FROM NYU CHILD STUDY CENTER: ASK THE EXPERT
Eating Disorders
By Glenn Hirsch, M.D.
What are eating disorders?
Janine, 15-years-old, wanted to lose weight before the junior prom so she would look as good as the most popular girls in the school. She drank just coffee for breakfast, had a hard-boiled egg and apple for lunch, and then ate lettuce and cottage cheese for dinner. This system worked so well that she continued it all summer until she fainted while walking her dog one night.
When 17-year-old Betsey found out how her best friend kept eating bags of chips and two bowls of ice cream every day for lunch without gaining weight, she decided she would also try throwing up after she ate.
Janine and Betsey each have an eating disorder. Janine has Anorexia Nervosa and Betsey has Bulimia Nervosa. Eating disorders affect up to 5-10 million girls and young women and up to one million boys and young men. Concerns about eating and food dissatisfaction are popping up at an early age, as young as age six.
Signs and symptoms of eating disorders
The overall term, Eating Disorders, refers to several disorders, including Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. The common feature of all these disorders is disordered eating behavior, often accompanied by a distorted body image, a compulsion to exercise, restriction of food, vomiting after meals, and a focus, but little pleasure in food.
Anorexia Nervosa (someone like Janine) is diagnosed when a youngster’s food restriction causes weight to drop 15% below what is normal.
Bulimia Nervosa (someone like Betsey) is characterized by attempts to binge and/or get rid of food already eaten.
Binge Eating Disorder is also characterized by attempts to binge, but is not necessarily followed by attempts to get rid of food already eaten. Most recently neuro-chemicals have been implicated in the cause of eating disorders. A combination of medication, cognitive behavior, individual and family therapy are the most common forms of treatment.
Parents ask questions
How do we know if a child has an eating disorder?
You may not realize it right away. It is common for youngsters to hide their weight loss by wearing loose fitting clothes or by engaging in other behaviors to disguise the disorder. Be concerned if your child complains of being fat, avoids meals, or makes excuses for a marked change in weight.
My child spends a lot of time in the bathroom after meals. Should I worry?
Certainly many youngsters, especially teens, seem to spend a lot of time in the bathroom analyzing and adjusting their appearance. However, the child with an eating disorder may go to the bathroom after meals to purge (a term used to describe vomiting) or take laxatives in order to get rid of food.
Should I force my child to eat?
Forcing anyone to do anything is never advisable. An eating disorder is a serious problem, but pressuring a child to eat will not change her behavior, her thinking or her self-image. Forcing her can lead to increased tension and guilt, stresses that can exacerbate the problem. It is especially important to avoid power struggles and drama around food.
Isn’t there a medication that can help?
There is no quick fix for a person with an eating disorder. There is evidence to suggest that medication can be enormously helpful, due to a possible neuro-chemical imbalance in the brain or for the medication that sometimes accompanies depression.
Why do eating disorders usually affect teenagers?
Adolescence, in addition to the individual family and psychological issues, presents a special stress. Entering adolescence is a more complex rite of passage than it has previously been. Adolescents have to accustom themselves to changes in their bodies as well as life changes, such as entering high school or college, beginning sexual relationships and psychologically separating from their parents.
How can I parent a child with an eating disorder?
Patience is critical. Although it is frightening to see a child physically compromised, intervention should be carefully planned, at times under medical supervision. Treatment can involve both the child and family over a period of time. Even when a child’s weight returns to normal, it takes time for new, healthier behaviors and a realistic self-image to be established. #
