Eating Difficulties


Eating Difficulties

It’s not unusual for teens to experiment with dieting, either as a way to lose weight or to be healthier, but diets can be more than just a phase – they can represent the onset of an eating disorder. Most diets start as a resolve to stop eating junk food, but over time other major food groups are cut out as well. Portion sizes become smaller and the variety of food that your teen is willing to eat becomes more limited as well.

Early intervention is critical in the treatment of eating disorders so if you’re concerned your child is showing early signs, seek the advice of a clinical psychologist. Red flags to look out for include:

  • A sudden interest in being “healthy”
  • Dieting
  • Skipping meals
  • Picky eating
  • A preference for eating alone
  • A change in diet (e.g.  to a vegetarian diet)
  • Visits to pro-anorexia websites
  • Disappearing into the bathroom after eating

Most teens with eating disorders will be reluctant to seek help and will often refuse to acknowledge that they have a problem with eating. If your instincts tell you otherwise, trust this and push for an assessment with a clinical psychologist. Regardless of whether your child meets full criteria for a diagnosable eating disorder, early intervention may help to prevent the onset of a full-blown eating disorder.

Click here for more information about how to help your teen build a positive body image and a healthy relationship with food.

Anorexia Nervosa

Anorexia Nervosa is a serious and potentially life threatening illness.Most people with Anorexia Nervosa will restrict both how much and the variety of food they’ll eat in a day. Going against Anorexia and eating banned or ‘unnecessary’ food causes intense anxiety and guilt, which can trigger self-induced vomiting, compulsive exercise, or resolutions to eat less at the next meal to make up for ‘excessive’ calories.

What Are The Symptoms Of Anorexia Nervosa?

The main symptoms of Anorexia Nervosa are:

  • An intense fear of gaining weight, or maintaining a weight within a healthy weight range
  • Deliberate attempts to restrict energy intake to control weight
  • Intense dissatisfaction with body shape and weight and/or disturbed body image (someone seeing themselves as fat when they’re not)
  • Denying the seriousness of a low body weight
  • An over-emphasis on the importance of body shape and weight

What Causes Anorexia Nervosa?

Why someone develops Anorexia Nervosa will differ from person to person but the onset of Anorexia is nearly always preceded by a period of dieting. Some teens, will diet in attempt to lose weight and be ‘skinny’ wheres other teens will diet to feel more in control of their life.

Bulimia Nervosa

Bulimia Nervosa is a complex disorder with serious medical consequences. Triggers for binge eating vary from person to person but common triggers might include stress, low mood, loneliness, boredom, or dieting. Strict dieting can lead to intense hunger which can cause binge eating and breaking a food rule can also trigger a binge. After binge eating, people with Bulimia Nervosa usually feel distressed and frustrated. To try to cancel out binge calories, they may force themselves to vomit, take laxatives or diuretics, resolve to restrict their food intake the following day, or exercise.

What Are The Symptoms Of Bulimia Nervosa?

The main symptoms of Bulimia Nervosa are:

  • Frequent episodes of binge eating
  • Feeling out of control while binge eating
  • Binge eating in secret
  • Relying on binge eating and purging to manage distress
  • Compensating for binge eating with purging (e.g. vomiting, laxatives, diuretics), exercise, or dietary restriction
  • Avoiding “binge foods” to avoid binge eating
  • Over-emphasising the importance of body shape and weight

What Are The Warning Signs For Bulimia Nervosa?

Whereas teens with Anorexia Nervosa are usually underweight, teens with Bulimia Nervosa are usually within a normal weight range – though some people may be slightly under- or overweight. Because weight is normal and binge eating happens in secret, most parents are usually unaware that there is a problem. Signs to look out for include:

  • Secrecy around eating
  • A lack of control around eating
  • Eating unusually large amounts of food with no changes in weight
  • Disappearance of food
  • Alternating periods of eating larger amounts of food and periods of restriction
  • Going to the bathroom after eating
  • Smell of vomit on clothes
  • Packets of laxatives or diuretics

What Causes Bulimia Nervosa?

There is no single cause of Bulimia Nervosa and why someone develops Bulimia will vary from person to person, but factors that might contribute to someone developing Bulimia include a negative body image, strict dieting, low self-esteem, and a lack of skills for coping in a more adaptive way.

Binge Eating

Binge Eating disorder is a complex disorder with serious health consequences. It differs from Bulimia Nervosa in that teens with Binge Eating disorder don’t try to compensate for their binge eating by vomiting or through dietary restriction or exercise.

What Are The Symtoms Of Binge Eating Disorder?

The main symptoms of Binge Eating disorder are:

  • Recurrent binge eating
  • Feeling out of control while binge eating
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not physically hungry
  • Binge eating in secret due to embarrassment
  • Relying on binge eating to cope with negative emotions
  • Eating rapidly
  • Feeling disgusting, depressed, or guilty after binge eating

What Causes Binge Eating?

Binge eating can be triggered by strict dieting, but it might also develop as a way to cope with low mood, loneliness, low self-esteem, or boredom.

Other Eating Difficulties

Some teens might engage in disordered eating like skipping meals, restrictive dieting, or compulsive eating, but have fewer symptoms or symptoms that are less severe than those experienced by teens with Anorexia Nervosa, Bulimia Nervosa, or Binge Eating disorder.

When Should I Seek Help For My Teens Eating?

Regardless of whether your teen meets full criteria for an eating disorder, if they show some signs and symptoms of an eating disorder, and if you suspect your child is developing a negative body image and a negative relationship with food it may be worthwhile seeking advice from a clinical psychologist. These symptoms may turn out to be nothing, but they may also be the start of an eating disorder and if this is the case, seeking help early is critical.

What Are The Treatment Options For Teens With Eating Disorders?

How your child’s eating disorder is treated will depend on the type and severity of their eating disorder, as well as their age. There are two main treatment approaches: Maudsley Family Based Treatment and Cognitive Behavioural Therapy.

What is The Maudsley Approach?

Maudsley Family Based Treatment is a treatment designed specifically for adolescents living with Anorexia Nervosa. It is suitable for children and adolescents under the age of 19 and is currently the most effective treatment for Anorexia Nervosa in this age group.

The Maudsley model encourages families to separate their child from the Eating Disorder and aims to help parents to play an active and positive role in restoring their child to full health. The ultimate goals of Maudsley are to restore weight, transition control over eating back to the child, and encourage ‘anorexia free’ normal and age-appropriate development. These goals are achieved by parents taking full control of the Anorexia Nervosa on their child’s behalf.

What’s Involved In Maudsley Family Based Treatment?

The Maudsley model has three core phases of treatment:

Phase 1: Re-feeding
Because of the serious medical consequences of anorexia nervosa, the first phase of treatment of the Maudsley method focuses on weight restoration. Anorexia Nervosa creates anxiety at meal times which makes decisions around food impossible for a child suffering from Anorexia, so in this phase parents are charged with the task of taking full control over meals and snacks.

Phase 2: Negotiations for a New Pattern of Relationships
Once weight has been restored, treatment shifts to focus on giving your child more control over their food. While more under control, Anorexia is still likely to be present at this time so this transition of control happens gradually.

Phase 3: Adolescent Issues and Termination
Once your child is able to maintain a healthy weight on their own, treatment focuses on helping your child to develop their identity outside of Anorexia. Families are encouraged to return to their normal ‘pre-anorexia’ life.

What Is Cognitive Behavioural Therapy for Eating Disorders?

Cognitive Behavioural Therapy is the leading treatment for eating disorders in adults and it can also be adapted for use with teens. It aims to change the cognitive (e.g. over-evaluation of weight and shape, negative body image) and behavioural (e.g. dietary restriction, body checking) factors that maintain an eating disorder through goal setting.

There are three main phases of treatment:

Phase 1: The Behavioural Phase
The first phase of treatment focuses on developing a plan to stabilise eating and eliminate behavioural symptoms. Because making changes to eating can be distressing, tools and strategies for managing meal anxiety are also introduced.

Phase 2: The Cognitive Phase
Once progress has been made in terms of eating, treatment incorporates cognitive restructuring techniques. This involves identifying and challenging unhelpful (and usually inaccurate) patterns of thinking that perpetuate and strengthen the eating disorder. Other areas like body image and self-esteem are also covered in this phase of treatment.

Phase 3: Maintenance and Relapse Prevention
The final stage of CBT looks at strategies for maintaining progress and preventing future relapse. This may involve addressing areas that increase vulnerability for relapse like self-esteem or relationship problems.

Maudsley vs. CBT – Which Should I Choose?

While Maudsley Family Based Treatment is considered the most effective treatment for teens with anorexia nervosa, depending on the age of the teen and family dynamics it may not always be the most feasible treatment option. Where this is the case Cognitive Behavioural Therapy may be a treatment option for some teens, with adaptations for parent involvement (though to a lesser extent than is the case in the Maudsley approach). Few teens will have the ability to recover from their eating disorder independently and parent involvement is an important component of treatment.