories or fat) and foods considered to be “safe.” As the disorder advances, the list of “safe” foods shrinks. Anorexics prefer to exact extreme control over what they eat, and so variety and spontaneity are perceived as a threat to that control. This partly accounts for another sign of an eating disorder:
Your child is socially withdrawn.
Part of the reason bulimics, but especially anorexics, withdraw socially has to do with their desire to avoid situations in which others will call their behavior into question, or situations in which they may not have as much control over what foods are available. The body, in starvation mode, makes food its very first priority, so the risk of not having access to “safe” foods outweighs the anorexic’s desire to visit with friends or venture out into unfamiliar territory.
Your child goes through mood swings and is often irritable, especially around meal times.
A person suffering from an eating disorder often experiences the common symptoms of starvation, such as low blood pressure, dizziness or light-headedness, and irritability, especially at times when the body is used to being fed. These symptoms can look similar to those of a diabetic suffering from a low blood sugar attack. As anorexia becomes more advanced, the rules that determine when, where, and what an anorexic will eat become increasingly restrictive. When the circumstances of a meal do not align with the anorexic’s rules—for example, your family has chosen to go to a restaurant that does not serve a particular type of food that the anorexic feels is “safe”—the anorexic may become angry and defensive, looking for ways to sabotage the outing and retreat, or may avoid eating all together.
Your child exhibits odd portioning or consumption patterns such as breaking food into pieces or spending extreme amounts of time eating a small portion.
An anorexic might spend several hours eating one container of yogurt or a bowl of oatmeal. The purpose for this sort of behavior is to trick the mind into telling the body it is being fed and satisfied, while in fact, very few calories are being consumed. Anorexics might take their time chewing every bight, or cut their food into tiny pieces. They are driven to cut fat and calories by whatever means. If you see your child using his or her napkin to dab oil off of a plate of sautéed vegetables, or scraping the bread out of the curst of a bagel, this should be treated as a sign of disordered eating.
It’s important to remember that the best chance for recovery from an eating disorder comes during the early stages of the disorder’s development, when disordered behaviors are not as deeply ingrained. Human bodies are designed with mechanisms in place to help prolong survival during times of famine. When activated over persistent periods of time, as happens when a person suffers from an eating disorder, these mechanisms actually work to exacerbate disordered eating behaviors by offering psychological rewards for self-starvation. Over time, physical and chemical changes in the body and brain can make recovery all the more difficult. That’s why it’s essential to catch an eating disorder early; it is better to err on the side of caution when you suspect your child may be suffering from an eating disorder.
If you are interested in seeing how the human body responds to eating disorders, this weekend marks the final days of Body World RX at The Health Museum in Houston. This traveling exhibit, is in its final week, and illustrates how the human body responds to common diseases like diabetes, back pain, skin cancer, colon cancer, heart disease, lung disease, and eating disorders, among others.
Goodwin, Jennifer. “Rate of Eating Disorders in Kids Keeps Rising.” HealthDay. 29 Nov. 2010.
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Public Health Services Office in Women’s Health, Eating Disorders Information Sheet. 2000.
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Shisslak, Catherine M., Marjorie Crago, and Linda S. Estes. "The Spectrum Of Eating
Disturbances." International Journal Of Eating Disorders 18.3 (1995): 209-219. Academic Search Complete. Web. 28 Jan. 2013.
Sullivan, Patrick. American Journal of Psychiatry, Vol. 152 (7), July 1995, p. 1073‐1074.
University of North Carolina at Chapel Hill. "Three Out Of Four American Women Have
Disordered Eating, Survey Suggests." ScienceDaily, 23 Apr. 2008. Web. 28 Jan. 2013.