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Eating Disorders

Eating disorders are complex and typically develop as a result of genetic, psychological, social and/or environmental factors. They often begin with a well-intended attempt to “get healthy” or “eat healthier” but may look different for each child and teenager. According to the National Association of Anorexia Nervosa and Associated Disorders, up to 30 million Americans have an eating disorder at some point in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder or another eating disorder not specified. Furthermore it’s believed many cases go undiagnosed because those suffering hide their behavior. While eating disorders are very serious and potentially life threatening, early diagnosis and intervention, combined with family-involved treatment, greatly improves the chance for long-term recovery.

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Our Experts

Julie Lesser, MD

Julie Lesser, MD, is the Medical Director for the Center for the Treatment of Eating Disorders at Children’s Minnesota. She is a child, adolescent and adult psychiatrist and is the only provider in Minnesota certified in Family Based Therapy. She has a special interest in working with younger children with atypical eating disorders.

A photo of Dr. Beth Brandenburg.

Beth Brandenburg, MD, is the Associate Medical Director for the Center for the Treatment of Eating Disorders at Children’s Minnesota. She has extensive training in Cognitive Behavioral Therapy Enhanced for Eating Disorders and Family based Therapy, as well as a special interest in treating eating disorders in athletes.

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Your Eating Disorders Questions Answered

Why do children and teens develop eating disorders?

Eating disorders are believed to result from and co-occur with a combination of biological, social and emotional factors such as depression, anxiety, anger and low self-esteem, though their exact cause is unknown. Eating disorders often begin with a focus on diet, on eating too much or too little, and can reflect a child or teen’s underlying effort to use control of food to deal with painful, overwhelming feelings.

Research is continuing on the role of genetics, in light of the relatively small percentage of dieters who go on to develop one of the major eating disorders. Studies are also being done on brain activity, in an effort to understand the trigger by which vulnerable people go from a focus on food and weight to serious illness.

What are the different types of eating disorders?

Some of the most common eating disorders include:

  • Anorexia nervosa: when individuals obsess about their weight and what they eat, holding a body weight well below normal for their height and age, often through starving or excessive exercise. Anorexia is the third most common chronic illness among adolescents according to the National Association of Anorexia Nervosa and Associated Disorders.
  • Bulimia nervosa: a cycle of binging and purging calories through vomiting, use of laxatives or compulsive exercise – all related to self-image.
  • Avoidant/restrictive food intake disorder (ARFID): this often begin in infancy or childhood and involves resistance to eating certain foods – picky eating – that can lead to nutritional problems. Unlike anorexia or bulimia, individuals with AFRID are not necessarily concerned about their weight or appearance.
  • Other specified feeding or eating disorder (OSFED): if an individual has an eating disorder that doesn’t fit the criteria of anorexia, bulimia, binge eating disorder or AFRID, he or she is diagnosed with OSFED.

What are eating disorder signs and symptoms parents should look for?

Eating disorder signs and symptoms can widely vary and may be subtle, especially as children and teens with a disorder may make special efforts to hide it. Some of the possible signs and symptoms for the most common eating disorders include:

  • Anorexia signs: obsessing about weight and diet; maintaining a weight well below what’s normal for their height and age; eating tiny portions, refusing to eat, not being hungry; avoiding fat, sugar and meat; feeling fat even though thin; exercising too much; depression and low self-esteem; withdrawing from family or friends; perfectionism; feeling “huge” after eating small portions; possibly purging.
  • Anorexia symptoms: unhealthy weight loss (more than 15 percent of body weight or much weight loss in a short span of time); stomachaches, headaches or dizziness; feeling cold a lot; constipation; loss of muscles; loss of menstrual periods; weakening of bones; below normal heart rate, blood pressure and body temperature.
  • Bulimia signs: binge eating followed by purging; unusual food choices or cravings; vomiting; laxative or diuretic use; disappearing after eating, often to the bathroom; excessive exercise to “get rid of” calories; shame or guilt after eating; feeling out of control about eating; eating secretly or hiding food; obsessing about appearance and body; depression and low self-esteem; and poor self-control in areas other than eating.
  • Bulimia symptoms: frequent changes in weight; stomach pain; muscle weakness and tiredness; constipation or diarrhea; loss of dental enamel; irregular menstrual periods; enlargement of cheeks and neck; changes in blood chemistry; sore throat and swollen glands.
  • ARFID, or “picky eating” signs: restricted eating, inability to eat certain foods (based on texture, smell or color), excluding entire food groups and avoiding situations with food. and even entire food groups).
  • AFRID symptoms may include: significant weight loss or inability to achieve expected weight gain; significant nutritional deficiency; dependence on oral nutritional supplements. These symptoms often show up among infants or younger children, though they can persist into adulthood.

How serious are eating disorders?

Eating disorders can cause serious medical and psychological complications. Extreme and frequent weight loss can lead to other health issues. Eating disorders may cause cardiac arrhythmia, cognitive impairment, osteoporosis and infertility, among other things. They often co-occur with depression and anxiety, and cause untold distress to families of patients.

In some extreme cases, eating disorders can cause death. They are among the most lethal of mental illnesses. One study of long-term data found that mortality rates were 4 percent for anorexia, 3.9 percent for bulimia and 5.2 percent for eating disorder not otherwise specified. They also found a high suicide rate in bulimia nervosa.

When do eating disorders start?

Eating disorders tend to be initially diagnosed in teens and young adults, and more commonly in girls than boys, though the gender gap isn’t as wide as many people think. They’re also diagnosed in adults and even children as young as six or seven. Because children and teens with eating disorders often hide their behavior, it’s believed many cases go undiagnosed.

Are families – mothers in particular – responsible for eating disorders?

No, but the myth that they are responsible is widespread. However, families play a crucial role in family-based therapy, a key strategy for treatment of eating disorders such as anorexia and bulimia. The supportive role families can play in recovery is still underappreciated in many circles.

Can eating disorders be treated?

Typically yes. Eating disorders can be treated to remission, though by one estimate from the Eating Disorders Coalitions found only one in 10 people with an eating disorder receive treatment. Studies show that patients do better when parents and family are involved in treatment and recovery. Children’s Minnesota is one of the only programs in the country offering both Family Based Therapy (FBT) and Cognitive Behavioral Therapy-Enhanced (CBT-E) evidence-based treatments for eating disorders. With the outpatient programs, patients continue to live at home and engage in familiar activities, including school life and normal dining routines. In addition, short-term hospitalization is offered for those who require immediate medical stabilization.

More Resources

  • What you may not know about eating disorders: the Children’s Center for the Treatment of Eating Disorders team clears up common misconceptions about eating disorders and shares signs that may indicate when a child or teen is suffering from an eating disorder.
  • Eating disorders program: learn more about Children’s Minnesota Center for the Treatment of Eating Disorders programs and services.