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Teenagers often eat differently from the rest of the family or change the eating habits that they had in childhood. This may be just part of this 'time' in their life and nothing more. However, for some young people it can be a sign of something more serious. If you have some information about eating disorders it gives you a better chance to help your children if they need it or not to worry unnecessarily.

An eating disorder is a serious emotional problem. People with eating disorders:

• become obsessed with their bodies, food and how much they weigh
• can be any age - although the disorder usually begins in the teenage years
• can be either male or female (anorexia is most common in girls and women between the ages of 14-30)
• believe that life will get better and that they will become better people by gaining absolute control over their food intake and body size.

Anorexia and bulimia are two of the best known and most serious eating disorders.

ANOREXIA NERVOSA

Anorexia nervosa is an emotional and psychological illness where people starve themselves to try and get thin. They:

• often believe that they are overweight even though they may actually be underweight
• think of food most of the time but will not eat because for them eating normally would lead to terrifying weight gain
• fear becoming fat so much that they deny their hunger pains
• limit their food intake, are very choosy and may not eat many foods
• often exercise obsessively in order to lose weight, or work towards keeping a very low body weight.

Not everyone with anorexia nervosa is thin all the time.

Sometimes anorexia begins with a weight loss after a physical illness or from dieting.

BULIMIA NERVOSA

People with bulimia have a similar fear of being overweight. With this eating disorder the person gets caught up in a binge, purge, fast cycle.

• Binge eating is uncontrolled eating of vast amounts of food, usually in a short space of time and often done in secret.
• Purging is getting rid of the food by vomiting, using laxatives or diet pills and/or over exercising. Some people vomit even after small amounts of food, especially if the food is something like chocolate which they believe will hurt them.

The binge, purge, fast cycle
Breading this cycle is extremely difficult.

• People binge often as a result of feelings they find difficult to manage. This, in turn, leads to more feelings of guilt - and weight gain.
• To deal with these feelings they purge themselves. This may give some relief at first, but then the guilt returns - along with the feeling of being out of control.
• In an attempt to gain control they stop eating.
• After a while hunger strikes and the cycle begins again.

The cycle can happen many times a day leaving people feeling depressed, sometimes suicidal, disgusted at themselves, withdrawn and having a belief that they are not able to control their behaviour.

Both anorexia and bulimia are serious problems and deserve specialised and sensitive care.

CAUSES

There is not one single cause for an eating disorder. An eating disorder usually develops because of a combination of things eg. social pressures, family factors, personal feelings and chemical or hormone changes in the body at adolescence.

Some of the stresses or pressures that may contribute to eating disorders include:

• being worried about all the new responsibilities that 'growing up' brings
• communication problems between family members (this is common in adolescence as young people test limits and move towards independence)
• low self esteem
• stress (a major change or stressful situation such as breakdown of a relationship, birth of a child or the death of someone important in the persons life). These situations can make people feel overwhelmed and unable to cope, and they may focus on dieting and body image as a way of getting some control back into their lives
• being a 'perfectionist' and setting their standards so high that they can never do as well as they want to and then they feel they have failed
• depression
• severe shock, such as sexual abuse
• messages from the media, television, films and magazines presenting the 'ideal' shape as slim and fit. With such a great emphasis placed on being thin, many people believe that they need to be thin to be successful and attractive
• social pressure for women to compete.

WHAT TO LOOK FOR

Eating disorders can show up in what people do but the underlying emotional stresses are not always easy to see.

Although the list of signs below show that something is wrong, the cause may not always be an eating disorder. You should check with your doctor.

Signs:

• weight loss, failure to gain weight when growing, or weight that goes up and down
• lack of regular meal patterns (but remember, lots of young people dont eat meals regularly)
• tiredness, lack of energy and strength
• depression
• thinking and talking all the time about food and dieting
• obsession with body weight or shape
• a preoccupation with the preparation of food for others to eat
• over-exercising and being worried if they are not able to exercise for some reason
• avoiding eating with other people
• secrecy around food
• hoarding food
• fear of losing control of eating
• regularly going to the toilet during and after meals
• irritability and mood swings
• avoiding friends and family
• menstruation (periods) stopping or not starting.

LONG TERM EFFECTS

If left untreated severe anorexia and bulimia can mean long term problems with physical and mental health. Some people will recover completely, others will not. With some it can be fatal. Taking notice of early warning signs and getting early treatment is very important.

Physical effects
The physical effects can be serious but are generally reversible if the illness is tackled in the early stages.

Short and medium term effects on the body can include:

• strain on (and sometimes damage to) most of the body and internal organs
• indigestion
• constipation
• diarrhoea
• the loss of, or irregular periods
• severe sensitivity to the cold
• down-like hair all over the body (a result of inadequate nutrition)
• inability to concentrate.

Severe bulimia is likely to cause:

• erosion of the enamel on teeth from vomiting
• swollen salivary glands
• chronic sore throat and gullet
• the possibility of damage to the stomach and throat.

• difficulties with activities which involve food (eg not wanting to eat with others)
• loneliness
• deceptive behaviours relating to food
• fear of disapproval should the illness become known, mixed with the hope that family and friends might step in and give help
• mood swings, changes in personality, emotional outbursts or depression.

• DON'T PANIC - help is available!
• Dont assume that the person knows what is needed in regard to help. On the other hand, the person may know what is needed for help but may not be ready or willing to take that step.
• Gently speak to a child who is showing any of the above behaviour. Use open-ended questions eg "How do you feel about going to school?" rather than "Do you like going to school?"
• Pick the best time to ask your children or young people how they are going and what is happening in their world.
• Try not to focus too much on food and weight. Remember, food is not the main issue, it is how they feel about themselves that directs their behaviour with food.
• Be aware of the comments you make about the other peoples appearance - children and teenagers will listen closely to your opinions about what you find acceptable.
• Be patient . . . it can be difficult for children who may not understand the problem themselves.
• Give praise and encouragement for small achievements as well as large ones. Do what you can to build your children's self esteem.
• Think about your own feelings about anorexia/bulimia and your own body.
• Don't let the eating disorder dominate your relationship with your child or teenager. Separate the young people from the problem. Make sure you see all the other good things about them as well. Tell the child or teenager honestly that you love and care for her.
• Get support for yourself as well as for your children.
• Dont try and control your childs life
• If your children are uncooperative, still seek advice and support for yourself.
• Do encourage them to get professional help; find out whats available and then let them know
• Remember there is no quick and easy to solution.
• FAMILY AND FRIENDS CAN HELP
• Don't blame yourself. No-one is to blame.

TREATMENT

Responding to early warning signs and consulting a doctor is one of the most important things you can do.

Once the illness has been diagnosed a range of health professionals may play a role in helping your child to recover. They may be doctors, nurses, psychiatrists, psychologists, dietitians, social workers, occupational therapists and dentists.

• Sometimes it may be necessary for a young person who is severely malnourished through anorexia to spend some time in hospital.
• Treatment may include counselling and medication to help severe depression or to correct hormonal and chemical imbalances.
• Dietary education might be provided to help guide new healthy eating habits.
• Out-patient treatment is usual for people suffering from bulimia.