When Jean Robinson's daughter Abby* was sixteen years old, she seemed happy to most people who knew her. A junior in high school, Abby was involved with a dance company and thinking about going off to college. To Abby's parents, however, something felt off.
"I began to notice her withdrawing from friends," said Robinson. At the same time, Abby's food choices became rigid and repetitive. Salad-only meals at restaurants turned into excuses not to dine out at all. Then one Friday night after dance class, Abby landed in the emergency room with heart palpitations from taking too many laxatives. "Reality was here," says Robinson.
As mom and dad, you may not always be the first people your tween or teen choose to confide in. You do, however, have a behind-the-scenes view of what's actually going on in your child's life that can help you spot an eating disorder early on. In retrospect, Robinson says, the signs were there.
"Individuals with eating disorders are not easy to identify from outside appearance," says Wendy Oliver-Pyatt, M.D., FAED, CEDS, founder of Oliver-Pyatt Centers, an eating disorder treatment center in Miami, FL, and Clementine adolescent treatment centers.
There are, however, subtle behavioral clues that creep up long before physical symptoms. Those early stages are a crucial time. "The sooner we can intervene, the better the prognosis," says Dr. Oliver-Pyatt.
Here are some of the eating disorder warning signs to look out for in your tween or teen:
It's fine for your child to get on a wellness kick. It's not okay for her to spend countless hours planning meals, or skipping social events because of the food that may or may not be available. "Being able to adapt to a variety of foods in a variety of situations is a sign of healthy eating," says Dr. Oliver-Pyatt.
Inflexibility around what to eat whether it's "good" vs. "bad" foods, permissible eating times, hours between meals, or any other strict rules can be a red flag. Creating new rules around food that haven't been vetted by an informed healthcare provider like going gluten-free, dairy-free, or on any other restrictive diet is worth taking a closer look.
Tensions can be high with any teenager, but does your child's stress level seem to peak before or during a meal? Avoidance of eating with others, particularly family members, and nervousness during meals can be a sign there is a bigger problem.
If your child consistently runs for the loo after she's eaten, this may be a tip-off that she's engaging in purging behavior. A person who is purging may be eating a completely normal or even a large amount of food at meals.
"Adolescence is a time for growth, and any type of weight loss in any size individual is a huge red flag," says Dr. Oliver-Pyatt. If your child expresses a reasonable desire to lose weight, consult first with their pediatrician. Once the doctor gives the OK, work with a registered dietitian nutritionist who can help him or her shed pounds in a balanced, healthy way.
Other physical symptoms that can occur in people with eating disorders include hair loss, changes in skin texture, missed periods, and dental issues, says Dr. Oliver-Pyatt.
If your son or daughter is not taking in enough calories to support his or her body's needs, you may notice a general fatigue or tiredness. A person with an eating disorder may also seem irritable, unable to focus, moody, or socially withdrawn.
A teenager who is abusing the family credit card may be exhibiting compulsive shopping behavior; compulsive buying, like bulimia, is an impulse-control disorder. A person who has one may be more likely to have the other, say researchers.
Looking back on the experience, Robinson now knows that Abby's eating disorder existed for years before she and her husband acknowledged it. There were months that she knew deep down something was wrong, and she was right. "As mothers, we have a gut instinct," she says.
Don't be discouraged, however, if your gut sends you nothing more than a shrug emoji. Experienced healthcare providers can, and should, see the signs and offer help.
"The best approach is to involve a professional who is skilled in the assessment of eating disorders," says Dr. Oliver-Pyatt.
That may or may not be your child's pediatrician, as many doctors surprisingly are not trained in this area. The Robinson's trusted family pediatrician sent them to another doctor who specialized in eating disorders, which was the first step in a long road that led to Abby's eventual recovery.
And, as in any other issue you may face with your tween or teen, both experts and parents who have been there say that communication is key.
"If you think anything is wrong, talk with your child," says Robinson.
For more on how to help, check out this brochure from the National Eating Disorders Association, or call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text "NEDA" to 741741.
*Names changed for privacy