How can I tell if my daughter has an eating disorder?

By Patrick J. McGrath, OC, PhD, FRSC

Dr. Pat

Question:

My 14-year-old daughter is quite thin. She likes to cook but doesn't eat much. She always eats good food and is always going to the gym. I am happy about her good health habits but how can I tell if she has an eating disorder?

Dr. Pat responds:

Anorexia nervosa is one of the major eating disorders. The other major eating disorder is bulimia, which involves bingeing on food and purging but not low weight.

The features of anorexia nervosa are:

• deliberately keeping low weight. In children and adolescents this is measured by being below 85% of the expected weight for height.
• an intense fear of becoming overweight even if underweight
• a distorted view of one's body. Many teenage girls emphasize minor flaws in their body: "I have thunder thighs." "My breasts are too big (or too small)." "My bum is fat." But teenagers with anorexia worry they are fat when they are very skinny.
• lack of menstruation

There are two types of anorexia nervosa: anorexia with binge eating and purging and anorexia with restrictive eating.

Binge eating with purging means that large quantities of food are eaten at one time and then gotten rid of by throwing up or using diuretics, enemas, or laxatives. Diuretics are pills that eliminate water from the body.

For example, a person with anorexia and bingeing and purging might eat a dozen donuts and a litre of ice cream in an evening and then vomit all of it up.

In anorexia with restrictive eating, there is no bingeing, just not eating enough. Sometimes exercise is used to burn calories and control weight.

People with anorexia deny that their low weight is a problem. They often try and hide how little they weigh by wearing bulky clothes. When parents want to see how much they weigh, teenagers with anorexia will lie, or wear weights under a bulky sweater to fool their parents. Adolescents will hide and deny purging.

Eating disorders increase sharply at about 12 years of age. Although there are relatively few young children with eating disorders, it does occur. Girls are five or six times more likely to have eating disorders than boys. However, eating disorders in boys may be increasing.

Cooking food could be a way of her knowing exactly how many calories are in what she eats and being able to keep her caloric intake down.

There are other physical changes with anorexia.

The semi-starvation may cause:

• fine downy hair all over the body.
• low blood pressure
• slowed heart rate
• fainting
• low body temperature
• difficulty sleeping
• depression

Teens that vomit frequently may have damage to their teeth.

Girls who are dancers, runners, and gymnasts are at higher risk for anorexia because of the amount of exercise they do. Sometimes anorexic teens were somewhat pudgy as children.

If you are concerned, talk to her about it. Be careful not to accuse her. Tell her you are concerned about her health. Try to understand her point of view but don't be fooled just if she says there is no problem. People with anorexia deny they need any help or that there is a problem.

Team up with your daughter's family doctor or paediatrician. Tell him or her about your concerns before your daughter's appointment. By weighing and measuring your daughter, her doctor can determine if she is severely underweight and then can assess if she is anorexic

Treatment can help, but only if anorexia is diagnosed.

Anorexia can kill, so don't delay acting on your concerns.

Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. Read more "Ask Dr. Pat" columns Ask Dr. Pat a question