Understanding Eating Disorders in Teens

Medically Reviewed by Amita Shroff, MD on July 28, 2023
5 min read

Eating disorders are not uncommon among teens. Take "Kerri" (not her real name) for example. Upset with a sudden weight gain, the 15-year-old forced herself to throw up after eating her school lunch. It seemed harmless. After all, most of the kids at her lunch table had done it before, and they seemed OK.

Then, after doing it five times, Kerri had a new ritual of vomiting right after eating. She did it at school and then again at home. No one knew -- until Thanksgiving. She had eaten more than usual and told her parents she felt sick. Suddenly, there was a tap on the bathroom door. Kerri's parents were standing outside the door, asking how long she'd been throwing up her food.

"Mason," 14, was also obsessed about his weight. Short and chunky most of his life, Mason had a growth spurt. Now tall and thin, he was determined to never to be "the fat kid" again. Mason hated throwing up. So, he started eating salads with no dressing, running miles each day, and taking laxatives to keep his weight down.

It worked. He looked trim and athletic. But he felt exhausted, fatigued, and irritable. In the middle of the night last winter, Mason became violently ill with stomach cramps and a high fever. His doctor admitted him into the hospital and began running tests to figure out his mystery illness.

Weight obsession affects millions of teenagers today, especially girls. At any given time, one out of every seven women has or is struggling with an eating disorder. One study a few years ago found that 36% of adolescent girls -- more than one out of every three -- believed they were overweight, while 59% were trying to lose weight.

More than 90% of people with an eating disorder are girls. Teenage boys, though, also have body image concerns. Many boys strive for the perfect body by dieting or by doing compulsive exercise.

Eating disorders, including anorexia nervosabulimia nervosa, and binge eating disorder, are psychological disorders that involve extreme disturbances in eating behavior. A teen with anorexia refuses to stay at a normal body weight. Someone with bulimia has repeated episodes of binge eating followed by compulsive behaviors such as vomiting or the use of laxatives to rid the body of food. Binge eating is characterized by uncontrolled overeating.

Anorexia nervosa affects as many as one in every 100 females. Teens with anorexia fear gaining weight and are at least 15% below their ideal body weights. They believe the main gauge of self-worth is their body image.

Experts believe many American girls are bulimic and have kept the problem a secret. Bulimia often starts in the late teens and early adulthood. People with bulimia go through cycles of eating enormous amounts of foods followed by purging by vomiting, using laxatives, or diuretics or hours of aerobic exercise.

Warning signs of bulimia include:

  • Extreme preoccupation about being overweight
  • Strict dieting followed by high-calorie eating binges
  • Overeating when distressed
  • Feeling out of control
  • Disappearing after a meal
  • Depressed moods
  • Alcohol or drug abuse
  • Frequent use of laxatives or diuretics
  • Excessive exercising
  • Irregular menstrual cycles

There is no one cause of an eating disorder. Experts link eating disorders to a combination of factors, such as family relationships, psychological problems, and genetics. The teen may have low self-esteem and be preoccupied with having a thin body. Perhaps they have been bullied because of their weight.

Sometimes, being part of a sport such as ballet, gymnastics, or running, where being lean is encouraged, is associated with eating disorders in teens. In one study, researchers linked anorexia with an obsession with perfectionism -- concern over mistakes, high personal standards, and parental expectations and criticism.

Symptoms of eating disorders may include the following:

  • A distorted body image
  • Skipping most meals
  • Unusual eating habits (such as eating thousands of calories at one meal or skipping meals)
  • Frequent weighing
  • Extreme weight change
  • Insomnia
  • Constipation
  • Skin rash or dry skin
  • Dental cavities
  • Erosion of tooth enamel
  • Loss of hair or nail quality
  • Hyperactivity and high interest in exercise

Teens with eating disorders are often in denial that anything is wrong. They may be moody, anxious, depressed. They may withdraw from friends, and become overly sensitive to criticism. The problem arises when parents are not aware of these symptoms because the teen keeps them hidden -- just like the trauma, insecurities, depression, or low self-esteem that may help trigger the disorder.

Although there is no easy treatment for eating disorders, they are treatable.

A combination of treatments, including cognitive behavioral therapy and antidepressant medication, can be used to help teens overcome bulimia. Cognitive behavioral therapy helps by identifying and replacing inaccurate thoughts to help change behavior and emotional state.

Anorexia treatment usually involves nutritional feeding, medical monitoring, and psychological treatment.

If left untreated, eating disorders can lead to serious illness and even death.

Along with the lower body weight, girls with anorexia nervosa can lose their menstrual periods (amenorrhea). The loss of periods is associated with osteopenia, early bone loss that can lead to painful fractures.

Eating disorders are also linked to other serious health problems, such as kidney disease , liver disease, and heart disease. Each of these health problems requires specific tests and treatment.

If you think you have an eating disorder, talk to your doctor. The sooner you get medical and psychological treatment, the faster you will be on your way to recovery.

If you suspect a family member or friend has an eating disorder, talk with them about the problem.