5 Misconceptions About Anorexia in Teens and Adolescents That Parents Need To Know
Teenagers and adolescents are at a heightened risk for anorexia nervosa, and your teen may be struggling.
You’ve probably heard a thing or two about anorexia, as it’s one of the more well-known eating disorders. While you think you may know the nuances of anorexia, this eating disorder and its connection to teenagers and adolescents is often widely misunderstood. If you’re concerned that your teen may be struggling with anorexia, we’re here to help you debunk common misconceptions and learn the truth about this eating disorder.
What is anorexia nervosa (AN)?
According to the DSM-V, anorexia nervosa involves the following criteria:
Restriction of energy intake relative to needed energy requirements leading to a change in body weight in the context of age, sex, developmental trajectory, and physical health.
Intense fear of gaining weight or becoming fat no matter one’s body size
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of eating behaviors and body size
There are physical, behavioral, and emotional signs and symptoms of anorexia nervosa in teenagers and they include:
Physical signs & symptoms of anorexia nervosa in teens:
dizziness
fainting
difficulty concentrating
thinning or brittle hair
presence of lanugo (fine, downy hair on the body)
muscle weakness
sleep problems
stomach cramps and gastrointestinal issues
electrolyte imbalances
constantly feeling cold
dry skin
dental issues (i.e. frequent cavities)
impaired immune system
Behavioral signs & symptoms of anorexia nervosa in teens:
Dramatic or sudden weight loss and/or weight changes
Frequent comments about feeling “fat” or overweight
Refusal to eat certain foods or food groups (carbohydrates, fats, dairy, gluten,etc.)
Cooking for others but not eating themselves
Avoidance of social gatherings or events involving food (such as birthday parties)
Anxiety or distress at mealtime
Preoccupations with weight, calories, and/or food
Wearing baggy/loose clothing
Display of food rituals (rearranging food, excessive chewing, etc.)
Struggles with spontaneity of social events
Distorted self-perception of body size
Why are teens at a heightened risk for anorexia?
Teenagers and adolescents are at an especially great risk for developing anorexia for a multitude of reasons, including:
Bodily changes associated with puberty
Teenhood and adolescence involves intense periods of growth and change, both emotionally and physically. Your teen suddenly becomes hyper-aware of the changes happening to their body during puberty and also may be receiving lots of commons about their changing body size from peers, adults and/or medical clinicians. Clothes no longer fit, curves exist where they didn’t use to, and intense hormonal fluctuations create a chaotic environment. With such chaos and change, your teen may feel an intense urge to intervene and stop these changes, and this especially so if they are being pressured to loose weight or go on a diet based on their body size. They may do so by engaging in behaviors like restriction, over-exercise, and disordered eating. If continued without intervention, these disordered eating behaviors often lead to the development of eating disorders like anorexia nervosa.
Unhealthy comparisons to peers and friends
While teens are experiencing the trials and tribulations of a changing body image during puberty, they are also constantly criticizing themselves through comparison. Teens are often growing and changing at different rates from their peers, leaving them in a constant cycle of self-doubt. If your teen is developing at a faster rate than their peers and/or gaining weight, they may try to hinder their own growth by physically preventing their body from gaining weight. They may begin to restrict food, exercise more, or engage in other compensatory behaviors to avert the effects of puberty. Alternatively, it’s also common that if your child is developing at a slower rate than their friends, they may become hyper-aware of their body and begin fixating on weight and appearance. Over time, these behaviors can develop into anorexia nervosa.
Effects of social media
Teens and adolescents have near constant access and exposure to social media. While social media has the potential to cultivate connection and spark inspiration, it also has the potential to expose teens to the harmful effects of diet and wellness culture. The truth is, social media portrays unrealistic beauty and body standards to teenagers and children. From thin models, to plastic surgeries to immense wealth, teens are caught in an endless pursuit of unattainable bodies that are touted as the beauty standard of the moment. As a result, they engage in compensatory behaviors, like restricting food, in an attempt to look like what they see on social media.
Involvement in extracurricular activities and/or sports
Majority of teens immerse themselves into extracurricular activities throughout middle school and high school. While sports and clubs have great benefits, both mentally and physically, they also have the potential to cause great harm. There are some sports that have intense preoccupations with weight and body size, in which they equate body size with the quality of performance. These sports include but are not limited to track, cross country, swimming, diving, wrestling, dance, cheerleading, and more. Coaches, parents, peers, can fuel teens’ desire to perform well, even if it means physically altering their appearance to improve said performance. They may develop unhealthy eating patterns in order to become “leaner” or engage in excessive exercise in an attempt to lose weight.
Underlying or coexisting conditions
Eating disorders, like anorexia nervosa, are psychiatric conditions that run deeper than the physicalities of thinness. There are often underlying neurological and psychiatric conditions, such as anxiety, depression, ADHD, post-traumatic stress disorder, and obsessive compulsive disorder, that predispose your teen to anorexia. Each of these conditions can create intense mental stress and emotional chaos, and your teen may not have the tools to healthily cope with these stressors. In addition to this, these other mental health conditions can alter hunger and signaling pathways in your teen’s brain. This can cause your teen to not feel hungry, not feel a desire to eat, or use strict eating in order to feel some sense of control in their seemingly out-of-control internal environment. Combined with the intensities of teenhood, this creates a recipe for disaster.
Dieting or restriction at home
We want to encourage you as a parent to self-reflect for a moment. With the understanding that you have your teen’s best interest at heart, it’s important to ask yourself these important questions:
“Do I frequently make comments about my weight or appearance, other people’s weight or appearance, or my child’s weight or appearance?”
“Do I frequently diet, restrict certain foods or food groups, only allow “healthy” foods in the house, or talk about restricting foods or food groups?”
“Do I ever tell my child that they should stop eating so much food or watch what they eat?”
“Is there anyone in the home that has struggled with anorexia, another eating disorder, or disordered eating?”
If you said yes to any of these questions, it’s likely that your relationship with food is impacting your teen’s relationship with food. Even if it’s entirely unintentional, a child’s greatest influence on their relationship to food and their body is in the home. If your teen is receiving the message that their body size is directly associated with their worth as an individual, and/or love or respect that they will get, it’s likely that they’ll engage in disordered eating in an attempt to feel more worthy. For more information on the impacts of parental weight and food struggles, consider reading What Is An Almond Mom & Why Is It Problematic and Body Image & Mothers.
How does the healthcare system contribute to your teen’s anorexia nervosa?
Doctors know best, right? Unfortunately, this isn’t true.
It’s possible that your teen’s doctors may be causing or worsening your teen’s anorexia. The truth is - weight stigma is harmful and real and gets in the way of many teens accessing eating disorder support. Even though body mass index (BMI) and weight have been scientifically proven as unreliable sole indicators of health and eating disorder severity, doctors are still using them to evaluate the health of your children and teenagers.
Picture this: your teen has a healthy relationship with food and their body image. They eat intuitively and have no desire to lose weight or alter their appearance. That is, until they see their doctor, who advises a low calorie diet due to slightly elevated BMI and/or weight and encourages weight loss. In the pursuit of “health”, your teen engages in excessive exercise, restriction of food, and extreme dieting (all precursors to anorexia!).
Weight loss should NEVER be encouraged during teen development or throughout adolescence. In fact, any weight loss during childhood or adolescence is extremely concerning no matter your child’s body size. Not only does this impact your teen’s physical development, but it teaches them that their body is something to “fix”.
5 Myths About Anorexia in Teens:
#1. Only girls struggle with anorexia.
Anyone of any gender can experience anorexia. There is a false misconception that anorexia is a female teenage disorder. This couldn’t be further from the truth. Because of this misconception, teenages males and non-binary teens are often undiagnosed because of this misconception. In fact, nearly ⅓ of all teenage boys engage in disordered eating behaviors. Just as teenage girls find themselves in constant comparison with models and celebrities, teenage boys are in the same position. Anorexia is non-discriminatory, and just because your teen isn’t a female doesn’t mean they aren’t affected!
#2. Teens with anorexia never eat.
Just because you see that your teen eats sometimes this doesn’t mean that they don’t have anorexia. The truth is, eating disorders are incredibly conniving and deceitful because they want to go unseen. The longer the eating disorder remains in disguise, the longer it can persist. It’s quite possible that your teen wishes for their anorexia to remain unnoticed. They may eat around friends or at home, but severely restrict themselves at other points in their day. They may physically eat while out at a restaurant, but then avoid eating for days afterwards. In fact, it’s likely that your teen spends way more time outside of the home than at home, and it can be difficult to identify their eating patterns based on what you see at home.
#3. Teens with anorexia just want attention.
No one chooses to have an eating disorder, and no one chooses to have an eating disorder in the pursuit of attention. Anorexia is a psychiatric illness that runs much deeper than a desire for attention, and any teen struggling with anorexia isn’t choosing to have an eating disorder. Eating disorders are complex biological, social and psychological mental illness and develop for a multitude of reasons. Your teen deserves help with their struggles with food and their body.
#4. You can just tell your teen to eat and this will fix the eating disorder
Unfortunately healing from anorexia is not as simple as making your teen eat more food.
The psychological impacts of anorexia run much deeper than the food itself - anorexia is about self-doubt, issues with self-compassion, struggles with body image and self-perception, the complexities of coexisting conditions, weight stigma, trauma experiences, and more. Telling your teen to eat more or forcing them to eat more doesn’t address the root of the problem, and it won’t make your teen’s anorexia magically disappear.
While your teen may need weight-restoration (achieved by increasing food intake), full recovery from anorexia requires a multi-team approach to recovery. This includes psychiatric care, dietitian nutritionists, mental health counselor, and a doctor to monitor health to address the root issue.
#5. Your teen has to be thin or very thin to struggle with anorexia.
Just because your teen isn’t in a thin body doesn’t mean they can’t be struggling with anorexia.
There is a false belief that you can physically tell if someone is anorexic upon the basis of appearance, but this is rarely the case. And this assumption is perpetuated by the media and by the way that Anorexia nervosa is defined and diagnosed in the DSM. Most people who struggle with anorexia aren’t underweight! Anyone of any weight, appearance or body size can struggle with anorexia. In fact, this is referred to as atypical anorexia.
Atypical anorexia is when an individual meets all of the diagnostic requirements for anorexia except the body size and/or weight loss requirements to meet a diagnosis. This means they are not underweight.
At Bravespace Nutrition we don’t use the term “atypical anorexia” because it’s not representative of the true experiences of teens struggling with anorexia. This terminology sends the message that it is abnormal to exhibit symptoms of anorexia in a larger body, which is false, and this then minimizes a teen’s experience and stops teens/adolescents/parents from getting help and support.
What can I do as a parent if I suspect my teen is struggling with anorexia?
Educate and inform yourself. One of the best things you can do for your teen is learn as much as you can about anorexia and its effects. Your teen can't handle this on their own, and they need your help. Listen to podcasts and read books. Consider reaching out to an anti-diet dietitian to work on your relationship to food and body which will help your kid tremendously.
Trust your parental instincts. If you feel like there is something wrong, trust your gut! If your child has expressed anger, withdrawal, or extreme discomfort upon your inquiries about their relationship with food, we want you to know that this is normal and expected. Your teen’s anorexia is a coping mechanism, and when we threaten to take that coping mechanism away, your teen perceives this as a threat. It can feel incredibly overwhelming, and the uncertainty of disrupting your teen’s life often prevents parents from seeking help. We want to empower you to trust your gut, and seek help anyway.
Ask for help. Eating disorders like anorexia are incredibly complex and difficult illnesses to treat. You can’t do this on your own, but the good news is that you don’t have to.
References:
https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia
https://www.eatingdisorderhope.com/information/atypical-anorexia