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

Dear Dr. Pat,

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 I am worried she might have an eating disorder. What signs should I look for?

Dr. Pat responds:

Anorexia nervosa is one of the major eating disorders. 

The features of anorexia nervosa are:

  • Deliberately keeping a significantly low body weight. In children and adolescents this is a weight that is less than minimally expected for their age, height, developmental trajectory and physical health.
  • An intense fear of becoming overweight even if they are 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." 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.

When someone is engaged in binge eating with purging, they eat large quantities of food at one time and then get rid of it 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 with bingeing and purging might eat a dozen donuts and a litre of ice cream in an evening and then vomit all of it up.

Teen girl not eating dinner Teen girl not eating her dinner  

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. They will also 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 are on the rise.

Cooking food could be a way for your daughter to know 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. 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 who vomit frequently may also have damage to their hands and teeth.

Girls who are dancers, runners, and gymnasts are at higher risk for anorexia because of the amount of exercise they do, and the emphasis on weight among some coaches and teachers. Sometimes teenagers with anorexia were somewhat pudgy as children.

If you are concerned, talk to your daughter about it. Be careful not to accuse her. Tell her you are concerned about her health. Try to understand her point of view but do not be fooled 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 them 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 do not 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. He is also the CEO of the Strongest Families Institute, which provides mental health care to families across Canada.

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Dr. Pat will respond to as many letters as possible with evidence-based answers. We hope that the column will be interesting and helpful for readers; however, Dr. Pat cannot provide health care through the column. Please contact a physician or other registered health care professional to provide health care guidance or advice.