Eating disorders are still a problem for pre-teen and teen boys and girls, particularly in this social media age of Instagram and Snapchat.
The issue has grown across the world and all social classes, says Joann Hendelman, clinical director of The Alliance for Eating Disorders Awareness. The national nonprofit organization, based in West Palm Beach, provides programs and activities aimed at outreach, education and early intervention of eating disorders.
“Eating disorders are more common than autism, breast cancer and Alzheimer's disease, more deadly than drunk driving, and even more costly than depression and anxiety,” says Hendelman, a licensed clinical psychologist.
Common eating disorders include anorexia nervosa, bulimia nervosa and binge eating. Anorexia causes the highest mortality rate among psychological disorders. Parents can find detailed information about the main types and long-term health implications here.
Discomfort during meal times, overanalysis of calories and excessive amount of time spent worrying about food, weight or body image may be signs of the problem, says Henah Gupta, past president of South Florida’s chapter of the International Association of Eating Disorder Professionals.
Common consequences of anorexia include bone weakening, brittle hair and skin, anemia, weakness, gastrointestinal issues and low blood pressure, while bulimia can cause swollen glands, dental complications, gastrointestinal issues, kidney problems and dehydration, according to Gupta’s website.
“People with eating disorders may experience shame or guilt within themselves,” she says.
“Their relationship with food is usually anxiety-ridden and difficult to manage. Eating may be a stressful event for them.”
Symptoms of food restriction or avoidance, emotional eating, compulsive eating, compensating for eating by excessive exercise or some method of attempting to reduce the guilt for eating may be clues, says Gupta, who has a doctorate in clinical psychology.
“A person's self-esteem may be low, and the amount of value and importance placed on their body can become astronomical,” she says.
Hendelman cautions family members and caregivers of teens to watch for simultaneous conditions such as mood and anxiety disorders, drug or alcohol abuse, self-harm, such as cutting, and suicidal thoughts and behaviors.
Understanding the causes
Eating disorders tend to run in families, and eating disorders share common genes, Hendelman says. “About 60 to 80 percent of the risk of developing an eating disorder is genetic. Genes load the proverbial gun, and the environment pulls the trigger,” she says. “The No. 1 reason for children to be bullied is body size, either too large or too small. The problem is that our culture judges people regarding body size, yet body size is a genetic issue, not a cultural one.”
Certain factors can contribute to developing an eating disorder, Gupta says. “These factors can include family history of mental health illness, low self-esteem, poor peer relationships, unhealthy living environments, social factors, emotional instability, limited coping skills, cultural and biological factors, etc.,” she says.
Trauma, other psychiatric illness, physical illness and activities that require weight regulation, such as ballet and wrestling, also can be triggers. “Society’s obsession with thinness and the war on obesity also play a part,” Hendelman says.
Social media is often a source of false information and may impact body image more than traditional media because people are prone to compare themselves to their friends, Hendelman says. Social media users can perpetuate the stigma by altering posted images.
“Fifty percent of social media users Photoshop their images and choose the best image to post while posting images of friends that are not Photoshopped and perhaps not the best images of that friend,” she says.
The Mental Health Association of Palm Beach County’s MPower for Teens program in high schools educates teenagers on mental health issues, including eating disorders.
A phone call or email to The Alliance for Eating Disorders Awareness can reach a staff member who can support the person struggling with an eating disorder, Hendelman says. Six free support groups meet weekly at the alliance, including an adolescent support group and a group for family and friends.
The alliance aligns people with programs and therapists accepting their insurance while helping decide which programs are most appropriate. The organization has a new national website offering a confidential way to find a therapist or treatment program.
Overeaters Anonymous has approximately 6,500 meetings in more than 80 countries. The Palm Beach County group is available at 561-820-9242. The Palm Beach County Intergroup also hosts a New Young People's meeting. A list of monthly meetings is here.
Eating disorders are not just about food, Gupta says. Working on changing the underlying emotional issues is part of the treatment. Parents can help their children by talking openly and supportively about this, she says.
“Sometimes families may benefit from psychotherapy as well as the individual,” Gupta says. “I would encourage parents to have their child evaluated by an eating-disorders professional if they feel concerned about their health. The sooner the individual gets into treatment, the better the chances for long-term change.”
A multidisciplinary approach is best, and parents also may want to consult a dietitian who can recognize if their child’s eating patterns are concerning, Gupta says.
Signs of an eating disorder
Those struggling with an eating disorder may have some, but not all, of the following emotional and behavioral signs. Encourage the person to seek professional help if you notice patterns.
· Intense fear of gaining weight
· Negative or distorted self-image
· Frequent checking the mirror for perceived flaws
· Self-worth and self-esteem dependent on body shape and weight
· Fear or avoidance of eating in public or with others; eating in secret
· Preoccupation with food
· Eating tiny portions or refusing to eat
· Hoarding and hiding food
· Disappearing after eating, often to the bathroom
· Unusual food rituals, such as chewing each bite too much or eating very slowly
· Any new practice with food or fad diets, including cutting out food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
· Little concern over extreme weight loss
· Obsessive interest in TV cooking shows and collecting recipes
· Consuming only “safe” or “healthy” foods
· Social withdrawal
· Excuses for not eating
· Cooking elaborate meals for others but refusing to eat them themselves
· Eating strange combinations of foods
· Hiding weight loss by wearing bulky clothes
· Flat mood or lack of emotion
· Mood swings
· Hyperactivity and restlessness (unable to sit down, etc.)
· Rigidity in behaviors and routines, and extreme anxiety if these are interrupted
· Excessive exercising or exercising when ill or injured
SOURCES:• Joann Hendelman, clinical director, The Alliance for Eating Disorders Awareness