Warning Signs/ Symptoms

Body Image

Body image is defined as one’s thoughts, perceptions, and attitudes about their physical appearance. A child with positive body image is able to have a realistic view of their body. They feel comfortable about their body, and are accepting of their natural shape and size, realizing that one's physical appearance is unrelated to one's character and value as a person. A child with negative body image, on the other hand, has a distorted perception of their body. They often have feelings of shame, anxiety, and self-consciousness about their appearance and routinely compare their bodies to others. Research reveals girls as young as 6 start to express concerns about their own weight or shape. 

Emotional and Behavioral Signs

• In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns
• Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
• Appears uncomfortable eating around others
• Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
• Skipping meals or taking small portions of food at regular meals
• Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
• Withdrawal from usual friends and activities
• Frequent dieting
• Extreme concern with body size and shape 
• Frequent checking in the mirror for perceived flaws in appearance
• Extreme mood swings

Physical Signs

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
• Dizziness, especially upon standing
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dry skin and hair, and brittle nails
• Swelling around area of salivary glands
• Fine hair on body (lanugo)
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin (in context of eating large amounts of carrots)
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning

Source Credit: National Eating Disorder Association, NEDA

Prevention

Prevention Tips for Parents

Eating disorders develop differently for each person affected, and there is not a single set of rules that parents can follow to guarantee prevention of an eating disorder. However, communicating with youth about food, their bodies and their perceptions of their bodies is important and may provide a foundation of understanding that can contribute to children recognizing thoughts or feelings that can lead to behaviors related to eating disorders.

Do:

• Examine your own beliefs and feelings about body image and weight and consider how your attitudes, comments or nonverbal responses are being communicated to your children.
• Encourage healthy eating and exercise. 
• Allow your child to determine when she is full.
• Talk about different body types and how they can all be accepted and appreciated.
• Discuss the dangers of dieting.
• Show your children you love them for who they are, not because of how they look. 

Do not:

• Label foods as "good" or "bad." 
• Use food as a reward or punishment.
• Diet or encourage your child to diet. 
• Comment on weight or body types: yours, your child's or anyone else's. 
• Let anyone ridicule, blame or tease your child. 

Tips to Share with Your Children

• No food is "good" or "bad." Everything from pizza to carrots to peanut butter and candy can be part of a healthy menu. 
• Eat when you are hungry. Stop when you are full. Try to do this most of the time.
• Don't eat because you are bored, sad or angry. Find something interesting to do or someone to talk with instead. 
• Stay fit by exercising. You can take up a sport or join a class like dance or karate, but you don't have to. Playing with friends can be just as energizing and fun! 
• All bodies are different. People of all shapes and sizes can eat well and be healthy. 
• Teasing hurts. Don't take part in it, especially if it is about a person's body, weight or size. 
• Remember that fat does not equal bad and thin does not equal good. 
• If you're unhappy with your body or weight, talk to an adult. Parents, school nurses and teachers can often give you valuable information and support. 

Source Credit: The Renfrew Center

Book Resources for Eating Disorders

Livermore Learns Presents: Eating Disorders in Youth

Types of Eating Disorders

Anorexia

Young people with anorexia may take extreme measures to avoid eating and control the quantity and quality of the foods they do eat. They may become abnormally thin, or thin for their body, and still talk about feeling fat. They typically continue to diet even at very unhealthy weights because they have a distorted image of their body. It is also important to note that young people with anorexia often restrict not only food, but relationships, social activities and pleasurable experiences.

Behavioral signs of anorexia may include:

• A distorted view of one’s body weight, size or shape; sees self as too fat, even when very underweight
• Hiding or discarding food
• Obsessively counting calories and/or grams of fat in the diet
• Denial of feelings of hunger
• Developing rituals around preparing food and eating
• Compulsive or excessive exercise
• Social withdrawal
• Pronounced emotional changes, such as irritability, depression and anxiety

Physical signs of anorexia may include:

• rapid or excessive weight loss
• feeling cold, tired and weak
• thinning hair
• absence of menstrual cycles in females 
• dizziness or fainting

Child Mind Institute - "What Is Atypical Anorexia Nervosa?"

Bulimia

Young people with bulimia nervosa typically ‘binge and purge’ by engaging in uncontrollable episodes of overeating (bingeing) usually followed by compensatory behavior such as: purging through vomiting, use of laxatives, enemas, fasting, or excessive exercise. Eating binges may occur as often as several times a day but are most common in the evening and night hours. Those suffering from bulimia often have a preoccupation with body weight and shape, as well as a distorted body image. They oftentimes go unnoticed due to the ability to maintain a normal body weight. 

ARTICLE- Child Mind Institute: What is Bulimia Nervosa?

Behavioral signs of bulimia may include:

• Eating unusually large amounts of food with no apparent change in weight
• Hiding food or discarded food containers and wrappers
• Excessive exercise or fasting
• Peculiar eating habits or rituals
• Frequent tips to the bathroom after meals
• Inappropriate use of laxatives, diuretics, or other cathartics
• Overachieving and impulsive behaviors
• Frequently clogged showers or toilets

Physical signs of bulimia may include:

• discolored teeth
• odor on the breath
• stomach pain
• calluses/scarring on the hands caused by self-inducing vomiting
• irregular or absent menstrual periods
• weakness or fatigue

Binge-Eating Disorder

Binge eating disorder is characterized by a sense of uncontrollable excessive eating, followed by feelings of shame and guilt. Unlike those with bulimia, however, young people with binge eating disorders typically do not compensate for their binges. It can disproportionately affect young people who are overweight. They may feel like they have no control over their behavior and eat in secret when they are not hungry.

Behavioral signs of binge-eating disorder may include:

• Eating unusually large amounts of food in a distinct period of time (within 2 hours)
• Eating rapidly
• Hiding food or discarded food containers and wrappers
• Eating in secret because of feeling embarassed by how much they are eating
• Eating when stressed or when feeling uncertain how to cope
• Feeling that they are unable to control how much they eat and disgusted with themselves afterwards
• Experimentation with different diets

Physical signs of binge-eating disorder may include:

• long-term including weight gain (often leading to obesity)
• high blood pressure
• diabetes
• irregular menstrual cycle
• skin disorders
• heart disease

Source Credit: The Healthy Teen Project

Child Mind Institute Information on Binge Eating in Children and Teens

Diagnosis/ Treatment

Eating disorder treatment depends on the particular disorder and your symptoms. It typically includes a combination of psychological therapy (psychotherapy), nutrition education, medical monitoring and sometimes medications. Treating eating disorders involves not only tending to the psychology of the disorder, but also treating the physical ramifications of the disorder. Treatment often involves a combination of cognitive, behavioral and physical therapy. If you suspect your child may have an eating disorder, a good place to seek guidance is through your child's pediatrician. Once a diagnosis is given, an appropriate treatment plan can be developed. Depending on the severity of the diagnosis, a treatment team may be established to best meet the needs of your child. Treatment teams can include pediatricians, mental health professionals, dieticians, dentist and parents.. For young people still living at home, it is important that parents be actively involved in treatment.

Source Credit: the Mayo Clinic

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IMPORTANT!

If you are in need of further information, please contact your school.  For middle or high school students, contact your school's counseling office.  For elementary students, contact the school's main office.