When Ivy Silver got a call from her friend Jane telling her something wasn’t right with Ivy’s sixteen-year-old daughter Rachel, the Wyncote, Pennsylvania mom was frightened. “One of Rachel’s friends had approached Jane, an eating disorder specialist,” says Ivy, age fifty-two, who owns an insurance brokerage and employee benefits consulting firm with her husband, Steven Leshner. “Her friends had noticed Rachel’s eating habits were different. She wasn’t eating any meals with them and was fixated on losing weight, talking about how little she was eating and how she would try to limit her calories to less than five hundred per day.”

Ivy and Steven were surprised they hadn’t noticed Rachel’s unusual behavior. At five-feet-five inches, she had always been a “small” girl, but her weight was within normal limits, and she ate dinner with the family every night. Still, at a time when she should have been becoming more curvaceous, she wasn’t.

Ivy, who had struggled with bulimia in the past, understood the gravity of the situation. Scared for their daughter’s life, she and Steven sprang into action. In the end, they would spend two and a half years helping Rachel recover from anorexia and bulimia. They enrolled her in therapy, took her to a nutritionist, and scheduled weigh-ins at their family doctor’s office, which revealed that their daughter had lost 15 percent of her prediagnosis weight. Rachel underwent intensive treatment on an outpatient basis and then began in-patient treatment at a psychiatric hospital. Both caused her to miss a significant portion of her senior year. “The grim reality of seeing boys with feeding tubes and women still sick in their fifties really inspired her to work through this,” Ivy says. “She learned that this is not a glamorous disease.”

An Illness that Starts Young

It’s estimated that up to twenty-four million people suffer from eating disorders, including at least 10 percent of late-adolescent girls and adult women. While the disease is also known to affect boys, parents need to keep a particular eye on their girls, especially if they are athletes or people pleasers. Early traces of the illness can be seen around age seven, when kids often start referring to themselves as “fat.” Today, 95 percent of people with eating disorders are between the ages of twelve and twenty-five.

What causes eating disorders? Sharon Fried Buchalter, PhD, a clinical psychologist with advanced training in child and adolescent psychology, points to a variety of factors, ranging from psychological (low self-esteem) to genetic (depression, chemical imbalances) to social (super-thin celebrities on magazine covers).

What parents say matters, too. “Talking about feeling fat, your own dieting, or your kids’ weight can have a negative impact on how children look at themselves,” says Jane Shure, PhD, a Philadelphia-based psychotherapist who has specialized in treating eating disorders for more than twenty years.

The consequences of an eating disorder can range from very serious (low blood pressure, rotted teeth, stunted growth, loss of menstruation, liver damage, osteoporosis, ulcers) to fatal (heart attacks). In fact, eating disorders are the deadliest of all mental illnesses, according to the Renfrew Center, an eating disorder education and advocacy group with several treatment facilities. The mortality rate for anorexia is twelve times higher than that of all other causes of death in females fifteen to twenty-four years old.

Warning Signs

What begins as seemingly normal behavior (a child says she ate at a friend’s house or exercises more frequently), can quickly become a serious problem. Alarm bells should go off when children:

• Regularly refuse family meals or skip lunch at school.
• Stick to a few “safe” foods, including vegan or low-fat, low-carb options.
• Talk about (and fear) being fat even when they are slim.
• Become obsessed with exercise.
• Attempt to create a “perfect” image in every area of their lives.
• Consistently exaggerate the size of their body or body parts.
• Have an overriding sense of shame about themselves and their body.
• Experience rapid weight loss.

If you notice any of these signs, consider making a trip to your family doctor or pediatrician. “He or she will listen to your concerns, interview your teen alone, and do a physical exam,” says Laurie Mitan, MD, head of the eating disorders program at Cincinnati Children’s Hospital Medical Center. If there is a problem, the doctor will know where to turn next. “Having a mental health therapist, a medical doctor, and a registered dietitian is best,” says Dr. Mitan, “though patients with more severe
diseases will need a psychiatrist.” Anti-depressants are an effective part of the treatment for bulimia and binge-eating disorder, she adds. Many patients with anorexia may appear depressed, but this often results from malnutrition and will improve with weight gain.

Anorexia and bulimia are the most well publicized eating disorders, but they are not the only ones. Here, a brief primer on these complex illnesses.

Anorexia Nervosa

Present in about 1 percent of the general population, anorexia is the third most common chronic illness among adolescents. Sufferers are very underweight, sometimes to the point of emaciation. Terrified of being fat, they severely restrict calories. “Ironically, their fear only tends to heighten as the weight drops off,” says Trisha Gura, PhD, author of Lying in Weight: The Hidden Epidemic of Eating Disorders in Adult Women.

What to look for: A child who skips meals, eats tiny portions, or eats in strange ways (chewing food for half an hour, spitting food out before swallowing). Children with anorexia may avoid food-related events (such as a family barbecue or a pizza party with friends) or make excuses to avoid eating (“I’m not hungry” or “I have a stomachache”).

Bulimia Nervosa

Most bulimics are of normal weight and display few outward signs of their problem, making it difficult for parents to catch on. Affecting about 4 percent of the population, bulimia consists of cycles of binge eating (usually sweets and junk food) followed by unhealthy behavior that rids the body of the calories. About 80 percent of bulimics vomit to purge, but other methods include laxatives, diuretics, fasting, compulsive exercise, enemas, or other medications. Kids can lose major nutrients, especially potassium, which helps to regulate the heart. In chronic cases, the body has so little potassium that physical function suffers and hospitalization is needed.

What to look for: Empty food packages around the house, bathroom smells, or running water (the sound covers the vomiting). Children with bulimia may have scratched or black-and-blue knuckles (from scraping their fingers against their teeth); they may also use the bathroom at unusual times or make frequent bathroom trips, especially right after meals. Note the excessive use of mouthwash and breath mints.

Binge-Eating Disorder (BED)

BED consists of bingeing—like bulimia—but there’s no purging. Those with BED tend to be obese and racked by low self-esteem. They may also be frequent dieters who binge with the sense that they can’t stop themselves. Research shows that between 15 and 50 percent of people enrolled in dieting programs suffer from BED. The consequences mirror those of obesity: high blood pressure, heart disease, diabetes, and gallbladder disease.

What to look for: A child, who eats a lot of food quickly, exhibits a pattern of emotional eating or feels ashamed or disgusted by the amount that he or she eats. Note any irregular eating patterns, especially skipping meals and eating at unusual times (such as late at night).

Why is it so important to catch eating disorders early?

About 76 percent of people treated for anorexia either recover completely or make significant progress. But the earlier treatment begins, the better the outcome. “Getting into treatment in the first six months can make all the difference in a child’s life,” says Dr. Shure.

As the disorder takes hold, the physical and psychological damage becomes much harder to reverse. “Initially, there’s a lot of excitement for kids at being able to meet the goals they set,” notes Dr. Shure. Later, however, they realize that even if they want to eat more or exercise less, they can no longer control their behavior. “In the first months it is much easier to help somebody out of it. After a year, the system is patterned, making it much more difficult—and leading to years of treatment.”

What should you do as a concerned parent? If you notice even one thing that seems off, listen to your gut. And if your child’s friend, her friend’s parent, her coach or her school nurse comes to you with things they’ve noticed, hear them out, urges Dr. Mitan: Your child’s life could depend on it.

Rachel Silver’s did. She’s now a thriving twenty-one-year-old junior at the University of Miami. “She is happy, healthy, engaged, and has a good attitude toward food and exercise. She wants to move on with her life,” her mother says. “We credit Rachel’s recovery to her will not to be a sufferer for her entire life—and especially to early diagnosis and treatment.”

By: Danielle Schlass Saliman

Related Story: Ask Common Sense: Weighing Mixed Messages