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How to tell if your child has an eating disorder

By Melody Tan 6 min read
Sunday, May 24, 2020

Young people suffering from body image issues can be adept at hiding their insecurities or may not even realise they have a problem. Here’s how you can help them.

I’ve always been somewhat conscious of my less-than-flat tummy, even when I was a teenager with a higher-than-normal metabolism. I was borderline underweight but I didn’t have a flat tummy (go figure), and that’s all I was concerned about.

It’s a common bond between us women, this shying away from what we see in the mirror; hating our bodies for the way they look (or don’t look). For those of us who have had babies, the struggle can often be even harder: The stretch marks and saggy stomachs after a pregnancy certainly don’t help.

Having my son some three years ago has done no favours for my less-than-flat tummy. Today, whenever I’m exercising, I joke to my husband I need a bra for my stomach to support all the loose belly flesh bouncing up and down.

I’m luckier than some. My dissatisfaction with my body has often been an afterthought, probably because mine was mostly an internal struggle that I could keep mostly to myself. Nobody made snide comments and I certainly wasn’t bullied for the way I looked.

Belinda Hilyer, from Tasmania, was 14 when she developed an eating disorder. She was 1.8 metres tall and weighed 120 kilos.

“I was teased so much,” says Belinda. “Then my parents bought me a horse and I walked to him daily. I found that I was dropping weight and all of a sudden, other kids liked me. I thought, I must drop more weight and everyone will like me.”

Belinda ended up weighing a mere 28 kilos.

“Bulimia, pills, starvation . . . I’ve been there,” she says. She did so much damage to her body that by the time she was 20, doctors told her she wouldn't be able to have kids.

Body image issues start from as young as six

While we often think that young people start developing body image issues from around their teenage years, shocking studies have found that more than half of girls (and one-third of boys) as young as six feel their ideal body is thinner than their current body size.

Six.

Today, I’m complaining about just how much my son eats and how often he’s declaring, “I’m hungry!” He’s still got his baby fat, gorgeously adorable with his chubby cheeks and rotund belly. It breaks my heart to think that in just over two years, he may be rejecting food because he’s unhappy about his own body. A child who not long ago learned to write his own name could be hating the way he looks.

And even if he escapes having body image issues at that young age, the odds are against him as he gets older. Teenagers with eating disorders are growing at an increasing rate, and more so among boys. Around one in five woman has an eating disorder and it’s the third most common chronic illness in young women.

We tend to blame the media for generating unfair standards of beauty—which is true to a certain extent. However, as skincare company Andalou Naturals discovered in a survey they conducted last year, 70 per cent of women admitted that the overwhelming source of pressure comes from their own high expectations, and only 30 per cent said their pressure is driven from social media.

“Many young people have concerns about their body image, which is normal developmentally,” says Lauren Callaghan. “However, if these concerns start interfering with their ability to live life, see friends, socialise and go to school, then it is likely that your child has a significant problem."

Lauren is a specialist consultant clinical psychologist. She has worked at world-renowned research centres where she was recognised as a leading psychologist in the field of obsessive-compulsive disorders (OCD), body dysmorphic disorder (BDD) and anxiety problems. After running a successful practice in London, she now works independently as a clinical psychologist in Sydney and continues to write self-help books in her field of expertise.

When young people move on from being concerned about how they look to being completely fixated, it’s likely they may have a form of BDD. The worst thing is that if my son has BDD, I may be the last to know. The sad reality is that when it comes to body image issues and eating disorders, parents are often left in the dark.

“[People suffering from] body image problems and BDD . . .  often avoid seeking help,” Lauren writes in her book, Body image problems & body dysmorphic disorder. “They may believe they will be judged as vain, and not taken seriously. BDD is a serious psychiatric condition that requires evidence-based psychological treatment and may also need medication and specialist input from professionals who specialise in body image issues and BDD.”

Identifying body image issues in children

Whether it’s BDD or muscle dysmorphia (a form of BDD more common with boys), the signs and symptoms are the same. According to Lauren, these include:

  • A significant worry about one or more “perceived” defects or flaws in physical appearance which other people cannot see or notice.
  • Engaging in repetitive behaviours designed to camouflage the part of the appearance they worry about, and avoiding doing things that might draw attention to the area. 
  • Common BDD worries include the skin, hair or nose, but can be about any area of the body.
  • In muscle dysmorphia, boys may worry about their body being insufficiently muscular, too small or puny. They’ll regularly engage in compulsive exercising and adhere to strict diets.

In her book, she lists a few more behaviours that parents need to watch out for:

  • Checking appearance as often as possible, either by touch or in a mirror.
  • Avoiding any mirrors or reflective surfaces, as they remind them of their appearance and thus cause extreme anxiety.
  • Reassurance seeking—asking people to provide reassurance that a perceived or small flaw is not too visible, or has not worsened.
  • Skin picking in an effort to remove perceived flaws.
  • Excessive grooming
  • Frequently comparing appearance with others, online or in person.
  • Avoiding situations that may draw attention to their appearance. This will include avoidance of photographs, social events and intimacy.
  • Attempts to correct, camouflage or cover up the perceived flaw. This can even go so far as getting surgery to “correct” the problem.
  • Scanning the internet and gathering data on their perceived flaw and possible solutions that can “fix” the problem.

“People who have BDD aren’t usually seeking perfection. Most are not trying to be flawlessly beautiful. They are just looking to be acceptable, so that they can walk to the shop without offending people who, they believe, shouldn’t have to look at them. They are simply trying to reach a point where they look ‘normal’ enough to fit into society,” writes Lauren.

And as Andalou Naturals discovered, one in two young women will go to any lengths to achieve their perception of beauty, with half feeling more empowered when they have good skin.

With those kinds of odds, it’s vital that parents are vigilant when it comes to their children’s perception of self.

It wasn’t until Belinda got “super skinny” that they discovered she had an eating disorder as she used to hide food and give it to her dogs.

“BDD can be mistaken for social anxiety, depression, an eating disorder and OCD too, so if you are concerned that your child has BDD, please seek help. Even your local doctor may not understand the problem, so ask for a referral to a psychologist or psychiatrist to get a formal diagnosis. There is good help available and treatments that work for BDD so it is important to seek help,” says Lauren.

“With good help, your child should recover, although it may take time. Remember your child will be feeling anxious, and possibly depressed, and will need your patience, kindness and love.”

Recovery from eating disorders and body image issues is possible

For Belinda, her recovery process took several years. She talked to a few psychologists and at one point, spent 14 weeks in hospital. “I had a guardianship put on me which meant I couldn't legally leave the hospital until I hit 60 kilos,” she said.

Belinda’s turning point came the day after she went into cardiac arrest. “I was 29 years old,” she says. “When I woke up, I had lost the use of my entire left side and was told I wouldn't walk again. I finally decided to fight for my life and refused to believe this was as good as it gets. Twelve months later, I was walking . . . and met the love of my life.”

Even though she was told she would never be able to have children, Belinda and her partner started IVF attempts a few years later. After several years, “we were running out of money, so we decided to try one [last] time. Ten months later, I had Maisey. She is my miracle and the love of my life.”

Belinda says she still struggles with her eating disorder but has developed coping mechanisms.

“There isn’t a single day where I don’t think, Maybe I shouldn't have one more bite, or calculate in my head the calories that are in the piece of apple I eat. But there comes a point in time where life just means more. I see my daughter's face and it means more . . . and I choose me.”

Where to find help if your child has body image problems

Australia: Butterfly Foundation

New Zealand: Youthline

Melody Tan is project manager of the Mums At The Table multimedia initiative. She lives in Sydney with her husband and their preschooler son.