Eating disorder – how to recognise and prevent it

This week (11 – 17 February 2013) is Eating Disorder Awareness week. Dr Nihara Krause, a Consultant Clinical Psychologist and Lecturer as well as founder of the charity STEM4 that raises awareness and offer early intervention in four areas of teenage mental health through workshops in schools, talks to London Mums about eating disorders and prevention.

stem4 teenagers

What are eating disorders?

Eating disorders comprise of Anorexia Nervosa, Bulimia Nervosa and Binge Eating (compulsive over eating) Disorder. They are serious mental illnesses affecting 1.6 million people in the UK. They are most likely to develop in the teenage years and although more girls are affected, around a quarter of the population affected by an eating disorder at school age are boys.

Eating issues are common in childhood and are not to be confused with an eating disorder. Children can go through phases, particularly when young of being fussy eaters, picky eaters and selective eaters. They can also develop food phobias. Whilst these constitute disorders of eating, they do not form the main group of eating disorders and can be developmental or need some focused care.

Important facts for parents!

• Eating disorders are not ‘normal’ dieting and body shape concerns; they are serious mental illnesses with damaging physical consequences. They need consistent and long term monitoring. Don’t be deceived by thinking it’s just a ‘passing phase’.

• Eating disorders respond well to early diagnosis and appropriate help

• Eating disorders alter the sufferer’s thinking and behaviour so work with your child/teenager even if they may appear changed, secretive and defensive.

• Your role in working with your child/teenager with an eating disorder is important. Keep your connection with them.

What makes my teenager vulnerable to developing an eating disorder?

Here are four common contributory factors that make your child/teenager vulnerable to the development of an eating disorder:

• Family – Family history and family eating patterns can be relevant. There is usually a higher incidence of eating disorders in families where there may be one or more members who has or has had an eating disorder at some point in time in their life.

• Individual – Characteristics common to those developing Anorexia Nervosa are perfectionism and being high achievers. Impulsivity is more common in Bulimia Nervosa. There may be a possible history of being over-weight or chubby as a child or having an altered body perception of being over-weight. Usually all individuals with an eating disorder have low self esteem, although it may sometimes not be very obvious. Mood factors and anxiety can be high and an obsessive compulsive personality trait may be present.??There are indications that biological factors such as the role of particular neurotransmitters may play a role in instigating or maintaining the condition.

• Developmental – There may be a history of food and eating difficulties, emotional trauma, certain types of emotional upheaval and a high focus on achievement.

• Social – There may be a history of difficulties in integrating with peer groups – ‘feeling different’ is a common theme in eating disorders, possible bullying and exclusion, excessive competition. A lot has been written about media coverage and whilst socio-cultural factors are influential, they are not the primary cause of why a person develops an eating disorder but a possible single factor in a multitude of others.


In addition to these underlying factors, there are common triggers to why an eating disorder starts. These include:

• Going on a diet

• A major change, eg. new school, break up of relationship, parent’s divorce, bereavement

• Puberty

• A negative experience connected with weight, shape or eating

Fear of weight gain or loss of control are the main reasons for teenagers finding it difficult to change once they develop an eating disorder.

Common feelings shared by parents of someone who has an eating disorder:

• Feeling frustrated to be dealing with someone who doesn’t want help

• Being bewildered or confused

• Being distressed

• Feeling guilty – ‘did we/I contribute to the development of this in any way?’

• Feeling angry

• Feeling helpless

• Feeling panicked about the possible consequences

Some warning signs for parents include:

Changes in eating behaviours such as being on a long-term diet, eating very low calorie food

A goal to lose weight

A negative change in attitude to weight or shape

Low self esteem

Changes in weight

In girls the ceasing of her menstrual cycle

What you can do

• Discuss your concerns with your child/teenager; try to work on an agreement of what the next step is. Keep in mind that resistance to change is very common in Anorexia Nervosa. This is due to a fear of change. Be kind, patient but determined. Similarly, shame is high in Bulimia Nervosa, which makes for greater secrecy.

• Get a medical opinion as soon as possible– visit your GP.

• Find out all treatment options available and recommended. There are usually outpatient treatment options, which include individual sessions which could focus on psychological, pharmacological and nutritional treatments and family sessions. Sometimes group treatment may be recommended on a day programme. In some cases in-patient treatment is considered most appropriate.

• If the decision is outpatient management, you will be part of a joint programme. Be prepared to work hard to get an expert evaluation – for example, a dietician or family doctor will be helpful in advising on calories and nutritional requirements that will be required for different developmental stages, whilst a psychologist will be helpful in devising a behavioural programme to help with symptoms as well as to provide psychological intervention and support. Teenagers will often be referred to the CAMHS service or to a specialist eating disorder service.
For more helpful information and on what sorts of steps to take including ‘talking to your teenager about their eating’ visit

There are sections for teenagers, their friends, for parents and for schools.

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