As a parent, it’s terrifying to think that your child might be facing an eating disorder. Sadly, this experience is much more common than we’d like it to be, and the number of teens facing eating disorders has increased even further during the pandemic.

Anorexia Nervosa

Anorexia is one of the most well-known types of eating disorders, and is also the most deadly. Up to 0.4% of adolescent girls (and 0.1% of young men) are diagnosed with anorexia nervosa, and young people with anorexia are up to 12 times more likely to die than their peers.

Anorexia nervosa causes people to restrict their food intake in order to lose weight or maintain a certain idealized body shape. This is why anorexia is often so deadly – teens can become so underweight that they are malnourished.

Some signs that your teen may have anorexia nervosa include:

• Refusing to eat in front of you or others
• Playing with their food rather than eating it, or moving food around on their plate to make it seem like they’ve eaten more than they have
• An excessive preoccupation with their weight or body shape
• Missing periods, for people who menstruate
• Being underweight (although not all people with anorexia are underweight)
• Dry skin and brittle nails
• Being cold all the time
• Wearing baggy clothing to cover their body
• Having a lot of rituals during mealtimes

There are two general types of anorexia nervosa: the purging type and the non-purging type. Teens with the purging type of anorexia are sometimes misdiagnosed with bulimia nervosa.

Bulimia Nervosa

You may have also heard of bulimia nervosa. Bulimia nervosa is an eating disorder that causes teens to go through periods of binge-eating, in which they eat a large quantity of food over a short period of time. Then, they find ways to “purge” or to get rid of the excess calories consumed. 

Although self-induced vomiting is the most well-known type of purging, people with bulimia nervosa also purge through taking laxatives, excessive exercise, or fasting. 

Some studies have found that up to 12% of young women have symptoms of bulimia nervosa at some point in their lives. Although reports show that bulimia is more common in girls, it’s also likely that boys and young men are underreporting symptoms.

Bulimia nervosa isn’t as deadly as anorexia is, but it can still have serious health consequences. Teens with bulimia can experience hormone problems and electrolyte imbalances that can lead to death.

Some warning signs of bulimia in teens include:

• Periods of binge-eating, after which they feel extreme levels of guilt and shame
• Excessive preoccupation with weight or body shape
• Disappearing after meals for long periods of time or using breath mints after meals to cover up odors of vomiting
• Using diet pills or laxatives to prevent gaining weight
• Continuing to eat even when they’re full
• Physical consequences like damaged enamel on teeth or problems in the throat

Is purging anorexia the same as bulimia?

Bulimia nervosa and the binge/purge type of anorexia nervosa share many symptoms. Both of these disorders causes people to have periods of binge-eating followed by purging excess calories.

The main difference between purging anorexia and bulimia is that anorexia nervosa has a weight criteria for diagnosis. To be diagnosed with anorexia nervosa, your teen must have lost a significant amount of weight. In this scenario, weight restoration would be the first step in treatment. There is no weight criteria for a diagnosis of bulimia nervosa.

Binge-eating disorder

Binge-eating disorder was only recognized in the DSM in the latest edition (published in 2013). Teens with binge-eating disorder engage in periods of eating faster and in larger quantities than usual. Usually, a binge-eating episode lasts around 2 hours.

After the binge-eating episode, teens feel excessive guilt and shame. Unlike teens with bulimia nervosa, however, they do not engage in purging behaviors to compensate for the excess calories consumed. 

We all overeat sometimes, including teens. What differentiates binge-eating disorder are the feelings of excessive guilt and shame that comes after a binge-eating episode. People with binge-eating disorder also usually have less control over their eating during an episode; they aren’t able to stop. In addition, your teen must have at least one binge-eating episode per week for 3 months or more to be diagnosed with binge-eating disorder.

Signs that your teen may have binge-eating disorder include:

• Eating a large amount even when they’re full
• Eating more rapidly than normal when they’re binge-eating
• Feeling extreme amounts of guilt or self-disgust about their binge-eating
• Frequently eating alone because they feel embarrassed about how much they eat
• Seeking food as a response to stress or another painful emotion

ARFID

It’s not as well-known in the general public, but ARFID, or avoidant-restrictive food intake disorder, is actually one of the most common eating disorders among children and teens. ARFID affects up to 3% of the general population, and over 20% of children receiving inpatient care for an eating disorder have ARFID. It can be diagnosed in kids as young as 6 years old.

ARFID is unique among eating disorders in that kids and teens who have it aren’t worried about their weight. Kids with ARFID restrict their food intake not to lose weight, but because they are averse to certain textures or flavors of food. For example, a child with ARFID might refuse to eat anything green, or anything “mushy.” People with ARFID may also be averse to food because of a fear of choking or vomiting, or simply lack the internal motivation for food.

In many ways, ARFID is when picky eating becomes pathological. But it’s also a lot more serious than picky eating. When it’s left untreated, ARFID can cause extreme health consequences including malnourishment.

Some signs that your child may have ARFID include:

• Refusal to eat certain foods
• Excessive fear of choking or vomiting due to eating
• Eating very slowly for no known reason
• Being underweight for their age
• Slow start to puberty
• Refusal to eat certain foods causes problems for their social or family life

Orthorexia nervosa

We’re still learning more about orthorexia, which is not an official diagnosis in the DSM. It’s currently understood as a specific presentation of anorexia nervosa. Unlike teens with other eating order presentations, teens with orthorexia aren’t necessarily preoccupied with their weight (although orthorexia does sometimes come with concerns about weight). They do, however, become obsessed with eating “pure” or “healthy” foods. 

It can be positive for teens to take an interest in eating a healthy diet. But teens with orthorexia take this interest too far. And even if they aren’t trying to lose weight, their preoccupation with the “purity” of foods often leads to significant and unhealthy weight loss.

Research has shown that teens who use Instagram more frequently, especially when they follow “fitspo” or “clean eating” influencers, are at higher risk for developing orthorexia. Orthorexia may also be linked to other psychiatric conditions like obsessive-compulsive disorders (OCD).

Some signs that your teen may have orthorexia include:

• Excessive preoccupation with the origin of food and refusal to eat anything with an ambiguous origin
• Being more concerned about the nutritional value of food than flavor
• Worrying excessively about food’s “quality” such as if the food is organic or pesticide-free
• Refusing to eat food prepared for them by others
• Preparing their food in certain ways or having rituals around food preparation
• Obsessively following “pure eating” blogs or social media accounts
• Being overly critical of others’ food choices

Eating disorder treatment for teens in Bellevue, WA

If you suspect your child may have an eating disorder, it’s crucial to get them professional support right away.

At Cadence Therapy, we offer evidence-based eating disorder treatment for children and teens in the Bellevue area. Sadly, only around 6 to 35% of eating disorder “specialists” report adhering to the latest evidence-based treatments for eatnng disorders. 100% of our highly trained clinical team utilize the most effective and evidence-based approaches.

Our clinical team uses FBT, or Family-Based Treatment, which evidence suggests is the most effective outpatient treatment method for teens with eating disorders. Using FBT, we help your teen and your family restore your teen’s weight and overcome their disordered eating habits. We empower you, as the parent, to take necessary action against your child’s eating disorder and support them in their recovery.

We are conveniently located near I-405 and SR-520 in Bellevue. We commonly see patients from Seattle, Mercer Island, Kirkland, and Redmond.

Fill out our interest form to get in touch with us and start your teen on the road to recovery.

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