Eating Disorders 

Eating disorders are serious psychiatric disorders and are increasing in young people on a global level. Eating disorders can affect people of all ages, however, pre-teens, adolescents and young adults are particularly vulnerable. Eating disorders affect all cultures, countries and gender identities. 

Whilst the average age of onset is 13–25, with girls being more at risk than boys, an awareness of the early signs and symptoms is important for parents.

The Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5, outlines the criteria for diagnosis of eating disorders. 

Young people can reach the threshold for diagnosis in the following:

• Anorexia Nervosa (AN) 
• Binge Eating Disorder (BED)
• Bulimia Nervosa (BN)
• Other specified Feeding and Eating Disorders
• Avoidant / Restrictive Food Intake Disorder (ARFID)
• Unspecified Feeding and Eating Disorders 
• Pica
• Rumination Disorder.

Orthorexia is not formally listed in DSM-5 (instead, patterns may be grouped under ARFID or AN).

It can be frightening and frustrating to watch your child struggle with escalating symptoms of disordered eating. It can be difficult to understand why young people with eating disorders seem to be unable to simply ‘stop’ or change. It can also be difficult for parents to know when to reach out for professional advice. 

Please visit our library section for further reading recommendations to support and educate parents on eating disorders in children, teens and young adults.

Causes of Eating Disorders 

Eating disorders are complex. They are characterised by abnormal patterns of eating. However, there are many factors in the development of eating disorders that are not directly related to food intake or body image. 

Depression, anxiety, bullying, conflict at home, perfectionism, obsessive compulsive disorder (OCD), and other co-occurring psychiatric illnesses can all influence the development of eating disorders in young people. 

Having a parent or family member who has suffered from an eating disorder, or other mental health concern, can significantly increase the likelihood of a young person being diagnosed with an eating disorder or other mental health condition. 

Early Warning Signs and Symptoms

Whilst many young people will experience some of the following signs and symptoms, it is important to reach out for advice from an eating disorder specialist if you notice any of the following:

• Restricting food groups (meat, flour, butter, sugar, carbs, etc)
• ‘Clean eating’, Vegan or Vegetarian (in families where not routinely practiced) 
• Refusing meals or skipping meals
• Lunchbox regularly left untouched or ‘forgotten’
• Changes to eating patterns 
• Skipping family mealtimes of sharing foods
• Eating alone or in secret 
• Sudden interest in menu planning, food shopping, cooking or baking, but refusing to eat what they have cooked or baked
• Going to the bathroom immediately after eating 
• Adding water or other liquids to foods
• Cutting foods into small pieces, eating food in a specific order, or any other rigid habits around plating or ordered eating
• Insisting on certain plates or cutlery
• Time rules around eating (e.g. no food after 6pm, or no carbs after 2pm)
• Hiding, smearing, throwing or chewing and spitting food
• Eating large quantities of food (with or without appearing to gain body weight)
• Eating regularly overnight 
• Drinking excessively (particularly water before meals or when hungry)
• Changing clothes types – wearing baggy clothes 
• Starting a ‘Diet’ or ‘Food Plan’
• Regular use of meal replacements 
• Vomiting after meals 
• New exercise goals / over exercise / high exercise
• Changes in physical appearance 
• Increased concerns about appearance, shape or body size
• Expressing negative views on those in large bodies  
• Feeling cold more often
• Stomach pains / constipation / loose stools (laxative use)
• Expressing guilt or anger after eating
• Irritable mood / increased feelings of stress at mealtimes
• Self-harm or thoughts of suicide / depression / insomnia 
• Increased anger 
• Isolation.  

Brain Changes in Teenagers 

Our brains are continuously adapting and changing. The human brain is not fully developed until we are well into our 20s. The brains of teenagers are rapidly changing and developing, making the adolescent and emerging adult years developmentally important. It also makes the teenage brain vulnerable. Eating disorders, substance use, trauma and other mental health concerns may influence, change and impact the fragile system of a teenager or young adult. 

Eating disorders can cause significant changes to the brain, during these important developmental years. Inadequate nutrition, changes to eating patterns, restriction, bingeing, trauma and stress have all been shown to cause changes to the brain and affect some of its important functions.

Do Eating Disorders Need Specialist Treatment? 

Eating disorders are incredibly complex and always require specialist treatment. We know that the earlier treatment is started, the more favourable the outcome. Early intervention is one of the most important decisions that families can make. Decisions to engage in Eating Disorder Treatment should not be based upon weight, BMI, academic performance or ‘looking ok’. A professional evaluation is always needed. 

A specialist Eating Disorder Team will have psychotherapists, mental health professionals, dieticians, psychiatrists and nurses; who will work together to provide treatment plans to meet the individual needs of young people and their families.

Eating Disorder Treatment can often be a lengthy process, and it is important to complete treatment. Full recovery is possible.

Eating Disorder Programs at The Wave

Eating Disorder Programs at The Wave are designed specifically for teenagers, young adults and their families. The Wave Programs meet the differing care needs of young people with eating disorders, including: 

• Higher-Level of Care (HLOC) for Eating Disorders (1:1 Care) 
• Inpatient Care for Eating Disorders 
• Residential Programs for Eating Disorders
• PHP – Secondary Care at Transitions House for Eating Disorders
• Outpatient Eating Disorder Treatments (by assessment)
• Group Therapy for Eating Disorders (by assessment)
• Family Therapy.

Our Trauma-Informed Approach

At The Wave, we understand that the early intervention and treatment of eating disorders significantly improves the rate of full recovery and reduces the effect of any minor future lapses. Eating disorders (and associated behaviours) of up to three years’ duration have a significantly higher rate of successful treatment. (FREED, 2020. in conjunction with The Maudsley Hospital).

There are various approaches to treatment for eating disorders, and at The Wave, we take a trauma-focused approach that treats the whole ‘self’. 

Trauma-informed treatment of eating disorders in residential care is essential for the long-term foundations of recovery. We understand that eating disorders are much more complex than reaching the threshold criteria for diagnosis. 

There is a well-established link between trauma, dissociation and eating disorders. Indeed, living with an eating disorder in an active phase can be living ‘in the trauma’. 

Over time, a young person challenged by an eating disorder (ED) will become more deeply entwined with his/her eating disorder and less connected to the self, to others and to the hopes and dreams of earlier years. Teenagers who have experienced trauma and an eating disorder often have an unsettled identity, worthlessness, shame, perfectionism, avoidance and isolation. 

EDs often follow a series of hidden and overt lifetime trauma events. Teenagers and young adults with eating disorders report a high incidence rate of traumatic lifetime events; bullying (both online and offline), living in a family with untreated substance use or mental health issues, complicated parental separations and divorce, violence, adverse childhood experiences, critical or harsh environments and co-occurring mental illness. 

Our trauma-informed eating disorder treatment provides evidence-based care in medical, nutritional, psychological and neurological perspectives.