How stress impacts eating disorder development and relapse, and what to do about it

Studies have shown that one of the causes of eating disorders is stressful life events. These can be specific events that cause Post Traumatic Stress Disorder (PTSD) or simply day-to-day stressors common in life today. The correlation between stress and eating disorders is important and statistically relevant, both in eating disorder development and relapse. Since many of our kids develop eating disorders in high school and college, both of which are highly stressful, it’s worthwhile to monitor our kids’ stress levels and stress responses.

Common causes of stress for our children:

• School pressure
• Future college/career path
• Sports achievement
• Family stress (e.g. divorce, illness)
• Social group ruptures
• Peer pressure
• Trauma and abuse

A 2013 survey by the American Psychological Association found that teenagers report high levels of unhealthy stress, especially during the school year. The study found that school is the top source of stress for teenagers, followed by determining the “best” college and/or future career. Chronic stress can impact our children short- and long-term, and so the sooner we can identify a problem and support our children in finding tools to manage stress, the better.

Signs of chronic stress in our kids:

• Emotional: anxiety, depression, fear, anger, overwhelm, negative thoughts
• Pysiologically: sickness, chronic fatigue, hyperactivity, trouble concentrating, nausea
• Behaviorally (moderate): poor school performance, procrastination, arguing
• Behaviorally (serious): eating disorders, alcohol, and substance abuse, risk-taking

We have all heard of “stress eating” or “emotional eating.” Eating is a commonly-recognized antidote to stress in our culture, but the occasional over-eating episode is not the same as an eating disorder. When our children develop eating disorders, they consistently under or overeat, control or eliminate “bad” food groups, and attempt to purge calories through vomiting, laxative use or over-exercising.

The development of an eating disorder is often a coping mechanism designed to protect the person from uncomfortable, stressful feelings. A person who has recovered from an eating disorder remains vulnerable to relapse or the development of a new maladaptive coping behavior (e.g. alcohol and substance abuse) if they do not learn to identify and manage stress in their lives.

The greatest gift we can give our children who are in recovery from an eating disorder is support in learning to identify, process, and reduce stress. Here are some tips:

Identify stress

Help your child learn emotional vocabulary so that they can define and label their stress. Find descriptive words and help your child learn the subtle differences in how their stress feels physically and emotionally, and what behaviors the stress stimulates.

For example, a child may express stress as a buzzing in her heart that makes her feel anxious and upset. This feeling may make her want to eat a lot of cookies. Work with her to define her stress, because language can often help the human brain slow down and reflect upon (rather than react to) a stressful situation.

The ability to pause and reflect on stress is critical to recovery. The problem is not that we have thoughts about or the desire to use our maladaptive coping behavior (restricting, binging or purging); it’s only a problem when we act on that desire.

Process stress

Once your child has labeled their stress and defined how it feels physically and emotionally, help them learn healthy processing skills. Provide a toolbox of ideas to help process stress.

For example, would it help to take a walk around the block? Or is it the type of stress that would feel better with a nap? Perhaps talking about the stress with you or a therapist will help. Or maybe making a list will help. There are literally hundreds of ways to manage stress, and having a list of favorites to call upon can be essential to delaying the experience of stress from acting against stress with a maladaptive coping behavior from our eating disorder.

Work together on a list of items that help relieve stress, and then help your child try different methods when stress comes on.

Note that sometimes a child who is in recovery may add eating, not eating or exercising on their list of stress processing tools. Work closely with your child’s therapist to establish boundaries around these behaviors.

Reduce stress

Stress is a normal part of human life, and we cannot avoid it altogether. As your child develops a strong skill set in identifying and processing stress, you may start to notice patterns of stress. Build a list of common stressors in your child’s life, and categorize them as “optional stressors,” and “can’t be avoided stressors.”

For example, many females find that stress escalates at certain points in their menstrual cycle. You may find that a birth control pill can reduce this stress, or it may be that menstrual stress is on her list of “can’t be avoided stressors.”

Many kids feel stress leading up to exam periods. This clearly falls under “can’t be avoided” stress. When facing “can’t be avoided” stressors, the key is to ramp up healthy coping skills and also to identify whether there are any “optional” stressors that can be avoided during the stressful time. For example, if large family events are “optional stressors,” you may excuse your child from an event that coincides with exams.

See Our Parent’s Guide To Mental Health And Eating Disorders