Eating Disorders in Teens: What You Need to Know
Being a teenager has never been easy. But the stresses teens face today are arguably more intense than ever before. From unprecedented pressure around academic and athletic performance to navigating relationships both at school and online, today’s teens have a lot on their minds. One result of these modern stresses? A rise in teen eating disorders.
How common are eating disorders in teens?
A spike in teen eating disorders began during the COVID-19 pandemic, when emergency room visits for teen girls doubled [1]. From 2018 to 2022, eating disorder-related visits for all teens and kids increased by 107.4% [2], with visits for anorexia up 129.26%.
Over the same period, eating disorder symptoms in teens have grown increasingly complex. Teens seeking treatment today often show more severe psychiatric syndromes and multiple co-occurring conditions, including post-traumatic stress disorder (PTSD). And eating disorders often go hand-in-hand with other mood and anxiety disorders. Between 50% and 75% of individuals living with an eating disorder also report feelings of depression.
And yet, there is hope. Researchers are beginning to understand more about how eating disorders impact developing brains, and how a whole-person approach to care can bring relief to teens and their families.
Which eating disorders are most common in teens?
Anorexia, bulimia, binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID) rank as the four most common eating disorders in teens. When these conditions become extreme, they can lead to serious health problems and even death.
- Suicide is the number one cause of death in anorexia, bulimia and BED.
- Young people with anorexia between ages 15 and 24 have a 10 times greater risk of dying compared to other teens [3].
Which begs the question, what is causing the rise in eating disorders and mental health concerns in teens?
What causes eating disorders in teens?
Eating disorders are complex, and there is seldom a single cause. Often there is an interplay of multiple factors, including biological, psychological, sociocultural and environmental.
Specifically, genetics and hormone changes can play a role. Trauma is also a common contributing factor. And dieting and other forms of disordered eating are often slippery slopes that can quickly lead to an eating disorder.
“It seems one of the critical factors contributing to the onset of an eating disorder is a period of malnutrition,” explains Elizabeth Wassenaar, MS, MD, CEDS-S, DFAPA, regional medical director at Eating Recovery Center (ERC). “Malnutrition can result from intentional dieting or unintentional food restriction related to stress or anxiety, or being really busy and forgetting to eat lunch, or not having access to food.”
Regardless of what is causing or contributing to your child’s eating disorder, recovery is possible with the right support.
How eating disorders affect the teen brain
Teens who restrict their food intake severely, by reducing calories or macros or eliminating foods or entire food groups, may show signs of malnutrition and starvation.
Malnutrition and starvation profoundly affect the brain, both structurally and functionally – which can be especially harmful for teens because their brains are still developing and maturing. For this reason, teens with restrictive eating disorders may be quite limited in their cognitive functioning or ability to apply logic.
Some of the impacts of starvation on the teen brain include:
- Psychosis: This can include severe body image distortion, hallucinations or delusions.
- Obsessive fears: This includes fears teens get focused and stuck on, including insistent perceptions about eating and weight.
- Phobias: Teens may grow more anxious and fearful as they approach their “phobic threshold,” the point at which further weight gain creates intense fear.
- Paranoia: This can include a general distrust or fear of being “tricked” into gaining weight and getting well.
- Entrapment: This is often expressed as a perceived inability to change even if teens say they want to change.
In cases where a teen is experiencing malnutrition or starvation, nutritional rehabilitation can help. With proper nutrition in eating disorder treatment, the teen brain can get to a place in which therapy and behavior change strategies are effective. In order to get to this place, weight restoration is often an integral part of eating disorder treatment for teens with restrictive eating disorders. But how do you encourage a teen to get the care they need?
“The dialogue with patients, families and providers must shift from ‘weight gain’ to ‘brain rescue,’” explains Ovidio Bermudez, MD, FAAP, FSAHM, FAED, F.iaedp, CEDS (he/his/him), chief clinical education officer at ERC.
The good news is that with prompt and effective eating disorder treatment, the negative effects of starvation on the brain are reversible.
Trauma, PTSD and eating disorders in teens
As we mentioned earlier, there is also a strong link between trauma and eating disorders.
An estimated 14-43% of children and teens have experienced at least one trauma. Some teens may experience emotions after a trauma that are so overwhelming or distressing that they start restricting, bingeing and/or purging to suppress them.
But how do you know if a young person is struggling after a trauma? Look for these PTSD symptoms, which can start in the weeks, months or years following a trauma:
- A history of trauma (e.g., sexual assault, childhood abuse, witnessing violence)
- Intrusive, unwanted images of the trauma
- Flashbacks or nightmares related to the trauma
- Avoidance of people, places or reminders of the trauma
- Mood changes or changes in thought patterns
- Greater reactivity following the event (e.g., feeling easily startled)
How to talk to a teen about trauma
Parents who suspect that trauma may play a role in their teen’s eating disorder can set aside time to have an open and honest conversation. Below are some ways to approach a sensitive topic like this.
- Respond quickly and thoughtfully. Let your teen know that you are available to them when they are ready. Do not push them to talk. Instead, make it clear that you are there to support them and can handle whatever they are feeling.
- Emphasize stability through normalized routines. This can include day-to-day activities at home and at school, along with spending time with friends and community to avoid isolation.
- Create a sense of control or personal agency. Help your teen identify areas where they have choices about their lives. This can include making decisions about their self-care through joyful movement, hobbies and supportive relationships.
- Help your teen find a therapist. In therapy, they can talk through their trauma(s) and learn new skills to strengthen their ability to cope each day.
One of the hallmark symptoms of PTSD is a strong desire to avoid thinking or talking about past trauma. If your child is unable to talk with you about their feelings, we strongly encourage you to speak to a professional who may be able to help them recover.
Eating disorder treatment for teens
Teens with extreme eating disorders often get caught in the cycle of crisis care. The first crisis usually leads to an ER visit, followed by a short stay in an inpatient eating disorder treatment center, and then a return to outpatient care.
“Without sufficient support, containment and intervention in an outpatient setting, teens’ symptoms may intensify, leading to additional crisis episodes,” says Deborah M. Michel, PhD, CEDS-S, FAED (she/her/hers), national clinical director of virtual care at ERC.
To break the cycle of crisis care, parents can look for treatment options in-between outpatient services and crisis interventions. ERC is one of the few providers nationally offering evidence-based, intensive eating disorder therapy programs tailored to meet your child’s unique needs. ERC eating disorder treatment programs for teens include:
- Inpatient
- Residential
- Partial hospitalization program (PHP)
- In-person intensive outpatient program (IOP)
- Virtual intensive outpatient program (virtual IOP)
Within each of these programs, our expert care team will address all the issues your child is facing: psychiatric, medical, psychological, nutritional and social.
“The same behavior change achieved in just eight weeks of intensive, multidisciplinary treatment might take years to deliver across weekly outpatient appointments,” Dr. Michel says. “Given the mental health challenges facing our kids today — specifically the startling increase in suicide planning, attempts and deaths — families can’t afford to wait and hope for the best.”
Learn more about eating disorder treatment here.
Start the conversation today
ERC offers a unique continuum of care model so your child will get the exact support they need from an expert team that cares. If you have a feeling your child needs more support, reach out today to start the conversation. It only takes one call to get started.
Related Resources
Sources
- Radhakrishnan, L., Leeb, R.T., Bitsko, R.H., et al. (2022). Pediatric emergency department visits associated with mental health conditions before and during the COVID-19 pandemic – United States, January 2019-January 2022. MMWR Morbidity and Mortality Weekly Report, 71, 319-324. DOI: http://dx.doi.org/10.15585/mmwr.mm7108e2.
- Pastore, M., Indrio, F., Bali, D., Vural, M., Giardino, I., & Pettoello-Mantovani, M. (2023). Alarming increase of eating disorders in children and adolescents. The Journal of Pediatrics, 263, 113733. doi: 10.1016/j.jpeds.2023.113733.
- Smith, A., Zuromski, K.L., & Dodd, D.R. (2018). Eating disorders and suicidality: What we know, what we don’t know, and suggestions for future research. Current Opinion in Psychology, 22, 63-67. https://doi.org/10.1016/j.copsyc.2017.08.023.
