Eating Disorders: Treatment, Prevention, And What Parents Should Notice

What to do if you think your child may have an eating disorder

No one really wants to speak about eating disorders. But I’m here to shed light on a silent, often deadly, mental illness and hopefully extinguish the shame attached to it. I’ll discuss the reasons they happen, the myths and facts surrounding them, and the best way to treat them.

In Hong Kong, eating disorders are a very serious problem. According to the Hong Kong Eating Disorder Association, 75 percent of people between the age of 11 and 30 suffer from this illness. However, the government offers little help to support them, so there are no official statistics and sparse few studies available. They, like other mental health issues, are often seen as a choice in the Asian culture, which puts blame and shame on the sufferer and further blankets them in secrecy and stigma.

Practicing for more than 17 years as an eating disorder specialist, expressive art and clinical depth psychotherapist, and registered dietitian, I am fortunate to have integral clinical insight into the heart and mind of eating disorders. I can passionately say eating disorders are one of the most complex of all mental illnesses to treat and overcome. That said, full recovery is achievable, if you have the right treatment model support.

Is it about vanity?

Eating disorders have absolutely nothing to do with weight or looks (though present themselves as such), and everything to do with identity of self. And no, they are not a “choice”. No one ever chooses to go down this road. All eating disorders are an illness like any other “acceptable” diseases, such as cancer, heart disease, dementia, psychosis, etc., and should be given the same respect.

Why are they so difficult to detect?

A question I am asked repeatedly. And my answer is always the same: because you cannot ever see them coming.  It starts as a silent, abusive voice that creeps in slowly over time within the sufferers mind and is usually never expressed verbally.

Why do they occur?

There is no one reason a person develops an eating disorder, but all will present with a thread of varying levels of trauma and a co-occurring disorders attached to them. They are often bred through change, emotional, physical, and/or sexual abuse, bullying, familial dysfunction, anxiety, fear, lack of self worth, and aforementioned trauma.

What are common eating disorders in Hong Kong?

There are several eating disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Those commonly seen in Hong Kong include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Other Specified Feeding and Eating Disorder and Orthorexia (Orthoexia is not yet an official ED diagnostic).

Each eating disorder will present with a personality of its own, and should be treated as such. Approximately 80% of sufferers will present with one or more co-occurring psychological disorders with the eating disorder. The most typical include depression, anxiety disorders, substance abuse, addiction and/or personality disorders.

Do eating disorders only affect girls and women?

No. Boys and men suffer just as much as their female counterparts.

Prevention

While you cannot fully prevent your child from developing an eating disorder, you can take measures to be good role models for them and keep the dialogue open and honest. Be positive body image role models to your children. Avoid making comments about your own weight struggles (or worse, theirs); avoid dieting and exclusion of food groups as “good” or “bad”.  Keep the focus away from the physical and let them feel safe to express how they feel without judgment.

What to watch out for

Since eating disorders are marked by a variety of emotional, physical, and behavioural changes there are a number of cues you can also pick up on before they become a problem. The first step is noticing subtle changes at home, the second, is engaging in open communication with your children. While some of the behaviours may appear to be little more than adolescent dieting and body dissatisfaction (and, some very well are), taken together they can indicate a serious, life-threatening disorder.

The following are some subtle cues your child may be letting off that you can give voice to talk through with them.

Emotional Cues:

• Changes in attitude or performance.
• Expresses body image concerns; constant comparison to others.
• Displays rigid or obsessive thinking about food, eating, and/or exercise.
• Isolates; pulls back from friends.
• Emotions are flat or absent.
• Obsessed with maintaining unhealthy eating habits to enhance performance (sports/modelling/acting/dance).
• Target of current or past body or weight bullying.
• Seeks outside reassurance about looks.
• Incessant talk about food or cooking; uses #FITSPO, #THINSPO on social media.
• Labels foods as good or bad, on or off limits, inflexible about diet without reason.
• Intolerance for imperfections in image, academics, eating, social life, etc.
• Overvalues self-sufficiency, reluctant to ask for help.
• Unable or unwilling to acknowledge recent changes.

Behavioural Cues:

• Dieting or chaotic food intake (pretends to eat, throws away food, skips meals).
• Rigid rules/strict diet (without medical or religious reasons).
• Obsessively exercises for long periods.
• Gives away, shares or hoards food; refuses food prepared by others without knowing exact ingredients.
• Difficulty sitting still: hovers over chair instead of sitting, constantly jiggles legs, and gets up at every opportunity.
• Frequent trips to the toilet.
• Wears baggy clothes to hide a very thin body, or weight gain, or to hide a “normal” body due to concerns about shape and/or size.
• Works through lunch, eats alone.
• Evidence of compulsive behaviours (compulsive hand washing; repetitive movements or speech patterns; need for constant reassurance).
• Denies difficulty with food and/or body image despite evidence for concern.

Physical Cues (IMPORTANT TO NOTE: by this stage it is already a problem):

• Sudden weight loss/gain/fluctuation.
• Complaints of abdominal pain.
• Feeling faint, or cold.
• Feeling full or “bloated”.
• Thinning hair and pale or grey colouring of skin.
• Fainting or dizziness upon standing; frequent fatigue.
• Lanugo hair (fine body hair).
• Dark circles or bloodshot eyes; burst capillaries around eyes.
• Calluses on the knuckles (self-induced vomiting).

What do I do if I suspect my child has an eating disorder?

First and for most, do NOT try to deal with this yourself. Get help and get it fast. I cannot begin to emphasise this enough. The faster the intervention the faster your child can be pulled out of this to deal with the issues that lead them to dive into the illness in the first place. The longer the wait to get professional help, the longer the recovery – it’s as simple as that. And that can take years. And do not just get “any help”. The wrong help will do more damage than no help at all. You need to find a specifically trained specialist. If you cannot find a licensed specialist in your area make sure the clinical psychotherapist, psychologist, or registered dietitian professional has no less than 8 years of supervised ED treating experience and 70 percent of their case load is eating disorder cases.

The first starting point, when in doubt, is to contact your GP or psychiatrist (need not be ED trained) as a starting point.  Also feel free to reach out to me for support or advice, as I will happily refer you to the appropriate professional support if needed. Remember, any time you have concern even if you are panicked – perhaps and for good reason – take deep breaths! Always present a calm supportive front when approaching your child.

Let your child feel safe to talk to you about how they are feeling even if rationally it makes absolutely no sense to you at all. Don’t accuse, avoid raising your voice and whatever you d don’t get angry or blame them. This will ensure the opposite of what you are looking to achieve – open communication and an invitation to the inner mind behind the mask you are witnessing on the outside.

Common Eating Disorders:

Anorexia Nervosa – An eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat. Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling.  Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

Bulimia Nervosa – A serious, potentially life-threatening eating disorder characterised by a cycle of bingeing and compensatory behaviours such as self-induced vomiting designed to undo or compensate for the effects of binge eating. Purging is often conducted secretly so either the person is caught purging to be discovered or a smart dentist will catch on to the erosion of teeth enamel from vomiting.

Other Specified Feeding and Eating Disorders (OSFED) (previously known as EDNOS) – A serious, life-threatening, and treatable eating disorder that encompasses individuals who don’t necessarily fall into the specific category of anorexia, bulimia, or binge eating disorder. It is one of the most common ED diagnoses. Some examples include Atypical Anorexia Nervosa (individual’s weight is within or above the normal range), Purging Disorder, and Night Eating Syndrome.

Binge eating disorder (BED) – A severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating.

Orthorexia – Although not formally recognized as an official diagnostic eating disorder, orthorexia is on the rise. ‘Orthorexia’ means an obsession with “healthy” or “righteous eating”. It begins with a genuine desire to be healthier then morphs into a fixation on defining “organic” “clean” or “right” foods and is often masked under “vegetarianism” and “veganism” with an overall focus not on calories but on overall “health benefits”. This is one the rise and usually morphs into full-blown anorexia. Without formal diagnostic criteria, it’s difficult to get an estimate on precisely how many people have orthorexia, and whether it’s a stand-alone eating disorder, a type of existing eating disorders like anorexia, or a form of obsessive-compulsive disorder. Many individuals with orthorexia also have obsessive-compulsive disorder.