Disordered Eating in Adolescence:
What it is and how to spot it

For many of us, most of what we know about eating disorders comes from depictions in film and media. With a lack of close exposure, it can be hard to understand the nuances of how eating disorders develop, present, and operate over time. Understandably, this can make it difficult to recognise in ourselves and others, especially in the early stages. The sooner symptoms can be identified and addressed, the better the outcomes are likely to be.

The term ‘disordered eating’ (as opposed to ‘eating disorder’) refers to a range of irregular behaviours, attitudes and beliefs about food and eating. Changes may be subtle at first but will often escalate over time, as patterns become stronger and more entrenched. If this pattern of behaviour fits with a certain type and severity of symptoms, we call it an ‘eating disorder’. Some people who experience disordered eating go on to develop a diagnosable eating disorder, while some experience enduring patterns of irregularities that do not align with a particular diagnosis. In either case, therapeutic intervention is a useful and often necessary component of breaking the cycle.

Statistically, adolescence is the time when disordered eating is most likely to develop. This makes it a great time for early intervention. Because adolescence is a time of significant growth and change, it can be hard to tell what parts are attributable to normal development, and what may be cause for concern. When it comes to disordered eating, no single symptom will tell the full story. While it is important not to be over vigilant, it can be useful to know what to look out for.

Here are a few things to keep in mind:

1. Changes in body weight or shape
   While some fluctuations in body weight and shape are normal during adolescence (especially puberty), large and/or sudden changes may warrant concern. You may notice a marked increase or decrease in your young person’s weight that cannot be easily accounted for. It is important to remember that, despite being a well-known indicator, weight loss is not always a symptom of disordered eating and should be considered in the context of other symptoms or behaviours.

2. Changes in eating habits or behaviours
   Disordered eating looks different from person to person. Some young people actively restrict their food intake in ways that include skipping meals, reducing serving sizes, frequent dieting or extending gaps between meals. For some, disordered eating may be less obvious. They may engage in patterns of eating that are irregular (oscillating between over and under eating), eliminate certain food groups, or feel a loss of control over their eating. Having a logical explanation for these changes (e.g., excluding animal products due to veganism) doesn’t necessarily rule out concerns.
   
   People who are anxious about their eating may also eat in secret or make marked efforts to avoid eating in front of others. They may be more withdrawn and avoid social activities that involve eating or body exposure (e.g., going out for dinner or swimming with friends). These changes may be subtle at first but often build and combine as the problems increase.

3. Changes in beliefs or attitudes
   Disordered eating is almost always accompanied by ruminating thoughts. People often become preoccupied with thoughts about food, calories or weight and can have difficulty focusing on other things. This makes it hard for a young person to be as present and alert during their usual activities, often resulting in reduced participation and performance. For example, they may have a harder time maintaining grades or following conversations.
   
   Unfortunately, young people with disordered eating tend to overvalue the importance of physical appearance. They may use it as the primary measure of their self-worth, achievement or likability. Behaviours and thought processes that prioritise looks above all else may be indicative of this overvaluation process.
   
   As our brain becomes malnourished, our thought processes become more and more rigid, and we are less able to integrate new information and ideas. We are more likely to see things as black-or-white, good-or-bad, and to be guided by strict rules instead of instincts. You may notice fewer moments of spontaneity, playfulness and joy. As you might imagine, getting stuck in these patterns of thinking tends to perpetuate skewed perspectives and beliefs.

5. Compensatory behaviours
   In an effort to alleviate guilt for eating or to reduce the impact of the food/calories on their body, some young people engage in what is known as compensatory behaviours. This includes deliberately throwing up after eating (purging), engaging in excessive exercise and/or inappropriate use of laxatives. These behaviours strain the body and are often associated with medical complications.
6. Physical health complaints
   Disordered eating can influence the development or exacerbation of unpleasant or harmful physical symptoms. Gastrointestinal issues are common and include constipation, bloating, diarrhoea, and abdominal pain. Lack of adequate nutrition can cause dizziness, fatigue and fainting and put undue pressure on the heart. When medical stability is compromised, you may also notice changes in skin and hair (dry and brittle) and menstrual regularity. As you can imagine, it is important that your young person see a doctor for medical examination and monitoring.

If you or someone you know are noticing these symptoms, look into it. Speaking to a parent, friend, school counsellor or any trusted adult is a great first step. Making a time to speak to your GP is highly recommended to do a further assessment and investigate any physical health complications. They can also refer you to relevant health professionals, including a mental health worker, to start the process of getting well.
Remember, early intervention is key!