Signs of Anorexia Nervosa in Adolescents and Family-Based Treatment

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Anorexia is an eating disorder where someone worries about gaining weight and takes extreme measures to lose or avoid weight gain. It can be life-threatening if left untreated. If you have noticed that your child or loved one has been worrying excessively about their weight, skipping meals, or losing an extreme amount of weight, there may be concern for anorexia. Family-based treatment is an effective way to help your child or loved one manage their eating disorder because it involves your family members in their treatment. Read on if you want to know more about the signs of anorexia in your child or someone you love, and learn how family-based treatment can help.

What Is Anorexia?

Anorexia, more specifically called anorexia nervosa, is an eating disorder where someone has abnormally low body weight, an intense fear of gaining weight, and a distorted perception of their weight. This differs from anorexia, which involves losing weight or not eating due to other medical problems, such as cancer. With anorexia nervosa, the underlying problem is a psychological disorder. 

When someone has anorexia nervosa, they typically equate thinness with self-worth and go to extreme efforts to avoid weight gain, such as vomiting after eating or misusing laxatives, diet aids, diuretics, or enemas. These efforts often interfere significantly with their daily life. They may use these unhealthy behaviors to cope with an underlying emotional problem.

Signs Of Anorexia

The most common age for anorexia nervosa to begin is 15-19 years, in both young females and males. Therefore, it is important to be aware of the signs of anorexia in adolescents so that you can keep an eye on your children. There are both physical and psychological signs of anorexia nervosa, so you should be on the lookout for both types in your teen. Your pediatrician will also monitor your teen’s weight at their annual check-ups to screen for any concerning trends. 

Physical Signs of Anorexia Nervosa

The physical signs of anorexia nervosa to look for in your teen include:

  • Weight loss
  • Lack of age-appropriate weight gain
  • Lack of menstrual periods
  • Difficulty tolerating the cold
  • Constipation
  • Swelling of the arms or legs
  • Blue discoloration of the fingers 
  • Dry or yellowish skin
  • Thin hair that breaks or falls out
  • Dizziness or fainting

Psychological Signs of Anorexia Nervosa

Anorexia nervosa is a psychological disorder. The emotional and behavioral signs and symptoms of anorexia nervosa to look for in your child or loved one include:

  • Severely restricting food intake through dieting or fasting
  • Exercising excessively
  • Binging and then making yourself vomit
  • Excessive use of laxatives, enemas, diet aids, or herbal products
  • Excessive preoccupation with food
  • Frequently skipping meals or refusing to eat
  • Denial of hunger or making excuses for not eating
  • Eating only a few “safe” foods, such as those low in fat or 
  • calories
  • Having a rigid meal or eating habits
  • Not wanting to eat in public
  • Lying about how much food you’ve eaten
  • Fear of gaining weight
  • Repeatedly weighing or measuring your body
  • Frequent checking in the mirror to look for perceived flaws
  • Complaining about body fat
  • Covering up in excessive layers of clothing
  • Lack of emotion
  • Social withdrawal
  • Irritability
  • Insomnia

Binge/Purge Subtype

There are different subtypes of anorexia nervosa, and one is called binge/purge type. People with this type of anorexia, they eat too much in one sitting and then make themselves vomit afterward to avoid weight gain. The difference between binge/purge anorexia and bulimia is body weight. With anorexia, the individual has an abnormally low body weight. In contrast, with bulimia, they will have normal to above-normal weight.

Treatment for Anorexia Nervosa

Anorexia nervosa can be life-threatening. The treatment for anorexia nervosa is centered around nutritional rehabilitation and psychotherapy. This therapy can be provided at an inpatient facility where the patient lives while receiving treatment. If the case is less severe, it may be treated with outpatient therapy. While there is no medication to treat anorexia nervosa and nothing can cure this psychological disorder, therapy can help people to get control of it. One important component of this therapy plan for teens is to include their support network through family-based treatment.

What Is Family-Based Treatment?

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Family-based treatment, or FBT, is an effective treatment for anorexia nervosa, especially in adolescents. It usually lasts for six to 12 months. It is a therapy that heavily involves the family, especially the parents or caregivers of someone with anorexia nervosa in the recovery process. Though FBT is typically used for adolescents, studies have shown that FBT is effective in people of many ages, from adolescents to older adults.

If your child or loved one is undergoing FBT for their anorexia nervosa, your role would be to support them on their nutritional therapy journey while they learn to eat more and return to a healthy body weight gradually. Other trusted family members, such as siblings, can also participate in FBT.

Principles of FBT

There are three main principles of FBT:

  1. No assumptions are made about the causes of your child or loved one’s eating disorder. This principle helps prevent anyone in the family from feeling like they’re at fault or being blamed for the eating disorder.
  2. The eating disorder is considered separate from your child or loved one. This tenet treats their eating disorder as an illness that can be overcome rather than a fixed part of their identity.
  3. The therapist involved in your child or loved one’s care guides you through the recovery process but does not tell you what to do. This principle helps you form a plan to help your loved one recover while tailoring their meals to your family’s eating patterns.

Who Benefits from FBT?

FBT is beneficial for treating anorexia nervosa in teens because it allows the family to understand and participate in the nutritional therapy plan. Because teens rely on their families for food and meals, educating the whole family about what nutritional support is needed during their recovery can be very helpful. FBT can be useful to identify and correct any problems with the home environment or family dynamic that may be contributing to the problematic behavior. It also improves rehabilitation because it helps surround the person with their support network during recovery.

FBT is not right for every family. If FBT doesn’t work for you or your loved one, alternative treatments, such as multifamily treatment (MFT), may work for you. MFT is similar to FBT, except you work with five to seven other families undergoing the same treatment, and the families support one another during the process.

Phases of FBT

Phase One

The parents or caregivers of someone with anorexia nervosa are very important for helping them get back to a normal weight. If you have a child with anorexia nervosa, for example, you would decide what they eat and how much, monitor their food intake, and prevent them from exercising to lose weight. You would do this to help your child recover at home. Phase one continues until your child’s condition starts to improve with weight gain and decreased resistance to eating.

Phase Two

You and your child visit a therapist to talk about effective ways to have family meals while helping your child overcome their eating disorder. Your child is gradually given back control over their own eating. For example, your child may serve themselves food at dinner with your supervision. The purpose of this phase is to show you that your child is improving and encourage them to eat more than they normally would.

Phase Three 

This phase involves a review of your child’s progress and assuring your therapist that you and your child can return to your everyday lives. You and the rest of the family identify issues your child may face moving forward and talk to the therapist about healthy ways to cope with those issues. Then FBT ends with your child becoming independent again.

Results of FBT

It’s important that the recovery and rehabilitation process be gradual. When someone has been starved for a long time, it can be dangerous to refeed them too quickly. It’s important for teens with anorexia nervosa and their families to be patient throughout this process. It may be helpful to think of it as learning a new skill, so it will take time.

With the help of FBT, recovery from anorexia nervosa is possible. Most people who received FBT had improved physical and psychological symptoms after therapy. There is always a risk of relapse, so you should continue to support and monitor your child or loved one even after therapy has been completed.

How To Get Help

If you suspect your teen has an eating disorder, take them to their pediatrician. Unfortunately, many people with anorexia don’t want to seek help for their eating disorder and may hide it from their families. If you think you have an eating disorder but don’t want to tell your family, speak to someone you trust about your condition and reach out to your doctor. Your doctor will talk to you about treatment for anorexia and let you know if FBT is right for you.

You can learn more about eating disorders from these organizations:

Resource Links:

  1. “A Brief Modified Family-Based Treatment Intervention for Youth With Mild Eating Disorders: A Case Series” via Frontiers in Psychiatry
  2. “Anorexia Nervosa” via Mayo Clinic
  3. “Eating Disorders – Resources” via MedlinePlus
  4. “Family-based treatment of eating disorders in adolescents: current insights” via Adolescent Health, Medicine and Therapeutics
  5. “Anorexia Nervosa” via StatPearls 
  6. “DSM-5 Changes: Implications for Child Serious Emotional Disturbance” via Substance Abuse and Mental Health Services Administration 
  7. “Anorexia nervosa in adolescents” via British Journal of Hospital Medicine