What every parent needs to know about eating disorders

An eating disorder is not a choice, a diet “gone wrong”, nor conscious attention-seeking behaviour. In fact, it’s not really about food at all. It is is a complex mental illness where someone controls their food intake in order to help them cope with difficult feelings or underlying psychological issues such as anxiety, low self-esteem, depression or past trauma.  

What forms do eating disorders take?

Different types of eating disorder manifest with varying behaviour around food, including restriction of certain types, textures or colours of foods, restriction of calories, and disordered patterns of eating, bingeing or purging.

Anyone, regardless of background, ethnicity, gender, shape or age, can develop an eating disorder. In the UK, around 1.25 million people are thought to be affected. NHS figures show a significant recent increase in the numbers of hospital admissions for young people because of eating disorders. Of the 24,300 hospital admissions in 2020-21 (up from 13,200 in 2015-16), almost half were aged under 25. 

Umairah Malik, clinical advice coordinator of UK eating disorder charity Beat, says, “There is no research that talks about age of onset with any certainty, but eating disorders often develop in adolescence around the age of 13 to 14 – perhaps because this is a period where young people experience great physical and emotional change.” 

Left unchecked, eating disorders have a devastating effect on the physical and emotional health of those affected and take a massive toll on those who care for them. However, recovery is possible. “Early intervention is key,” says Malik. “Research shows that the earlier treatment is sought, the greater the chances of recovery.” 

What are the signs of an eating disorder?

Signs vary depending on the type of disorder and the severity of its grip, but any overt focus on or secretive behaviour around food should ring alarm bells. 

Alan Bore, psychotherapist and co-founder of The Surrey Centre for Eating Disorders, a facility that provides support for adults and children from the age of 13 upwards, warns eating disorders can be tricky to spot and that caregivers should always trust their instincts: “First and foremost, parents should be aware of any changes in patterns around eating and exercise. If your child begins skipping or avoiding meals, is suddenly telling you they’ve eaten earlier or will grab something later, cuts their food up into tiny pieces or only eats very small amounts, these could be red flags.”

Bore explains that while some behaviours are more obvious – such as leaving the table immediately to go to the bathroom, or excessively exercising by walking miles to school and back, having always taken public transport previously – other signs are more subtle. “Your child might, for example, tell you they want to eat healthily and try to take over food preparation. While, on the surface, helping in the kitchen seems great, this could be an early sign of orthorexia [an eating disorder that includes an obsession with ‘pure’ food].  

“In addition, you might notice mood swings, social withdrawal, irritability or fatigue, or perhaps your child has lost or gained a bit of weight. Any or all of these things in isolation or observed from time to time might be nothing – your child might simply be interested in eating well or getting fit – but trust your instincts and if the new behaviour becomes frequent, obsessive or secretive, don’t wait to tackle it.”

I believe my child is at risk – what should I do?

Expert consensus is to tackle the issue head-on with empathy, patience and sensitivity. “The first thing to do is open up a conversation with your child,” says Malik. “Do not do this around mealtimes or when tensions in the home are high. Pick a time when your child and the environment is calm. In the first instance, avoid talking directly about food or weight. A good opener would be: ‘I’ve noticed you’ve been a bit quiet lately, do you want to talk about it?’”

Bore agrees: “We advise sitting alongside your child, putting your arm around them and asking ‘How can we get through this together?’ That’s far less isolating and non-shaming. They may well deny anything is wrong at first, but again, trust your instinct, keep communication going and seek professional help if you are concerned.”

The path to professional help will normally begin with your GP, who should refer you either to CAMHS (Child and Adolescent Mental Health Services) or a specialist service. However, NHS services are under extreme pressure and waiting times can be frustratingly long. 

Integrative psychotherapist Tanya Garrity is a member of the British Association for Counselling and Psychotherapy and works on the frontline with young people and their families directly affected by eating disorders. She says: “The guidelines from NICE [the National Institute for Health and Care Excellence] describe a set of symptoms for GPs and professionals to look at when they suspect a child has an eating disorder, but there are still cases of misdiagnosis, and parents and carers can sometimes feel their concerns have not been heard. 

Beat has a downloadable sheet you can print out and take with you when you see your GP, and if you still feel you aren’t getting anywhere, use an online directory of services such as the one from the National Centre for Eating Disorders or Beat’s Helpfinder page and call a private practice to get advice, as they can signpost you to further help so you don’t feel stuck. You can have a one-off assessment or, if money is tight, most therapists will speak to you by phone or email without charge to offer guidance. It can seem difficult to access help at first, but the important thing is not to give up.”

But what if your child doesn’t want to see a professional? Again, communication is key. “Explain to them that you feel it would be good if they had someone outside the family to talk to about what they’re experiencing,” says Garrity. “A surprising number of children will take help when offered, but if they won’t see a GP or talk to a therapist, you can always take the first steps and book an appointment yourself to talk things through so that you feel empowered.

“It’s vital that you educate yourself ,’ agrees Bore. “The Beat website is an incredible resource, offering a helpline, webchat and peer support groups, plus a directory of professionals, so you can be proactive in helping your child.”

Both Bore and Malik are at pains to underline that parents should not blame themselves. “Blame and shame are unhelpful,” says Bore, “but it can be useful to look at your own behaviours around food and check you are modelling good, safe habits. Make sure you have a support system for yourself too. Helping someone with an eating disorder is tough.”

What can cause an eating disorder?

It is not known exactly what causes eating disorders and there is certainly no one root cause. Research points to some people having a genetic predisposition, and areas of study include gut health, as poor gut health is thought to contribute to the onset of eating disorders by influencing thoughts and behaviours. 

Neuroscientists are also discovering more about the correlation between the brain and the onset of eating disorders, using brain imaging to look at the differences in our motivations to eat and how those with eating disorders struggle to read the body’s internal messages or cues. 

Research shows that changes in brain chemicals such as serotonin contribute to eating disorders by shaping our personalities. Having high levels of serotonin increases the likelihood that someone will develop personality traits such as perfectionism, anxiousness or compulsivity, which may help to cause anorexia. Lower levels of serotonin are associated with those who have personality traits like low mood and high impulsivity – commonly found in those with bulimia or binge eating disorders. These serotonin differences are present in recovered individuals, showing serotonin levels are likely to be a cause, rather than a consequence, of eating disorders. Negative thinking is another area of study: people with eating disorders have negative thoughts more often than people who don’t, making negative self-evaluations and negative social comparisons. 

What about social media?

In the digital age, with so much information at our fingertips, it’s normal to wonder whether access to social media is at fault. It’s something many parents ask about, says Bore. “Social media is not in itself a cause,” he says, “but looking at content focused on societal ‘ideals’ around body shape may contribute to the feelings of low self-worth and anxiety that, in those who are vulnerable, may trigger an eating disorder. Parents should have an idea of what their child is accessing and our therapists may suggest a phone detox.”  

Online content termed “pro-ana” (short for “promotion of anorexia”) or “pro-mia” (pro-bulimia) also actively promotes harmful behaviour around food as a lifestyle choice rather than acknowledging eating disorders as an illness. Beat cautions that this content “is dangerous to those who are vulnerable to developing an eating disorder or already ill as it can stir up damaging feelings of competitiveness and unrealistic goal setting”.

Who is most at risk of developing an eating disorder?

Anyone can develop an eating disorder, but certain factors are known to raise the risk in children and young people. Those already suffering from other mental health issues such as trauma (including following sexual abuse), anxiety, depression and OCD may be at increased risk, as are those with autism or ADHD. Children living with a close family member (parent or sibling) who has a mental health issue, an alcohol or drug addiction or an eating disorder are also more likely to develop one themselves. 

A child may be at risk if they have experienced bullying – whether specifically around their weight or not – as this leads to increased feelings of isolation and low self-esteem. Such feelings of powerlessness may lead a child to look to food intake as a way to regain feelings of control over their life. Stress is another risk factor – so starting a new school, moving house or experiencing a change in family relationships (such as divorce) can be flashpoints. 

Types of eating disorder

While most people are aware of anorexia and bulimia, there are many types of eating disorder, all of which are serious and require professional support.

What is anorexia nervosa?

Anorexia is characterised by a deep fear of gaining weight. It involves limiting and negating calorie intake through extreme restriction of food and drink and or excessive exercise, purging or misuse of laxatives. 

For more information and support, visit Beat and the National Centre for Eating Disorders’ dedicated pages about anorexia.

What is bulimia nervosa?

Individuals in the grip of bulimia go through distressing cycles of bingeing on large quantities of food followed by forced purging, making themselves vomit or taking laxatives or diuretics, and putting themselves through excessive exercise. 

For more information and support, visit Beat and the National Centre for Eating Disorders’ dedicated pages about bulimia.

What is binge eating disorder?

People with binge eating disorder eat large quantities of food in bursts – however, unlike those with bulimia, they don’t then “purge” by vomiting, using laxatives or exercising. It can affect anyone but it is more likely to begin in those over 18. Although many people comfort eat from time to time, binge eating disorder is diagnosed if binges are occurring frequently, secretly and involve lack of control and negative emotions such as guilt, shame and anger. 

For more information and support, read Talk ED’s guide. 

What is OSFED?

OSFED stands for “other specified feeding or eating disorder” (also termed EDNOS or “eating disorder not otherwise specified”). These are umbrella terms to describe atypical eating disorders that do not meet the diagnostic criteria for commonly known disorders such as anorexia and bulimia. For example, someone with atypical anorexia might have all the symptoms of anorexia yet their weight remains steady, while someone with atypical binge eating disorder might binge less often and for less prolonged periods. Other conditions that come under OSFED include purging disorder and night eating syndrome. As with other eating disorders, an OSFED can involve secretive behaviour around food and feeling self-conscious or refusing to eat in front of others.

Read more about OFSED here. 

What is orthorexia?

This is an unhealthy obsession with eating “pure” food. Sometimes termed “clean eating”, it becomes an issue when the eating behaviour is used to help the person cope with negative thoughts or feelings, or to feel in control. Those suffering with orthorexia might start out by limiting or cutting out specific food groups, but may cut more and more over time. 

Find more information and support on orthorexia here. 

What is pica?

Pica involves ingesting substances that are not food and should not be eaten, such as paper, chalk, ice or soap, usually in addition to their normal diet. The reasons people develop it are unclear but it is more likely to occur in children on the autism spectrum, who have OCD, depression or schizophrenia or who have suffered a brain injury or psychological trauma. Such cravings can be harmful and it is important to seek medical help if you or someone you know has eaten something other than food. 

Find out more about pica from The Child Psychology Service or the National Autistic Society. 

What is ARFID ?

ARFID stands for avoidant/restrictive food intake disorder, which usually means that people become extremely selective eaters or have little interest in eating. They may have very strong reactions to “new” foods or certain textures, colours, smells or tastes. They may be fearful of what might happen if they eat, such as choking, vomiting or experiencing pain.

For more information and support, visit ARFIDA Awareness UK. 

What is rumination syndrome?

This is a rare behavioural disorder in which food is brought back up from the stomach and either rechewed and swallowed or spat out. 

Find information and support about rumination syndrome here.