Are you worried that your teenager might have an eating disorder?

Eating disorders are rare, but very serious, psychiatric illnesses. Any family that has had a young person with an eating disorder knows how deeply distressing and challenging it can be, and that the earlier it is picked up the better.

So what are eating disorders?

A young person with an eating disorder does not just worry about their body image or food; they are tormented by out of control thinking that drives their behaviour to control their weight, food and appearance. The thoughts that drive an eating disorder become very abnormal and go beyond the usual ways to lose weight and look good.

As one young patient describes it, “Sometimes I feel that there are two voices in my head, the louder one telling me that if I eat that, I am weak and ugly, I will get fat, that is soooo many calories. And then there is a small voice that says that I should listen to my parents – a small breakfast is OK since I have so much on at school and sport afterwards. But the loud voice keeps drowning out the other…”

It is important to note that a person does not have to be underweight to suffer from an eating disorder. Both anorexia nervosa and bulimia nervosa are eating disorders, but in this blog we are talking about anorexia nervosa.

How common is anorexia nervosa?

After asthma and obesity, anorexia nervosa is actually the third most common illness in adolescent girls, occurring in about one per cent of teenage girls. Anorexia also occurs in boys and men, and about 10 per cent of all people with an eating disorder are male.

Anorexia occurs across all ages, cultures and in all types of families. Tragically, amongst mental illnesses, anorexia has the highest rate of death – up to 20 per cent – which is why I am talking about it in this fortnight’s blog.

But what causes an eating disorder?

Unfortunately, we don’t exactly know what causes eating disorders, apart from understanding that genes and the environment both contribute. There are a number of factors that may make young people more vulnerable to developing an eating disorder, such as:

• being an adolescent female
• having a perfectionistic personality
• being a high achiever
• having obsessive thinking
• having ineffective coping strategies
• having a family history of an eating disorder
• having depression or anxiety.

What are the signs of an eating disorder, and what should I be looking for?

If you have noticed some worrying behaviors in your teenager around food and exercise, here are some signs that may mean your teen has an eating disorder:

• They impose strict rules on themselves around food consumption, or in avoiding certain food groups.
• They frequently skip meals.
• There are unusual food behaviours, such as an obsessive interest in food and/or cooking
• They are increasingly consumed with their body shape, weight and appearance.
• They have an intense fear of gaining weight.
• They excessively or compulsively exercise, perhaps doing sit-ups or push-ups in their room, using a treadmill or doing other strenuous exercise after meals.
• You notice that they have lost weight; or you might notice that they are frequently weighing themselves.
• Your daughter might have a loss of or delay in her menstruation.

What is the treatment for anorexia?

It is important to get treatment early if your teen has anorexia to prevent worsening medical problems and the need to go to hospital. Early intervention is also linked to a better outcome. Therefore, it is important to raise your concerns with your teenager early and to try to take charge of their eating (provide regular meals and snacks, supervise their mealtimes) and limit the amount they exercise. If there is a problem, it will become more evident with efforts to contain these behaviors, and then you can seek specialist help.

Family Based Treatment (FBT), also known as the ‘Maudsley model’ (named after the hospital in London where the treatment was first developed), is the treatment with the strongest evidence base as having the most success in treating adolescents with anorexia.

FBT is an outpatient treatment that empowers parents and encourages them to be proactive and take charge of their adolescent’s eating and behavior. The focus is primarily on returning the young person to their healthy weight and previous physical health. The family works with a trained therapist and a specialist team to present a united front in their fight against anorexia. FBT proceeds through three phases, and treatment is usually completed in six to 12 months. The young person is also medically monitored by doctors and nurses throughout FBT to ensure that they are safe to continue their treatment as an outpatient.

Many parents are often told ‘don’t make food an issue’ – but if a young person has anorexia and you do not make food the focus, or issue, this will lead to further weight loss and delays in treatment. Most young people with anorexia do not want to seek help; this is part of the disease. It is up to the parents or carers to seek help for the young person and ensure treatment is established.

If you are worried, do continue to seek help or speak to a specialist eating disorder service for advice and consultation. The first step is for the young person to have a medical assessment by a GP. Referral to a specialist eating disorder service should then be considered if there is continued weight loss, clear eating disordered behaviours or worsening in their medical condition.

Remember: Early referral is the key to preventing hospitalisation and worsening of symptoms.

Where can I go to find help?

The Royal Children’s Hospital has an outstanding eating disorders program. A multi-disciplinary team provides assessment, consultation and treatment services to young people with a variety of eating concerns, living in the western metropolitan region of Melbourne.

Public services for eating disorders are organised regionally, so the services you can access depend on where you live. These regional services include: The Royal Children’s Hospital, Austin Health, Monash Medical Centre and Box Hill Hospital.

Other useful resources

Websites:

www.eatingdisorders.org.au – Eating Disorders Victoria (EDV) provides a comprehensive support and information service on all aspects of eating disorders.
www.maudsleyparents.org – A website that explains Family Based Treatment (FBT).
www.nedc.com.au – National Eating Disorders Collaboration: eating disorders in Australia.
www.feast-ed.org – International organisation for caregivers of people with eating disorders. Serves families by providing information and mutual support.

Books:

Help Your Teenager Beat an Eating Disorder, by James Lock and Daniel le Grange. (Available from the Kids Health Info Bookshop at RCH.)
Anorexia and Other Eating Disorders – How to help your child eat well and be well, by Eva Musby.