Anorexia Nervosa, Bulimia and Binge Eating: The Warning Signs of an Eating Disorder

I am particularly pleased to have this article by Bonney Reed-Knight, PhD, a Clinical Psychologist at Emory University School of Medicine and Children’s Healthcare of Atlanta, not just because it's a wonderful help for parents who are concerned about the possibility that their child has an eating disorder, but also because Bonney was one of my patients as a teen and it's gratifying to now have her contributing as a respected colleague --Dr. Stan

Have you wondered if you would be able to recognize the signs of an eating disorder in your child? Anorexia nervosa (sometimes just called anorexia in the press), bulimia and binge eating have the potential for serious emotional and physical consequences. They can even be life-threatening.

They typically begin at 12-13 years old, though parents and doctors may not discover symptoms until years later. But you want to pick up the subtle signs that revolve around disordered attitudes, emotions, and behaviors in relation to food and body image, because patients who receive prompt, intensive treatment for eating disorders have the best chance for recovery.

Anorexia nervosa is characterized by (1) self-starvation resulting in weight loss or failure to gain weight so that the individual is significantly underweight, (2) fear of being fat or weight gain, (3) distorted thoughts in relation to body image.

Bulimia is another pattern of disordered eating characterized by (1) binge episodes in which the individual feels out of control and eats a large amount of food followed by self-induced vomiting or other behaviors to make up for the binge and (2) undue influence of weight on their self-esteem.

Binge eating disorder consists of episodes in which the individual feels out of control of eating and gorges, but these episodes are not followed by compensatory behaviors. Patients with binge eating disorder typically feel shameful regarding their eating and suffer health consequences of being overweight.

Recognizing the warning signs of eating disorders can help parents begin a conversation with their son or daughter if disordered eating is suspected. Warning signs may include:

  • Weight loss
  • Preoccupation with weight, body image, or specific body parts
  • Refusal to eat certain foods or entire categories of foods (e.g., “I don’t eat carbs because I want to be healthy).
  • Comments about body shape, feeling “fat”, or comparison to others
  • Avoidance of family meals or activities involving eating
  • Obsessive exercise rituals that occur rain or shine. For boys especially, this may include excessive weight lifting.
  • New food rituals (e.g., pushing food around on the plate, refusing to eat past 5 pm)
  • The patient may visit the bathroom immediately after meals to purge. Parents may also notice increased laxative use or the smell of vomit.
  • Purging may also result in teeth damage
  • Constantly chewing gum or drinking diet sodas
  • Wearing baggy clothes
  • Withdrawal from friends and previously enjoyed activities
  • Difficulties with concentration

If symptoms of disordered eating are suspected, concern should be expressed in a non-judgmental and open manner, such as by saying, “I’m worried about changes in your eating and body lately” cited by specific examples. These concerns can be expressed during a visit with your child’s pediatrician to explore best treatment options.

Bonney Reed-Knight, PhD13 May 2015

Bonney Reed-Knight, PhD is a Clinical Psychologist and Postdoctoral Research Fellow at Children's Healthcare of Atlanta.  Her research focuses on the integration of psychology and Read more

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