In my last column, I presented data on how prevalent eating disorders are among teens and what the different eating disorder diagnoses are. It will be helpful to understand the causes and risk factors associated with eating disorders and the signs and symptoms to look for. As with all mental health issues, the more knowledge parents have, the more likely they are to take preventive measures, as well as recognize problems in their early stages. Naturally, early prevention and intervention reduces potential harm significantly.

Risk Factors: Risk factors for eating disorders fall into biological, social and psychological categories. Genetics play a role, and if a teen has a close relative with a diagnosed eating disorder, their risk for developing such a problem is greater. In the same vein, if there is a family history of significant mental health issues—such as depression, anxiety or addiction—it may predispose the teen for developing an eating disorder.

Psychologically, the trait of perfectionism is a leading cause for ED. When teens experience unrealistically high expectations and are faced with the prospect of needing to control the outcome of things, they often transfer those unrealistic expectations to trying to control their food intake or appearance. Along with perfectionism comes the need to control, and trying to control results when one does not have control of all the factors leads to frustration, anxiety and a distorted attempt to control certain things like food intake and body weight. Body image dissatisfaction/distortion is a significant factor in the unhealthy use of food to achieve unrealistic results.

Social risk factors are numerous, and grow daily with a teen’s devotion to social media. The internet is filled with messages to teens regarding “the ideal body,” often unrealistic and unattainable. A Stanford study found that 96 percent of young eating disorder patients admitted they learned about purging and weight-loss methods from the Internet. There are extremely dangerous websites for teen girls, Pro-Ana (for pro-anorexia) and Pro-Mia (for pro-bulimia), which provide “thinspiration” for girls, accompanied by photos of bony-thin fashion models, along with advice about losing weight, being thin, attracting male attention and other destructive suggestions. As an example, here are the “Thin Commandments” from one of the websites:

• If you aren't thin you aren't attractive.
• Being thin is more important than being healthy.
• You must buy clothes, style your hair, take laxatives, starve yourself, do anything to make yourself look thinner.
• Thou shall not eat without feeling guilty.
• Thou shall not eat fattening food without punishing oneself afterwards.
• Thou shall count calories and restrict intake accordingly.
• What the scale says is the most important thing.
• Losing weight is good/gaining weight is bad.
• You can never be too thin.
• Being thin and not eating are signs of true will power and success.

These are powerful and painful messages, aimed at vulnerable teenagers.

Another risk factor, closely associated with social media, is bullying and cyber bullying. A shocking 60 percent of teens with eating disorders reported that bullying contributed to the development of their problem. The anxieties faced by teens as they post pictures of themselves online, fearful of how others will respond, is so overwhelming that they often take hundreds of photos before they are willing to post the perfect one. Once a teen forms a negative body image, they may strive in unhealthy ways to achieve what the media portrays as the ideal body.

There are other subtle societal factors, such as constant bombardment in the media of Photoshopped perfect figures among teen celebrities and advertisements designed to manipulate purchases to make one look “better.” The attitude that parents demonstrate toward weight plays a significant role in how teenagers feel about themselves physically. While most of us as parents understand the need to avoid direct criticism of our children’s weight or eating habits, we are conflicted about trying to help them feel and stay healthy while at the same time maintaining their self-acceptance and self-care. Very well meaning parents will ask their child “do you think you really need to eat that piece of cake,” not knowing that it may have a devastating effect on his or her self-image. There are also powerful messages parents give off without realizing it. I believe this is especially true when the fathers of young girls are unaware of the impact of their comments about another person’s appearance. Remarking on the beauty or body of someone on TV, at the beach or somewhere else, either positively or negatively, will be absorbed by a teenage daughter, and often leads to unrealistic self-expectations.

Interestingly, most experts agree that ultimately eating disorders are not really about wanting to be thin, but rather, expressions of underlying issues of anxiety, depression and trauma. Controlling food intake is a way of managing internal pain and emotional discomfort, and trying to control. Although the vehicle for the problem is food—restricting, purging, etc.—the main issue is of control and obsession of thought. Teens with eating disorders are constantly thinking about their body and their weight, and what they are eating. It becomes a round-the-clock obsession which greatly impairs normal functioning.

In our next column, I will address signs and symptoms, what to look for and what steps to take if you are concerned about your teen and eating disorders.

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

Moe Gelbart, Ph.D. 
Executive Director, Thelma McMillen Center