Eating disorders tend to sneak up on us—in part, because they fall into such an emotionally fraught terrain. Many of us struggle ourselves with weight and body image. We’re eager for our kids to have a positive self image. We’re wary of the obesity epidemic. We’re careful about encouraging our kids to eat right. And still, eating disorders are rising.
Melanie Haiken has been there. She’s come to know more about physical and mental health, nutrition, and—yes—eating disorders than most people through her career as a leading health journalist. And yet as a mother, she felt as stunned and clueless as anyone when her daughter began to struggle with anorexia, bulimia, and mood disorders.
She and her daughter are still taking it one day at a time. But they want the world to know that eating disorders aren’t just about food, or dieting, or even weight. They’re a self-harming behavior with deep roots that too often go unrecognized and misunderstood, Haiken says.
Here, she shares more hard-earned insights that can help all of us:
What I wish more parents understood about eating disorders: What you see is the tip of an iceberg. If you’re seeing an unhealthy relationship to food—such as your child obsessing over food or trying to control eating in an unhealthy way—that’s a red flag that there’s more going on than just that.
There’s a misperception that it’s “dieting gone mad.” That’s only true in some cases. A lot of people don’t realize that eating disorders are often a self-harming behavior. The child is damaging herself due to some underlying condition, often anxiety or depression, but it can also be other things. A phrase you hear a lot is that “it’s not about the food,” and that’s totally true. But it’s also not about dieting. There may indeed be body image issues going on, but you also have to dig deep and uncover the psychological layers that can go way down.
A lightbulb goes off for many parents when they understand that eating disorders are a coping mechanism and an addiction.
Self-harming behaviors often happen in clusters—anorexia, bulimia, cutting. If you see one, you’ll want to look for others.
Something parents don’t worry about but should: When you hear your teen put herself down a lot. Every kid does that a bit: “I’m dumb.” “I screwed up that test.” But this happens on a continuum. If your child seems to have consistently negative feelings about herself, that’s not normal.
Something parents worry about but shouldn’t: When your child is focused on food but the reason is an attempt to get fitter, like trying to get in shape for a sport. Or a child who’s getting older and may seem food obsessed about learning to eat more healthfully. Usually, though, you can tease out whether it’s being done in a positive, self-nurturing way (“I really want to make the team!”) as opposed to a punitive, self-harming way (“I’m so fat, I hate how I look.”).
If you suspect an eating disorder: Common advice is to first talk to your child’s doctor. Be aware, though, that some doctors will just weigh her and say, “Well she’s not underweight.” But that’s not going to get at what’s going on. Also, depending on your insurance plan, that can make it harder to get a referral to a therapist. I think it’s always worth talking to a therapist early on. It’s helpful for your daughter to have someone besides you to talk to, and you can relay to the therapist what you’re seeing and ask him or her to be on the lookout.
A sign of an eating disorder parents often miss: Excusing one’s self right after meals or taking a shower soon after. Bulimia can be tricky to spot because the child won’t necessarily be thin. Another sign is for a child’s food preferences to suddenly narrow. A kid who liked pasta suddenly “hates” it, then hates bread, too, then all dessert.A risk factor parents often miss: Different types of social rejection, like bullying or girl politics (being on the outs with her social group), which can be traumatic for adolescent girls.
A red herring often pointed to that’s not necessarily a risk factor: Divorce. You hear this a lot. But in the many support groups I’ve seen, there are as many married people as divorced ones. A bigger factor seems to be troubled family relationships—whether the parents are divorced or together but the girl has a conflicted relationship with her father, for example, or the parents are married and there’s a lot of household conflict or money stress because a parent lost a job.
A question I hear over and over from parents is “Should I be worried?” Trust your gut. If you’re feeling concerned about your child, if something seems off, or if you’re seeing big worrisome changes, the answer is more likely to be yes. All adolescents go through changes, like eye rolling, grouchiness, rebellion, thinking you’re dumb. But if you’re feeling that your child seems out of sync with her peers or has changed in some way (a child who went out a lot now stays in her room, for example, or she used to laugh a lot but doesn’t), then trust that instinct.
There’s not a lot of harm in overreacting by, say, taking your child to see a therapist. Parents are often terrified of overreacting. When I was worried about my younger daughter after living through this with my older daughter, I brought her to a therapist, who determined that there wasn’t anything problematic going on. She did have a lot of stressors in her life, though, and that was validating for my daughter to hear. She thanked me later for the chance to talk to someone.
What my daughter wishes I’d done differently: She’d say she wishes I’d realized something was wrong sooner. She was hurting, and I missed the signs big time. She’d always been a toothpick. So she never had dramatic weight loss; she just never got bigger as she got older. I saw other signs that, in isolation, didn’t seem like big deals—troubled social relationships with friends, narrowing food choices, some anxiety. But I didn’t step back to put them all together.
One thing every kid with an eating disorder needs: For the underlying condition to be treated, and in a thorough, proactive way. Physiologically, an eating disorder is a stress reliever for coping with an underlying issue, such as anxiety, depression, or bipolar disorder. There’s fascinating research about how endorphins are actually released through behaviors like cutting, vomiting, or crunching food (that’s chewing it and then spitting it out). If the underlying issue is anxiety, for example, the child may need medication or a specific kind of therapy.
One thing every mom of a kid with an eating disorders needs: For us to de-stigmatize the whole thing. If your child is struggling in school, he may get diagnosed with ADHD or dyslexia, and you would get help but not feel like it’s something you should feel horrible about and blame yourself for. Eating disorders are awful situations, but they’re a mental illness. They don’t deserve the stigma and lack of support they often get from the medical community and schools.
You might get lucky. Some kids go through a period of seeming like they’re developing an eating disorder, but the ship rights itself somehow. More typically, you need to be prepared for a long journey.
Parents tend to want to cure or fix the eating disorder, put it behind them, and move on. But this is a relapsing condition by definition. Often there’s a false sense of security when things seem to be going well, but then it becomes three steps forward, one step back. Or one step forward and three steps back. That’s not a sign that you’re failing; it’s the nature of the condition. Progress isn’t linear.
Eating disorders will make you feel like you’ve failed as a parent. I hear this universally. You feel like everybody else’s kids are doing great and yours isn’t, so it’s hard to talk about it at, even with friends. But if you don’t talk about it, you get sucked into the secrecy and shame of this disorder.
I wish I’d talked about it sooner and gotten into support groups sooner. When you start to talk, a whole world of help opens up. You find out that other people’s lives aren’t going that smoothly. You meet people who have the same problem. And your friends can support you. They can’t if they don’t know what you’re dealing with.