Eating disorders affect five to ten million young and adult women and one million men in the United States. What is a parent to do when we suspect our child may be exhibiting symptoms of disordered eating? Come to think of it -- what are symptoms of disordered eating?
To answer these questions, I called up Liza Feilner, a licensed professional counselor and senior therapist at the Eating Recovery Center's Child and Adolescent Behavioral Hospital who for nine years has been working inpatient with individuals suffering from eating disorders.
Photo by Leonid Mamchenkov (Flickr).
A lot of us don't always have the opportunity to observe our children's eating behaviors throughout the day, meeting up with them only at dinner time. In the following list, Feilner offers some tell-tale signs that a child may be exhibiting symptoms of an eating disorder.
"Remember, you're looking for changes to previous patters that they've set with their eating," says Feilner.Symptoms of disordered eating
Weight loss or weight fluctuation. These are well-known indicators, though Feilner warns that neither of these in themselves are the only determinant that somebody is struggling with an eating disorder.
Significant changes in food behavior. "If suddenly they're cutting out a particular food group, that may signify a change in food behavior," warns Feilner. "For example, they may cut out fats or carbs or certain foods and begin getting more rigid with what they are willing to eat."
Limiting intake. "I already ate." "I'm not very hungry tonight." If your child is consistently skipping meals or otherwise trying to limit their food intake by pushing food around the plate or taking really small bites to make it seem like they are eating, watch closely for other symptoms of disordered eating.
Ritualistic behavior. Eating disorders tend to turn the consumption of food into a very rigid ritual. Any peculiar eating behaviors -- such as finishing one item on the plate before moving on to another, for example -- should signal a parent to become more observant.
Overindulgence. If your child is getting several helpings of something -- and this is a change from their previous behavior -- it might indicate binging. "Usually people who are binging will be drawn to what they have identified in their minds as 'bad' foods, so overindulging might involve desserts or carbs, of whatever they believe to be 'worse' for them," says Feilner.
Increased time spent in the bathroom. Any increase in the amount of time spent in the bathroom, or going to the bathroom immediately after a meal could be a sign that your child is purging. "Vomiting is a way to purge," says Feilner. "But you also need to be aware of other forms of purging. Is there any evidence of laxative use or diuretics?"
Rigidity in exercise behaviors. There is healthy working out and disordered working out. If a child is prevented from working out, does it cause them a disproportionate level of distress? "Most people would be inconvenienced if they couldn't do their normal workout routine, but they would get on with their day," says Feilner. "Somebody with an eating disorder has so much anxiety -- they're using exercise to alleviate their guilt around food -- that they'll become very agitated if they can't exercise."
Changes is style of dress. "You see this go both ways," says Feilner. "Some kids might start wearing more revealing clothes, showing off what they have accomplished, and other kids may start wearing really baggy clothes to hide weight loss."
Negative evaluations. You might hear your child talking more about their bodies, making comments about being fat or giving a generally negative evaluation of their appearance.
Obsession with health. It's important to mention that disordered eating doesn't always look like a disorder. An emphasis on healthy eating can also lead to an increased preoccupation with food. "It almost is socially acceptable, because it looks like self-control or discipline, when in reality it might be making food increase in importance until their rules surrounding food and general preoccupation begin dominating their lives," says Feilner.
Increased involvement in food purchasing decisions. "Some kids will insist on going to the grocery store or going over the food labels," says Feilner. "They want to exert some control over what is bought and consumed."
So what are some things a parent can do when they come across these behaviors? Communication, seeking support and being a good role model are key to responding to your child's unhealthy eating behaviors:Response tactics
Don't take a heavy handed approach. Eating disorders are about more than food, emphasizes Feilner. "Don't take a heavy handed approach and say, 'you're going to eat this.' A more effective approach is expressing your concern," she says.Show concern.
"Don't interpret their behavior for them," says Feilner. "Mirror back their behavior by saying, for example, 'I notice you're going to the bathroom a lot after meals and I'm concerned that maybe you're struggling and I'm wondering if something is going on. Why do you think you're going to the bathroom so much?' or 'I notice that you're losing weight and I'm worried about that.' Express your concern in a way that invites conversation rather than says, 'you're doing this, therefore you have an eating disorder and you’re going to eat.'"
Seek outside support. If you have evidence that your child is exhibiting disordered eating, seek outside support from a medical doctor who can assess your child; a dietician who can give some information about healthy meals and listen for some of the behaviors that can be problematic; and a therapist to discuss the underlying issues. "Ideally, you want people who already work together and can function as a team, but at the very least, seek people who are willing to communicate with each other. It's really important to have a cohesive group of people who can support the kid and the family," says Feilner.
Watch your body judgments. Parents can impact on their children with their behaviors and attitude. Be mindful of your body attitudes, try to cut down on talk about weight and physical imperfections, and avoid assigning judgments to people based on their weight. "We see a lot of kids whose parents make negative comments about people who are overweight," says Feilner. "Some kids internalize the fear that they may become a person who is rejected because of how they look."
Consider food attitudes. Assigning values to food, even simple labels like "good" and "bad" can inform disordered behaviors. This also extends to attitudes about people -- judging people based on their behavior with their food as "good" or "bad" can impact a child’s perception of consumption and later inform disordered eating.
Beware your exercise habits. As a parent, you should model that exercise is healthy, but be careful not to show that it is connected to your ability to function. "One of the tells that exercise is becoming a problem is when a person can't be without it for a day," says Feilner. "If there is a disruption in a parent's exercise routine are they distressed and upset? Showing your kids how to be flexible is important."
Careful with compliments. Limit the amount of compliments that are appearance-based. "You look thin." "You're very fit." "I was that small when I was your age." These body-focused comments are intended as compliments, but they shift an unnecessary amount of pressure on your child to maintain a physical ideal.
Don't assume. Eating disorders don’t just affect women. As mentioned above, there are at least one million men who suffer from disordered eating in the U.S. alone. Just because your child is a boy, or of normal weight, or even fit, does not mean they are immune to developing an eating disorder.
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