How To Support Teens Who Have an Eating Disorder

By 
Dr. Karolina Pekala

Why It Is So Challenging for Teenagers To Have an Eating Disorder

Eating Disorders are one of the more difficult mental health diagnoses to treat, and one that requires a great deal of support. Not only can eating disorders manifest in various ways - from binging to restricting, to compensatory behaviors like over-exercise or purging - the individual who struggles with their relationship with food cannot avoid it and must face it through the day as food is necessary for survival. Consequently, preoccupation with food, body image, and weight can end up being pervasive and unavoidable at times, such as deciding what to have for dinner or an afternoon snack. Here are some ways to help your teen on their road to recovery. 

Make Food a Normal Part of Your Day

Normalize meals throughout the day by holding back on commenting about your child’s eating. It may seem counterintuitive not to offer positive reinforcements, but observations such as, “Great job eating all of dinner!” or “I’m so glad you ate all of your afternoon snack!” simply end up reminding teenagers that they struggle with food.

We want meals and snacks to be commonplace and part of a daily routine, as typical as brushing teeth, bathing, or changing clothes. By not commenting on food consumption, we send the message that we’ve completed one necessary daily activity and are on to the next.

Similarly, try not to watch their utensils or hands as they eat, as this can also send an unintended message. Instead, engage in conversations completely separate from food that are focused on their lives and other aspects of their identities. What are their hobbies, passions, activities? Ask about the book they’re reading, their progress with artwork, what’s happening with their favorite sports team, or their goals for the future. 

Recognize that Progress is Not Perfection

Perfection is often the enemy of the good, and perfectionism often underlies personality traits found in certain eating disorders, especially anorexia. Expecting 100% meal compliance, no skipped meals, or continuous visible progress is not realistic in any kind of recovery. Sometimes there may be a forgotten lunch or consumption of snacks that parents may find excessive, but that does not mean that it erases all progress! Instead, we can use mindfulness techniques in these moments: try to recognize that while lunch was missed, that moment has passed, and it is not a regular behavior. Additionally, at the next appropriate time (even in the same day!), there will be another opportunity to be mindful and to eat to get back on track. 

Why Comments About Your Teen’s Appearance Can Reinforce Eating Disordered Behaviors or Thought Patterns

Studies have shown that a single negative comment from a parent that focuses on their child’s weight has more impact and long-term consequences than frequent comments from peers.

Comments focused on “needing to lose weight,” “looking chubby,” or “being happier when thinner” produce feelings of shame and guilt instead of weight loss. These feelings may then be the antecedents for binging or other unhealthy behaviors to self-soothe or as a response to the feeling. 

Similarly, complimenting weight loss for someone struggling with anorexia can reinforce thought preoccupation. For instance, a teenage girl may hear from her pediatrician’s nurse that she “got taller and thinner” at her annual physical, or a parent or family member may comment about how pretty she looks now that she “lost the baby fat and her face isn’t chubby anymore.” Although these comments may be well-meaning, they can add to the pressure of a distorted thought pattern around food that creates cyclical thinking such as: “Now that I weigh X and others have noticed, I need to work extra hard to stay at X. That means to be safe, I should restrict my eating and exercise even more so that I don’t have to worry about accidentally weighing more than X.” 

Make Food Neutral

Labeling foods as “good” or “bad” can influence weight in either direction. Foods that are labeled as bad are seen as forbidden. In homes where certain foods are banned completely, children may develop a scarcity mindset and gravitate even more towards overeating them. For example, when those forbidden foods are available (e.g., sleepovers, parties, other family members’ homes, etc.), your teen may be more prone to eating past satiation, or overeating to the point of physical discomfort; this happens because they don’t know when those foods will be available to them again. This mindset and behavior can then carry-over into adulthood with binge-eating disorder.

So How Do I Talk About Eating Disorders with Teens?

Since eating disorders are so tricky to talk about, it’s important to learn the signs of when a teenager is struggling or relapsing. I suggest the following: pick a time and place that is not emotionally activating (e.g., not during breakfast while eating, which can already be a struggle!). You can use an interpersonal effectiveness skill such as the start of DEARMAN as you offer your support. For instance, you might say: “I’ve noticed that lately when you have a snack, you’ve started to eat alone in your room instead of with others, and it concerns me. Is there something I can do or that we can work on together to help you feel more comfortable eating with us?”

Try to keep in mind that eating disorders and eating disordered behaviors are often symbolic: your teen may be open to such direct support, especially if you’ve participated in family therapy.

You can also note that you’ve noticed a difference in your child’s mood, and ask if there is something they’d like to talk about or get your support with, as eating disordered behaviors are often used to cope with distressing emotions or emotionally laden events.

Dr. Karolina Pekala is a Licensed Clinical Psychologist at NY Health Hypnosis & Integrative Therapy. To learn more about how mindfulness & hypnotherapy can help you or to make an appointment, please contact us here.

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