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Ask the Expert: How to spot the signs of an eating disorder

Young girl on scale - ask the expert: how to spot the signs of an eating disorderAn eating disorder is an extreme form of food and weight preoccupation. Unfortunately today we are seeing people being diagnosed at younger ages than ever before. Since the 1950s, the rates of both Anorexia Nervosa and Bulimia Nervosa in children and adolescents have been on a steady rise. Though anorexia is most common in girls 15 to 19, a 2010 report from the American Academy of Pediatrics noted that hospitalizations of children 12 and under rose 119 percent between 1999 and 2006.

A study in Southern Ontario showed that 30 percent of girls between ages 10 and 14 had dieted to try to lose weight, even though most of the sample fell within a healthy weight. Another B.C. study of almost 30,000 adolescents found that by 18, 80 percent of girls who were normal weight and height, still reported wanting to weigh less.

These statistics are of particular concern because research has shown that dieters are five times more likely to develop an eating disorder and “severe dieters” are 18 times more likely.

Ontario statistics reveal that one in four adolescent girls (13 to 18 years) have at least one symptom of an eating disorder and a significant amount of both boys (25 percent) and girls (30 percent) as young as 10 to 14 years, are dieting to lose weight, despite being within a healthy weight range.

Here are some of the symptoms of eating disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is used to help health professionals understand how each condition develops and progresses:

Anorexia Nervosa

  • Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health
  • Intense fear of gaining weight or becoming fat, even though underweight
  • Social withdrawal or avoidance of activities
  • Denial of hunger or frequent explanation of food abstinence
  • Development of food rituals
  • Increased irritability or drastic shifts in mood

Bulimia Nervosa

  • Recurrent episodes of eating large amounts of food within a two-hour period
  • Sense of lack of control over eating
  • Recurrent purging to prevent weight gain
  • Bingeing and purging both occur, on average, at least once a week for three months.
  • Preoccupation with food, calories, weight
  • Excessive, compulsive exercise despite fatigue, illness, or injury
  • Secretive eating and/or missing food
  • Frequent trips to the bathroom after meals
  • Chronic expression of guilt or shame
  • Rapid fluctuations in weight
  • Persistent sore throat and/or heartburn
  • Tooth discoloration or decay

Binge Eating Disorder

  • Eating, in a two-hour period for example, an amount of food that is larger than most people would eat, at least once a week for three months
  • A sense of lack of control over eating (for example, a feeling that one cannot stop eating or control what or how much one is eating).
  • The binge-eating episodes are associated with three or more of the following:
    • Eating much more rapidly than normal
    • Eating until feeling uncomfortably full
    • Eating large amounts of food when not feeling physically hungry
  • Binge eating may, but not always, lead to being overweight or obese.

How to talk to your child about eating disorders

If your child is struggling with any one of the aforementioned symptoms, sometimes known collectively as disordered eating, here are some tips for coping from Sheena’s Place, an eating disorder support and resource centre for people 17 and over:

  • Take a deep breath and be patient.
  • Check out the Sheena’s Place website at Call us.
  • Educate yourself about eating disorders to better understand what your child may be going through.
  • Write down your questions.
  • Remember, as a parent you are the expert on your child. Don’t try to become an expert on eating disorders. Leave that to the trained professionals who are there to support you. Be a mother, father, sister or brother.
  • Understand that an eating disorder is not a choice or an issue of vanity and try to avoid laying blame.
  • Try to view the eating disorder as a coping strategy for dealing with emotions and conflict.
  • Be trustworthy and (age-appropriately) honest. Let your child know that he or she is safe with you and that you will be there to listen.
  • Do not make promises you cannot keep.
  • Recognize that if you are emotionally and/or physically exhausted, you will not be able to provide much support.
  • Acknowledge and act upon life-threatening situations. Call an ambulance or go to the emergency room if required.
  • Reinforce the positive qualities of your child and do not focus all attention on the eating disorder.
  • Focus on issues of general health and wellbeing, not appearance and weight, by emphasizing and complimenting other characteristics.
  • Expect to be faced with denial of the problem.
  • Try to be optimistic and have hope.
  • Suspend your own dieting behaviours (eat regular meals, avoid buying diet products, stop weighing yourself).

Try to avoid

  • Discussing food and weight.
  • Talking about how other people look.
  • Engaging in power struggles related to eating and food.
  • Placing blame for the eating disorder on yourself, family members, or the child struggling with one.
  • Teasing/bullying, especially concerning appearance and body shape.
  • Being ashamed of your child’s eating disorder.
  • Putting pressure or deadlines on your child for change/treatment.
  • Expecting a fast solution or complete recovery.

Deborah S. Berlin-Romalis, BSW, MSW, RSW, is an Adjunct Lecturer in the Faculty of Social Work at the University of Toronto and Executive Director at Sheena’s Place (

Originally published in ParentsCanada magazine, February/March 2016.

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