Eating Disorders in Teens

Eating disorders may emerge during a person’s teenage years. Learn the types, signs, and symptoms of eating disorders in teenagers.

Being a teenager is a time of growth and transition, and includes both physical and emotional changes. This time period is also where disordered eating tends to emerge for the first time, and eating disorders among teens are relatively common compared to other age groups.

Eating disorders in teens can be distressing both for the teenager and those around them and can lead to future problems with mental and physical health if left untreated. It can be helpful to know the signs, symptoms, and treatments for eating disorders in teens.

Common Adolescent Eating Disorders

During the physical changes associated with puberty, changes to body shape and size can be confusing and distressing for some teens. A teenager might experience several types of eating disorders, each with unique symptoms and treatments available.

Typically, most eating disorders develop during adolescence. Common eating disorders can include a range of diagnosable disorders related to unhealthy relationships with food and appearance.

• Anorexia. Anorexia in teens includes key facts, signs, and symptoms. For example, signs of anorexia in teens can include avoidance or unwillingness to eat, and an extreme fear of weight gain or obesity. An anorexic teen may also experience significant weight loss and avoid situations where they do not have control over food.
• Bulimia. Bulimia nervosa in adolescence typically includes a cycle of binging on a large amount of food in a short amount of time and then compensating either through purging, fasting or over-exercising. Bulimia in teens may not be associated with significant weight loss, but still includes harmful and dangerous relationships with food and body image.
• Binge Eating Disorder. Binge eating disorder in teens involves periods of eating larger than normal amounts of food in a short time, with feelings of loss of control. Binge eating disorder can also be related to feelings of extreme guilt and self-criticism.
• Avoidant Restrictive Food Intake Disorder (ARFID). Avoidant Restrictive Food Intake Disorder, or ARFID, in teens is often present among those who were picky eaters as children. Essentially, ARFID includes avoiding or severely restricting food intake. Food restriction and avoidance are based on dislike or aversion to tastes or textures, fear of choking or gastrointestinal discomfort rather than a fear of weight gain.

Symptoms of Eating Disorders in Teens

The warning signs of eating disorders in teens can sometimes be hard to spot. Teenagers are often adjusting to physical changes and becoming more aware and mindful of appearance during middle and high school. Spotting the difference between a normal concern over appearance and a diagnosable psychological condition can be difficult.

Eating disorder symptoms are sometimes noticeable to others based on appearance or behaviors. Some of these symptoms might include:

• Sudden or significant weight loss
• Desire to exert extreme control over food, and distress if they are unable to
• Excuses or avoidance of situations involving food
• Very strict or regimented diet, sometimes excluding many major food groups (e.g., meat, dairy, grains)

Symptoms can vary significantly depending on the eating disorder, however, these signs can signal that a teen is suffering from an eating disorder and may require treatment.

Causes and Risk Factors of Teenage Eating Disorders

It can be hard to pinpoint exactly what causes eating disorders in teens, as they tend to be an interaction of genetics, life experiences, and personality. Genetics and personality can certainly put a teen at risk for an eating disorder, but whether or not a disorder develops usually depends on experiences.

During the teenage years, there is substantial pressure on physical appearance, and teens may be subject to social messaging about thinness or muscularity. Whether teens realize it or not, this pressure can contribute to disordered eating behaviors as a means to fit in or to be considered attractive or normal.

Some of the psychological or social risk factors for eating disorders in teens include:

• Perceived pressure to be thin
• Internalizing of the “thin-ideal,” a concept that the ideal body is thin and with low body fat
• Body dissatisfaction
• Dieting behaviors
• The presence of bullying
• Pressure from peers, who might encourage the “thin-ideal”

On top of the role of bullying and peer pressure on eating disorders, individual factors like personality or other mental health conditions can also increase the risk of disordered eating.

Early Consequences of Teen Eating Disorders

The consequences of eating disorders can be seen in physical health, mental health, and social well-being. Disordered eating can impact a teen’s ability to function normally and participate in all usual daily activities.

In terms of physical health, eating disorders can be linked with extreme weight loss, malnutrition, digestive problems or severe dehydration. The types of physical complications depend on the type of eating disorder as well as the severity.

Obsessions about food and body shape and size can be both time and energy-consuming. Someone experiencing an eating disorder might be socially withdrawn or seem secretive. They might also have a hard time keeping up with usual activities, like completing schoolwork or maintaining friendships. Eating disorders can be isolating, and teens who struggle with eating disorders may feel socially disconnected or alone.

It’s also common for eating disorders to co-occur with other mental health conditions. People with eating disorders might also experience symptoms of depression, anxiety or obsessive-compulsive disorders. In extreme cases, eating disorders may be associated with an increased risk of suicide.

Statistics on Teenage Eating Disorders

Although the statistics on how common eating disorders are in adolescence have shown an increase in recent decades, eating disorders are still relatively rare. The statistics vary by eating disorder, with prevalence estimates for anorexia at 0.3%, bulimia nervosa at 0.9% and 1.6% for binge eating disorder.

Importantly, disordered eating that may not meet all criteria for a clinical diagnosis (or Other Specified Feeding or Eating Disorders) can still be highly distressing and impairing for teens. The statistics for eating disorders in adolescence suggest that the burden of these disorders can be increased by co-occurring mental disorders, difficulty functioning in usual tasks, as well as risk of suicide.

Although eating disorders can significantly impact a teen and their loved ones, the majority do not receive treatment specific to their eating disorder. Health care and professional support can benefit a teen who has an eating disorder, but it is important to consider treatment strategies that address eating disorders specifically.

Treatment Options for Teens

Eating disorder treatment can look different for different people. Depending on the severity and type of eating disorder, patients may be treated as an inpatient in an eating disorder treatment center, or as an outpatient.

Treatment options for teens with eating disorders can include:

• Medical stabilization
• Nutrition rehab and counseling
• Family-based therapy
• Individual psychotherapy
• In-person or internet-delivered cognitive behavioral therapy
• Interpersonal therapy

These treatments can be used individually or in combination. Eating disorder recovery often includes not only the improvement of eating disorder symptoms but also the ability to return to regular functioning and activities.

Eating Disorder Prevention: Talking to Your Teen About Eating Disorders

Families play an important role in the prevention and treatment of eating disorders. Knowing the key risk factors for disordered eating can inform how to talk to a teenager about eating disorders.

There are a few strategies that can play a protective role in preventing disordered eating behaviors. These include:

• Dispelling common eating disorder myths
• Discouraging dieting behaviors
• Eating meals together as a family
• Avoiding weight talk, even if the comments are well-meaning
• Focusing on healthy eating behaviors
• Avoiding and discouraging teasing related to weight or body appearance
• Discuss body image and healthy behaviors in relation to promoting health, rather than managing weight

Eating disorder prevention can be encouraged by the family environment and how food and weight are discussed. Promoting healthy relationships with bodies and food — separate from weight and appearance — can encourage healthy eating behaviors.

When to Speak to a Doctor

Eating disorder behaviors represent unhealthy thought patterns and beliefs related to food, appearance, and self-worth. There can be many signs of eating disorders, ranging from avoidance of food to extreme binging, or a range of behaviors designed to compensate for food intake.

Signs that it may be time to speak with a doctor about eating disorders include:

• Rapid weight loss or gain in a short amount of time
• Defensive behavior about food or meals
• A teen admits to disordered eating
• Finding stashes of food
• Uncharacteristic clothing changes (e.g., people with anorexia may dress in layers despite warm temperatures)
• The teen’s friends or other loved ones show concern
• Avoidance of friends and family

These signs might be accompanied by weight loss, changes in mood or behavior, or a reduced ability to participate in or enjoy usual activities. Eating disorders can be complex, and it can be difficult to know how to talk to your doctor about an eating disorder. However, there are treatments available that can significantly improve health and quality of life for teens suffering from eating disorders.

If you, your teenager or someone you care about is suffering from a substance use disorder and an eating disorder, contact The Recovery Village today to discuss treatment options.

Editor – Camille Renzoni

Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more