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Could My Daughter Have an Eating Disorder?

How to tell when a “healthy lifestyle” crosses the line into illness.

Teenage girl looking in mirror
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Dear Doctor,

I think my 13-year-old daughter might have an eating disorder. About a year ago she decided to go on a diet, and within six months she had lost 15 pounds. But she didn’t stop there. She is getting more and more restrictive with her food, even though she is quite thin. How do I know if her dieting has become a problem?


“Worried Mom”

Dear Worried Mom:

It can be more difficult than one would think to tell if your child is developing an eating disorder, which is a psychological illness characterized by disturbances in eating behaviors. A disorder can initially be missed because it is disguised as healthy eating, and often parents—and even sometimes doctors—inadvertently encourage the disorder by praising teens for their “better” eating habits.

The biggest red flags for anorexia (one of the more common eating disorders) are restricting food and weight loss, but there are other signs to watch for. A child may become preoccupied with counting calories, or she might start exercising much more frequently and become obsessed with checking her Fitbit. These are disorders of secrecy, so sometimes a parent might find food in the garbage, or under their child’s bed. Kids will also wear baggy clothes and do whatever they can to conceal the fact that they’re losing weight. You should also be on the lookout for mood changes. Typically once a kid is malnourished, they're going to become very withdrawn and irritable.

You should sit down with your child and let them know you have concerns about the weight loss and want to help. If you suspect an eating disorder, the most important step is getting your child to see a doctor or therapist immediately, though you will likely be met with resistance. When the disorder is caught early, there is a greater chance of success with treatment in an outpatient program and the prognosis is better. An eating disorder can snowball pretty quickly, and in some cases, day programs, inpatient medical or psychiatric hospitalization, or residential programs are required. There is no room to sit on this issue, as eating disorders can lead to potentially life-threatening heart problems. What many people don’t know is that eating disorders have the highest mortality rates of any psychiatric illness. That’s partly because of cardiac complications, but there’s also a significant risk in terms of severe depression and suicide.

It’s not easy to have a child with an eating disorder. Your daughter may resent your involvement in what she deems a private matter, though the best evidence supports parental involvement at mealtime, including preparing, plating, and supervising all of your child’s meals and minimizing choices or negotiations at mealtime. To date, this approach, known as Family-Based Treatment, has the most evidence for success. You are going to have to tolerate a lot of distress and heartache. But remember, you are not trying to torture her. A child with an eating disorder is sick and you are helping them to get better.

It is important to remember your daughter isn’t doing this on purpose—eating disorders are, in fact, biological illnesses. Remember, you and your child did nothing wrong to cause this illness.

It can be very challenging to fight eating disorders alone. You might need to reach out to other family members for support. And of course, contact a professional for help.

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Published June 18th, 2019
A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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