People often hear about anorexia and bulimia in the media or read about them in magazines. But these well-known eating disorders are relatively rare: Approximately one in 100 adolescents with symptoms is truly anorexic or bulimic.
“Most people with food issues – adults and children alike – don’t develop full-fledged eating disorders, although they have some of the symptoms,” said Carmen Mikhail, Ph.D., director of the Eating Disorders Clinic at Texas Children’s Hospital and assistant professor of Pediatrics at Baylor College of Medicine.
One sign of an eating disorder involves self-disparaging comments about how clothes don’t fit and how everyone else is so thin. Another sign is compulsive dieting or disordered eating patterns, such as eating only low-fat foods or an unbalanced vegetarian diet.
While “dieting” doesn’t sound dangerous, taking it to an extreme can cause conditions including fatigue, chronic constipation, malnutrition (with hair falling out) and menstrual disorders.
The problem may come to light in various ways. A friend may inform the teen’s parents, or the school staff may call home to report that the teen is throwing away lunch, throwing up in the restroom or taking diet pills. Different eating disorders have defined patterns and symptoms.
Generally, anorexia appears in early adolescence, around the ages of 13 or 14, although some cases have been found in children as young as 10. While most of them are girls, about one in 10 is male. True anorexics start thinking and talking about their weight much sooner than others – often months before actual symptoms surface. This clue shows that the child is already struggling with these issues.
Symptoms of anorexia include sudden changes in diet (such as eliminating favorite high-calorie foods), a preoccupation with weight, self-critical comments and unexplained weight loss. Some teens may hide their lack of eating by avoiding family mealtimes.
“Anorexics derive a sense of mastery and control over their body when they diet,” said Mikhail. “Many of their issues are related to control issues at the family level.”
Bulimia
Bulimia tends to appear later in the teen years. In some cases, an adolescent who was anorexic may go through a bulimic phase during recovery. However, bulimia and anorexia are different diseases.
One symptom of bulimia may involve a teen disappearing immediately after eating. Parents also may notice a large amount of food missing without knowing where it went. Often, bulimics take an extreme stance toward eating, such as promising themselves they’ll eat only 500 calories a day, which sets the scene for binging behavior followed by purging.
Compulsive eating often includes using food for emotional reasons. For example, if families use food as a reward, children may frequently turn to food for comfort.
“Compulsive overeaters tend to set unrealistic goals, which leaves them feeling emotionally deprived and then they start binging,” explained Mikhail. “Bulimics partake in a symbolic purging to get rid of pent up emotions they’re trying to handle.”
Underlying social issues
“Eating disorders aren’t really about food and weight,” said Mikhail. “A lot of issues are involved, including perfectionism, lack of effectiveness, body image, expressing feelings, coping skills and recognizing unhealthy distortions about food. Anorexics especially are focused on socialization issues.”
“The third most common chronic disorder among adolescent females is anorexia nervosa,” reported Amy Middleman, physician in the Texas Children’s Adolescent Medicine Center and associate professor of Pediatrics at Baylor College of Medicine, “but many more young people have disordered eating that’s part of a larger psychosocial movement.”
Adolescents typically struggle with two main issues – independence (which involves separating from the family) and identity (asking: Who am I? What am I all about? What makes me special compared to other kids?). Parents should be aware that teens naturally need some degree of experimentation as they begin to separate from their parents and search for what makes them unique individuals.
“In many ways, adolescence is not that different from the toddler age, except now the child has the ability to act out their independent ideas, which can be much more dangerous at this age,” explained Middleman.
Parents also need to face the fact that adolescents slowly change their priorities from caring what their parents and teachers think to focusing on what peers think, until their peers eventually became the main gauge. Part of this change comes as teens learn to think more abstractedly about the world – and people – beyond themselves.
While young children typically think only about themselves, adolescents in the early phases of abstract thinking form an “imaginary audience.”
“When a teen begins to realize that other people have their own thoughts, at first the teen assumes those people are thinking about him or her – all others are basically an audience watching the teen, said Middleman. "A teen’s concerns about what others think about him or her is where peer pressure can become dangerous.”
Parents may not know it – and teens won’t admit it – but adolescents often rely on their parents to help them set boundaries, which serve as a safety net. Teens can use these boundaries when setting limits with their peer group. According to Middleman, “Parents need to maintain clear guidelines for behavior while also establishing a stance of openness.”
In addition to wanting the approval of friends, teens are eager to fit into the larger social scene, which is where the media comes in. As Mikhail pointed out, “Children are bombarded with images of sleek physiques, while food ads entice with high-calorie foods. The mixed messages put them in a bind.” 
