Eating Disorders in Teens

What Are Eating Disorders?

Eating disorders are complex mental health conditions encompassing a range of behaviors and attitudes toward food, body image, and weight. From anorexia nervosa’s restrictive eating to bulimia nervosa’s cycles of bingeing and purging, these disorders pose serious physical and emotional risks. Eating disorders aren’t just about food; they often reflect deep-seated psychological struggles.

Early identification and intervention for eating disorders are crucial, as the severity of eating disorders can escalate rapidly. Unfortunately, their prevalence is striking, affecting 28.8 million Americans.¹ Recognizing the signs and seeking professional help promptly can significantly improve outcomes and pave the way for lasting recovery.

Eating Disorders in Teens

The prevalence of eating disorders is 2.7% in teens aged 13-18 years, and they are more than twice as prevalent in females vs males.² These numbers are based on rates of anorexia, bulimia, and binge eating disorder, and rates are likely higher when including other eating disorders such as avoidant/restrictive food intake disorder (ARFID) and other specified feeding or eating disorder (OSFED).

Adolescents navigate a unique set of challenges—peer pressure, societal beauty standards, and identity formation—creating a fertile ground for the development of eating disorders. The quest for acceptance and the desire to conform to societal ideals can intensify body dissatisfaction, making teenagers particularly vulnerable to the onset of eating disorders.

Common Eating Disorders in Teens

Teens can develop a variety of eating disorders, with anorexia nervosa, bulimia nervosa, and binge-eating disorder being most prevalent. While anorexia nervosa often takes the lead as the most commonly seen eating disorder in adolescence in treatment settings, one 2011 study actually found the rates of binge eating disorder to be highest.³

Common types of eating disorders in teens include:

Anorexia Nervosa

Anorexia nervosa is a severe eating disorder characterized by an intense fear of gaining weight, leading to self-imposed starvation and extreme weight loss.⁴ Teens may develop anorexia due to societal pressures, body image concerns, or a desire for control in a period of intense change.

Anorexia often emerges during adolescence, potentially linked to hormonal changes, peer influences, and societal beauty standards that impact teenagers’ perceptions of self-worth.

Symptoms of anorexia in teenagers may include:

• Weight loss
• Brittle hair/nails
• Preoccupation with food, dieting, or body image
• Social withdrawal
• Compulsive exercise
• Dizziness
• Fatigue
• Development of a fine layer of body hair (lanugo) to conserve body heat
• Intense fear of weight gain
• Irregular menstrual periods

Bulimia Nervosa

Bulimia nervosa is characterized by episodes of binge eating, followed by eating disorder compensatory behaviors like vomiting, excessive exercise, or fasting.⁴ Teens with bulimia often grapple with a distorted body image and an intense fear of weight gain, leading to a cycle of secretive binge-purge episodes.

The pressure to conform to societal beauty standards, coupled with the emotional turbulence of adolescence, can contribute to the development of bulimia. The desire for control and coping with stressors may drive teenagers toward these harmful eating patterns.

Symptoms of bulimia in teenagers may include:

• Self-induced throwing up (often in secret)
• Preoccupation with body shape and weight
• Secretive eating habits (such as hiding or hoarding food)
• Mood swings
• Other compensatory behaviors such as laxative use or excessive exercise
• Calloused knuckles or swollen salivary glands
• Dental issues
• Frequent episodes of binge eating
• Weight fluctuations

Binge-Eating Disorder

Binge-eating disorder involves recurrent episodes of consuming large amounts of food without compensatory behaviors like vomiting or excessive exercise.⁴ Binge eating disorder is likely under-recognized and under-treated. Often driven by emotions rather than hunger, teens with binge eating disorder feel a lack of control during binges.

The pressures of adolescence, including academic stress, societal expectations, and body image concerns, can contribute to the development of binge-eating disorder. Emotional distress, a desire for comfort, or attempts to cope with life’s challenges may lead teenagers to engage in this unhealthy eating pattern as a way to manage stress and emotions.

Symptoms of binge-eating disorder in teenagers may include:

• Weight gain
• High blood pressure
• Frequent episodes of binge eating
• Eating rapidly
• Feelings of distress after binge eating
• Digestive issues (such as bloating)
• Secretive eating habits
• Eating driven by emotions rather than hunger

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/restrictive food intake disorder (ARFID) is characterized by limited food preferences, sensory aversions, and an unwillingness to eat certain foods or entire food groups.⁴ Unlike other eating disorders, ARFID isn’t driven by concerns about weight or body image but rather by an intense anxiety about the sensory aspects of eating.⁴

In teenagers, ARFID may emerge due to sensory sensitivities, past negative food experiences, or developmental factors. Anxiety around certain textures, smells, or tastes can lead to severe food restrictions, impacting both physical health and overall well-being. The disorder can significantly impact nutritional intake, potentially leading to deficiencies and compromising physical health.

Symptoms of ARFID in teenagers include:

• Limited food preferences
• Sensory aversions to eating
• Unwillingness to try new foods
• Food rituals or routines
• Avoidance of entire food groups
• Limited food variety
• Difficulty eating in social situations
• Nutritional deficiencies

Orthorexia Nervosa

Orthorexia nervosa is a term used to describe an unhealthy obsession with healthy eating. Although not formally classified in the DSM-5, many mental health professionals recognize it as a distinct eating disorder.

Teens with orthorexia may become fixated on consuming only foods deemed pure, organic, or healthy, leading to rigid dietary rules and anxiety around food choices. The societal emphasis on clean eating, coupled with the desire for control during the tumultuous teen years, can contribute to the development of orthorexia.

Symptoms of orthorexia nervosa in teenagers include:

• Obsessive focus on healthy eating
• Rigid dietary rules
• Anxiety around food choices
• Social isolation
• Excessive time spent researching, planning, and preparing meals
• Guilt or shame after “unhealthy” eating
• Nutritional deficiencies, weight loss, or digestive issues
• Negative impact on mood and interpersonal relationships

What Causes Eating Disorders in Teens?

Adolescence is a vulnerable period for the development of eating disorders, marked by hormonal fluctuations and body changes. The combination of biological changes and external pressures makes this age group particularly susceptible to the onset of eating disorders.

Teens experience intensified societal pressures, fueled by peer pressure and the pervasive influence of media portraying idealized body images. The desire for acceptance and fitting societal norms may drive teens to adopt unhealthy eating habits as a way to cope with stress or gain a sense of control.

Impact of Social Media & Peer Pressure

Social media can influence eating disorders, as these platforms wield significant influence over teens, exposing them to curated images that often perpetuate unrealistic beauty standards. Constant comparison with these ideals can exacerbate body image issues and a distorted self-perception.

Peer influences, coupled with the desire for social acceptance, may drive teens to adopt extreme dieting behaviors. The pressure to conform to online and peer expectations can contribute to the development of eating disorders.

Signs of Eating Disorders in Teens

Early recognition of signs and symptoms of eating disorders in teens is paramount for effective intervention and improved outcomes. Early intervention can prevent the progression of unhealthy behaviors, reducing the impact on a teen’s overall well-being. Recognizing warning signs enables parents, educators, and healthcare professionals to create a supportive environment, fostering resilience and promoting healthier relationships with food and body image.

Common signs and symptoms of eating disorders in teens include:

• Physical symptoms: Physical signs of eating disorders in teens may include sudden and significant weight changes, such as noticeable weight loss or unexplained fluctuations. Teens might experience persistent fatigue due to insufficient nutrient intake, impacting overall energy levels. Frequent dizziness or lightheadedness can also be indicative of nutritional deficiencies and dehydration, signaling potential concerns related to unhealthy eating patterns.
• Behavioral signs: Behavioral signs of eating disorders in teens may manifest as obsessive calorie counting, a preoccupation with food-related details, and meticulous tracking of dietary intake. Avoiding meals or consistently finding excuses not to eat with others could indicate unhealthy relationships with food. Frequent visits to the bathroom, especially immediately after meals, may be a sign of purging behaviors.
• Emotional indicators: Emotional indicators of eating disorders in teens may manifest as increased sensitivity to comments about body image or food choices, leading to heightened emotional reactivity. Mood swings and abrupt changes in emotional states can be indicative of the internal struggles associated with disordered eating. An extreme fear of gaining weight, coupled with persistent body dissatisfaction, may contribute to emotional distress and impact a teenager’s overall mental well-being.
• Social indicators: Social indicators of eating disorders in teens may include a noticeable withdrawal from social situations, particularly those involving food. Teens struggling with disordered eating may avoid gatherings where their dietary choices could be scrutinized or where they feel pressure to conform to societal norms.

Teen Eating Disorder Treatment & Intervention

Early intervention is incredibly important for addressing eating disorders in teens. There are various therapy options tailored to teens, and online eating disorder treatment programs are available in addition to in-person treatments. Treatment that includes group therapy and family therapy is crucial to long-term recovery.

Tailoring treatment to each teen’s unique needs ensures a holistic approach, fostering long-term recovery and improved mental health.

Treatment options for eating disorders include:

• Enhanced cognitive behavior therapy (CBT-E): CBT-E is a tailored approach designed to address distorted thoughts and behaviors surrounding food and body image. Through CBT-E, teens work collaboratively with a therapist to identify and challenge negative thought patterns, fostering healthier beliefs and attitudes. This evidence-based therapy equips teens with practical skills to manage emotions, develop coping strategies, and establish a more positive relationship with food and their bodies.
• Online eating disorder treatment programs: Some online eating disorder therapy options like Equip Health and Within Health provide accessible and comprehensive support for teens struggling with disordered eating. These programs offer a range of therapeutic interventions delivered remotely, including individual therapy, group sessions, and nutritional counseling.
• Group therapy: Group therapy for eating disorders provides a supportive community where teens can share their experiences, fostering a sense of understanding and connection. Within a group setting, teens gain insights into different perspectives on food and body image, reducing feelings of isolation. The shared experiences and mutual support in group therapy contribute to a collaborative healing environment, empowering teens to develop coping strategies and navigate their recovery journey together.
• Family therapy: Family therapy like the Maudsley method for eating disorders involving teens is essential, as it addresses the broader familial dynamics impacting a teenager’s relationship with food. Family therapy engages parents and family members in the healing process, fostering open communication and understanding. The goal is to create a supportive environment that reinforces positive behaviors, enhances communication, and promotes lasting recovery for the teen.
• Dialectal behavioral therapy (DBT): DBT for eating disorders can help with emotional regulation and distress tolerance. This may help someone manage their emotional experience without turning to disordered eating behaviors.

How to Support a Teen With an Eating Disorder

Maintaining open lines of communication is essential when helping someone with an eating disorder. Approach your teen with empathy and concern, expressing your observations without judgment. Encourage professional help, emphasizing that seeking therapy is a sign of strength. Additionally, fostering a positive environment around body image and food at home and in school can contribute to a healthier mindset for all teens.

If you’re a peer, approach your friend with care and express your willingness to listen without offering unsolicited advice. Encourage them to confide in a trusted adult and let them know they’re not alone. Educators can play a vital role by promoting body positivity in the classroom and being mindful of language related to weight and appearance.

Where to Find Professional Help for Teens With Eating Disorders

When a teen is negatively impacted by an eating disorder, seeking the guidance of a medical professional should be the top priority for parents. A pediatrician or family physician can conduct a thorough evaluation, ensuring a comprehensive understanding of the situation. These professionals can provide essential referrals to mental health specialists, including therapists and counselors who specialize in eating disorders.

To find a therapist, many parents utilize an online therapist directory. Seeking recommendations from the child’s school counselor, pediatrician, or trusted friends can also guide parents toward reputable therapists. It’s essential to choose a therapist who specializes in eating disorders and has experience working with teenagers to ensure the most effective and targeted support for the child.