I thought I knew a lot about teenagers and mental health — and eating disorders in teens specifically. I’d studied adolescent development in graduate school, worked as a high school teacher and athletic coach, and knew teens who had struggled with eating disorders. I should’ve been able to spot the early warning signs of an eating disorder in my own teen, right?

As it turns out, I wasn’t.

Because I believed some common myths about eating disorders — including that someone has to “look sick” to have one — I didn’t realize that one was taking root in my own house. I learned a lot the hard way, but as rates of eating disorders in teens continue to rise, it’s essential for more parents to become proactively educated about these deadly illnesses.

Rates of Eating Disorders in Teens

Although eating disorders can emerge across a person’s lifespan, the teen years are an especially vulnerable time; research indicates that around 95% of eating disorders begin between the ages of 12 and 25. And since the start of the pandemic, rates of eating disorders in teens have increased significantly, with hospitalizations doubling. It’s worth noting that these statistics don’t even account for the many teens who are never diagnosed.

And while anyone can develop an eating disorder, we know that certain teens may be particularly at risk: LGBTQ+ teens have significantly higher rates of eating disorders than their straight, cis peers, and teen athletes are more likely to develop eating disorders than teens who are not in sports. Both parents and health professionals may miss eating disorder symptoms in teens who don’t fit the stereotype of the thin, white, affluent, teen girl, but the truth is that eating disorders affect teens of all body sizes, races, socioeconomic classes, and genders.

Causes of Eating Disorders in Teens

It’s rare to be able to pinpoint one specific catalyst for someone’s eating disorder, and we lack research that could establish a simple, direct cause. Regardless of a person’s age, eating disorders often develop out of a “perfect storm” of contributing factors, such as genetic vulnerability combined with environmental, social, or cultural factors. (Read more about the different causes of eating disorders.)

The teenage years in particular present a host of factors that can fan the flames of an eating disorder, helping to explain the high rates of eating disorders in teens. For one, hormonal changes during puberty may play a role in the development of eating disorders, particularly for girls. Social media is at the center of many teens’ lives, and research has shown that these platforms may aggravate existing body image concerns or disordered eating. For older teens, the transition to college can be a high-risk time for the onset of an eating disorder or a relapse in those who struggled earlier in their adolescence.

Signs of Eating Disorders in Teens

The signs of eating disorders in teens are quite similar to those in other age groups. However, the unique characteristics of the teenage years can mask some signs, making it easier for caring adults to miss them.

Indeed, eating disorders at any age can be difficult to identify, but stereotypes about teenagers add a new layer of challenge. Family members, teachers, and coaches often mistake eating disorder symptoms for “normal” teen moodiness or self-consciousness, and the secrecy and isolation that tend to accompany eating disorders can be written off as a developmentally normal desire for more privacy and independence.

In addition, if a teen declares they’re adopting a new way of eating, parents can explain it away as them simply going through a phase. Well-meaning adults and peers might even praise and encourage these attempts to “eat healthier.” However, suddenly cutting out entire food groups (like meat, dairy, gluten, or processed foods, for instance) can be an early warning sign of an eating disorder.

Becoming more appearance-conscious is also a big part of adolescent development, and body dissatisfaction among teens has become so normalized in our culture that it’s frequently dismissed as a rite of passage. However, while negative body image might (sadly) be increasingly common, it can also be a sign the teen may be struggling with some serious mental health challenges –— especially if any of the other signs are coupled with it.

Challenges in Treating Teens with Eating Disorders

From schoolwork and extracurriculars to college applications and social pressure, the teen years are stacked with challenges even without the addition of an eating disorder. This reality means that prioritizing recovery usually requires a lot of adult support, especially for a high-achieving student or competitive athlete. A teen with an eating disorder may have to adjust their course load, pause participation in sports, or even take a medical leave from school — and they’re unlikely to be able to make these recovery-minded decisions on their own.

Even though family-based treatment (FBT) is the evidence-based treatment for eating disorders in adolescents, parents may feel uncertain about having such an active role in their teen’s recovery. Because independence is such a central part of the teen years, parents may feel uncomfortable making the shift to FBT, which requires that family members temporarily make all food decisions and supervise meals. The crucial thing to remember here is that in order for your

teen to develop true autonomy and resume their healthy development, they must first become independent from their eating disorder.

While it can feel like punishment for a teen to lose certain freedoms or to pause the trajectory of their external achievements, in reality they are being protected from the negative consequences of their eating disorder and given the chance at true freedom in the future.

What To Do If You Are Worried Your Teen Has an Eating Disorder

Family members who notice changes in their teen’s attitude toward food, exercise, or their body are often hesitant to say anything; parents may fear drawing attention to the behavior or worry they will end up making things worse. It’s easy for eating disorders to make the rest of the family start walking on eggshells, but staying silent means the eating disorder is thriving, at your teen’s expense.

In fact, one of the most powerful things a parent or guardian can do is approach their teen with compassion and curiosity rather than judgment. A conversation starter might sound like, “I’ve noticed you’ve stopped eating dessert. Would you tell me more about that change?”

If you’re worried about your teen, have them seen by their primary care physician as soon as possible. Checking their height and weight and ordering any needed lab work or other tests will give you some essential data to help guide next steps. Keep in mind that many primary care physicians lack sufficient training in eating disorders and may not realize how ill a teen is, especially if they are not medically “underweight.” Many doctors may recommend a “wait-and-see” approach, a well-meaning strategy that can lead a teen’s eating disorder to become more severe and more difficult to treat. Remember that eating disorders aren’t a “phase” your teen will “grow out of.” Since early intervention carries a better prognosis with eating disorders, if your gut tells you something isn’t right — even if the primary care doctor says not to worry yet — ask for a referral to an eating disorder specialist for a thorough evaluation.

All people with eating disorders deserve timely, effective treatment, but for teens, there are some particular health factors that can make the matter even more pressing. Teens who are malnourished are at risk for losing lifetime bone density during the body’s finite period of bone growth and development. Having an eating disorder also increases the chances of developing substance use disorder, which is particularly damaging for the developing teenage brain, and raises suicide risk in a population that already has the highest prevelance of suicidal thoughts.

What Families Should Remember About Teens with Eating Disorders

If your teen has an eating disorder, you may be feeling scared, helpless, or even guilty, wondering what you could have done differently. It’s important to remember that families are not to blame but can be a critical source of recovery support, even for a fiercely independent teen.

Your teen may be mature in many ways, but they are still your child. And as much as they and their eating disorder may want to push you away, your teen needs you more than ever. Through supporting the hard work of recovery, you are literally saving their life and giving them the foundation they need not only to survive but to thrive. The recovery process is challenging for the whole family, but it’s so worth it.

While I may have missed the early signs of an eating disorder in my teenager, it didn’t prevent our family from getting up to speed and learning what we needed to do to support recovery. And my early fears of harming the relationship with my teenager or interfering with adolescent development were allayed when we got to the other side of this illness. With support, eating disorder recovery for your teen is possible.

Citations:

1. Ward ZJ, et al. Estimation of Eating Disorders Prevalence by Age and Associations With Mortality in a Simulated Nationally Representative US Cohort. JAMA Netw Open. 2019 Oct 2;2(10):e1912925.
2. Asch DA, et al. Trends in US Patients Receiving Care for Eating Disorders and Other Common Behavioral Health Conditions Before and During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(11):e2134913.
3. Klump KL. Puberty as a critical risk period for eating disorders: a review of human and animal studies. Horm Behav. 2013 Jul;64(2):399-410.
4. Eisenberg D, et al. Eating disorder symptoms among college students: prevalence, persistence, correlates, and treatment-seeking. J Am Coll Health. 2011;59(8):700-7.