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Why eating disorders in teens are on the rise
Understanding the conditions, symptoms and signs of bulimia, anorexia and binge eating disorder
I recently described to a medical center colleague the program I run for children and adolescents who suffer from eating disorders. The participants suffer from conditions such as anorexia, bulimia and binge eating. When I said that our program admits patients between the ages of seven and 21 years old, it got quiet.
That age range is a tough fact about eating disorders to accept, among many.
Even before the pandemic, the number of patients we were treating was trending upwards. Once COVID-19 became real, our eating disorders program saw a four-fold increase in patients, in line with national and international trends.
For many, the pandemic created a sense of fear — fear of contracting Covid-19 or spreading it to loved ones. Children and teens were hit hard as the pandemic has torn at the fabric of our routines and relationships, from school and activity cancellations to a weakening or loss of friendships. For so many, uncertainty, lack of structure, lockdowns and loss worsened pre-existing anxiety and caused intense, new anxiety.
Treating eating disorders in teens and children
Eating disorders in teens and children have become more prevalent and more severe since we’ve grappled with COVID-19. Patients at the Eating Disorders Center at Cohen’s Children’s Medical Center are in transition, coming to us either on their way out of an inpatient or residential program, or we’re trying to prevent them from having to be admitted to one. But recently, many young patients have had to go straight to inpatient because of the severity of their symptoms and conditions.
Moving eating disorder treatment virtual
Though we’ve had to adapt from an in-person to an online format due to pandemic-related restrictions, we’ve done so seamlessly. We’ve built a schedule based on regular meals and snacks, individual and group therapy sessions and our participants’ school sessions. The remote format puts us right into patients’ homes — sometimes during meals — allowing us to strengthen parent participation and facilitate family therapy sessions. It gives us a chance to guide parents on how to refeed their children, for example, which occurs when an undernourished patient with anorexia increases their caloric intake after consuming little to no food for a prolonged period.
It’s important for patients and their families to understand the nature of eating disorders.
What is an eating disorder?
These conditions can be misunderstood, in part, because they’re often solely thought of as centering around food or body image. It’s easy, but inaccurate, to rely on the movie image of an eating disorder: a young, forlorn girl, wishing she looked different. People of every age, race, size, gender identity, sexual orientation and background can have eating disorders.
These conditions often begin with anxiety or difficulty regulating emotion. We work with patients to identify these feelings, understand them and manage them. Then we help them build healthy, balanced strategies for dealing with those feelings, rather than allowing the eating disorder to take center stage.
What’s important to understand about our children with eating disorders, is that they are experiencing significant emotional pain; the eating disorder is an attempt to communicate that pain.
Eating disorders can be deadly
For some patients with anorexia, for example, that pain can be deadly.
With an estimated mortality rate of around 10% anorexia nervosa, for example, can be “among the deadliest mental illnesses, second only to opioid overdose,” according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD).
Many young people with the disorder die from starvation and metabolic collapse, explains former National Institute of Mental Health Director Thomas Insel. Others, he writes, “die of suicide, which is much more common in women with anorexia than most other mental disorders.”
Risk factors for eating disorders
These facts make it imperative for parents and families to know the potential signs of eating disorders, particularly because of the interplay of three sets of risk factors:
- Biological – history of dieting; close relative with a mental health condition; Type 1 diabetes
- Psychological – perfectionism; history of anxiety disorder
- Social – weight stigma; historical trauma
Signs of an eating disorder
Signs of eating disorders in children and teens can include:
- A sudden preoccupation with weight or food, which can include wanting to eat “healthier”
- Refusing to eat certain foods
- Skipping meals
- New practices with food, like wanting to try vegetarian or vegan diets
- Frequent dieting
- Worrying about weight, which can include frequently checking body size in the mirror and weighing)
- Sudden, significant weight loss (which might be hidden by baggy clothes)
- Loss of menstrual period
- Dizziness
- Trouble concentrating
- Depressed mood
If parents think their child or teen is showing signs of an eating disorder, a good first step is to discuss it with a pediatrician who can make a thorough medical assessment. It’s also important to find mental health providers who specialize in identifying and treating eating disorders.
Though we’ve had to adapt our logistical approach to treating eating disorders in children and teens in light of the pandemic, it has forced us to innovate. It has allowed us to more effectively involve entire families in the treatment and recovery process, which we hope will help our young patients understand and build the skills they need to fully recover.
Lauren Salvatore, PsyD. is the clinical director of the Eating Disorder Center at Cohen Children’s Medical Center.
This article was updated on October 16, 2024.
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