Self-harm and eating disorders often coexist, and both are on the rise. A recent study found that nearly 1 in 4 teenage girls ages 14-18 in the United States engages in non-suicidal self-harming behavior. (American Journal of Public Health) Self-harm is the act of hurting oneself on purpose. The most common methods are cutting and burning.

Self-harm often co-occurs with eating disorders. One study estimated that about 25% of people in treatment for bulimia and 23% of people in treatment for anorexia engage in self-harm. (Eating Disorders) Based on my interviews and research, I estimate the number of people who both self-harm and have an eating disorder to be much higher than that.

Eating disorders and self-harm:

• Often occur together
• Require immediate, specialized help
• Are powerful emotional coping methods
• Frequently misunderstood as manipulation tactics
• Use the body as a communication vehicle

Why self-harm?

Self-harm may seem like a bizarre behavior. But it is actually a powerful self-soothing activity that is a way to manage otherwise inexpressible anguish. In other words, the person who engages in self-harm is in a tremendous amount of psychic pain. Like eating disorders, self-harm is a powerful form of non-verbal communication. Both can be a call for help when the person suffering lacks adaptive methods of seeking support.

Researchers have found that people who self-harm develop a conditioned response to pain similar to the numbing created by opiate drugs. This response is why many people who self-harm feel “addicted” to their behavior. They often experience powerful cravings and withdrawal-like symptoms when they try to stop.

Who self-harms?

Self-injurers are often bright, talented, creative achievers. Self-harm is common among perfectionist and people-pleasers who present a happy face even when they are suffering greatly.

People who self-harm often put on a mask of self-sufficiency and appear fiercely independent. Underneath their mask, people with both eating disorders and self-harming behaviors suffer from seemingly insatiable emotional hunger. They long for acceptance, love, belonging, approval, and nurturance. The self-harm becomes a way to soothe themselves.

Self-harm and eating disorders can be described as maladaptive coping mechanisms. They help relieve tension, release anger, regain a sense of self-control, and eliminate a sense of emotional deadness.

“I have come to regard these behaviors as morbid forms of self-help because they provide rapid but temporary relief from distressing symptoms,” says Marilee Strong, author of A Bright Red Scream: Self-Mutilation and the Language of Pain.

Self-harm and eating disorders

Researchers have observed common roots in both self-harm and eating disorders. They both have a strong correlation with childhood physical and emotional abuse, particularly sexual abuse. Oftentimes, the abuse was not acknowledged or adequately treated. As a result, the person may have suppressed the memory and “forgotten” it occurred.

Many (not all) people who self-harm and/or have eating disorders have untreated Post Traumatic Stress Syndrome (PTSD). They feel unable to talk about and seek comfort for their trauma. Instead, a person who has an eating disorder or self-harms seeks to process their trauma within their own body, alone.

It has been proposed that both self-harm and eating disorders use the body to work out psychological conflicts. They appear to provide temporary relief from overwhelming feelings of tension, anger, loneliness, emptiness, and self-hatred. Many people use maladaptive coping mechanisms to manage PTSD symptoms such as dissociation, flashbacks, and hyperarousal.

Both self-harm and eating disorders can build a form of identity around the maladaptive behavior. A person can become strongly associated with their maladaptive coping mechanism and extremely resistant to stopping their behavior. “They come to believe that they are their symptoms, that there really is nothing but a void inside, and that if they were prevented from cutting they would fall apart, go crazy, disappear, cease to exist,” says Strong.

What parents need to know about self-harm and eating disorders

First, parents need to know that self-harm and eating disorders are complex coping behaviors. They are maladaptive, but that doesn’t mean they don’t provide a deep sense of relief. Self-harm and eating disorder behaviors are calming and soothing behaviors. It helps when parents recognize that the behavior is indicative of desperate emotional turmoil.

Parents cannot simply demand that a child stop self-harming or engaging in their eating disorders. They also cannot trust the child who self-harms or has an eating disorder to stop without treatment. The fact is that it’s hard to stop without help. And if parents push too hard, children may say they are “cured.” Meanwhile, they just find a better way to hide their disorder.

Self-harm and eating disorders are neither manipulative nor attention-seeking. But their existence indicates that a child needs professional treatment.

Parents can become focused on the physical behaviors. But they must know that the pain their child is inflicting on their body pales in comparison to the acute psychological pain they are experiencing inside. Parents must train themselves to pay attention to the unexpressed pain vs. focusing on the harm exhibited on the body. The act of self-harm can be viewed as a “form of language written on the body,” says Strong.

What parents can do to help their child who self-harms

Parents are in a powerful position when it comes to helping a child who self-harms and/or has an eating disorder. But to help our children, we must learn more about what is going on. And we must prepare ourselves for a challenging recovery. Both self-harm and eating disorders are powerful behavioral compulsions. They should never be taken lightly or without sincere dedication to education and treatment.

Before following the steps below, you must assess whether your child is in immediate physical danger. Contact the National Suicide Prevention Lifeline (24 hours): 9-8-8 to determine whether hospitalization is necessary. Only consider these steps if you are sure your child is physically not in danger. 

1. Plan your approach

It is a common mistake to fly into a panic and approach your child immediately when you suspect self-harming behavior. This can backfire and create a greater obstacle to recovery. Take some time to learn about self-harm. Internalize the fact that self-harm is not “manipulative,” “disgusting,” “abhorrent,” or whatever it is that you naturally first assume. Only approach your child once you can find compassion for the behavior. Try to respect its role in your child’s life. Your goal is to get them into treatment. But they won’t go if they don’t trust you. Don’t think you can solve this by yourself. Once self-harm and eating disorders become known, they require professional treatment.

2. Seek help

If your child is a minor, then research treatment options. Ideally, find someone who is trauma-informed and has experience working with children. If your child resists treatment, don’t be afraid to attend treatment with them until they feel safe. Work with the therapist to determine the best course of action. You can do some work around identity, family roles, and boundaries if your child isn’t ready to address the behavior yet. If your child is an adult, then you can gently suggest treatment, but unfortunately, you can’t force it. Nonetheless, attend family therapy if your child is willing to go. Or get therapy for yourself to uncover ways you can build trust in the relationship so that your advice is more likely to be heeded.

3.  Begin treatment

Your therapist should help you identify the best course of treatment for your child. This may include various forms of therapy. For example, Dialectical Behavioral Therapy (DBT) has shown promise in treating people who self-harm. Also consider investing in family therapy. Self-harm is a private act your child is taking against themselves. But it is often indicative of larger challenges in your family structure. Your child may find greater success in recovery if everyone participates. This takes the entire burden of recovery off the child who is self-harming.

4. Become emotionally literate

Your child who is self-harming is suffering from a lack of language skills to express their pain and suffering. For whatever reason, they did not learn to process emotions in an adaptive manner. This means expressing negative feelings like anger, jealousy, grief, and fear. Parents can learn emotional literacy, which is the ability to accept, define, and express emotions. This will help children develop adaptive coping mechanisms to replace their self-harm and eating disorders.

5. Provide a balanced environment

Maladaptive coping mechanisms are responses that a person develops in response to emotional arousal. Emotional arousal is more likely in chaotic environments. This means that it really helps if you can create a calm, structured environment. Provide plenty of food, rest, play, comfort, and belonging.

6. Take it slowly

Never forget that self-harm and eating disorders provide a valuable form of self-care. If you try to remove the behavior before your child is ready, it may either dive deeper into the shadows or morph into another behavior like drug abuse, drinking, shoplifting, and more. Don’t try to control the behavior, but rather seek to replace it with kindness and compassion.

The most important thing a parent can do when their child is in recovery from self-harm is to trust that their child and the whole family can improve together. It takes a lot of effort, and will not be a perfect or linear process, but full recovery is completely possible.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

Dear Ginny,

I just put a lock on the pantry because my daughter binge eats. I know that binge eating is so unhealthy for her, and it seems to be getting worse. She just eats and eats. If I buy a package of cookies, it’s gone by the next day. Same with almost anything sweet, crunchy, or carby. She mainly does this at night when we’re all asleep. The fact that she’s sneaking the food is upsetting enough, but it’s even worse when she lies about it and pretends that the food I just bought has disappeared.

Not only do I worry about her health, I just can’t afford to buy so much food right now. Last night I lost my temper and installed a lock on the pantry doors. I also told her that I will no longer buy any processed foods or things she binge eats like bread, crackers, etc. I guess we all have to go on a diet because she can’t control herself!

I’m really frustrated, and this seems like the only solution. Am I doing the right thing? Should I get a lock for the refrigerator, too?

Signed, locks are the only thing that work

Dear Locks,

I’m so sorry to hear this. I know how hard it is to work with children who seem out of control around food. And I know that you are doing the very best you can in the circumstances. Lots of parents in your situation have put a lock on the pantry because it seems like the only solution.

What I would like to do is provide you with some information about binge eating and the treatment for binge eating. I hope that this information will help you understand your daughter’s eating disorder behaviors. It should provide some insight into how you can help.

About binge eating disorder

Binge eating is often presented as a lack of willpower. But it’s important to know that frequent binge eating is actually a symptom of an eating disorder. Binge Eating Disorder is the most common form of eating disorder, and it impacts far more people than either Anorexia or Bulimia. This means it’s not just frustrating and costly, it’s also a mental disorder that requires professional treatment.

Importantly, binge eating is often the third stage in a cycle. Usually it begins with negative body thoughts, which leads to food restriction. The No. 1 outcome of food restriction is binge eating. Even the thought that food might be unavailable, shameful, or disallowed can be enough to trigger a binge eating episode. But remember – the binge eating comes after restriction.

That’s why treatment for binge eating disorder typically involves taking a non-diet approach to health and supporting people in healing their relationship with food and their body.

Professional evaluation & support

I recommend that you seek professional evaluation and support for your child’s binge eating. Treating binge eating with dieting or restriction of any type can be very harmful, so it’s important to work with professionals who follow a non-diet, Health At Every Size® approach. We have a directory of professionals who can help.

As for putting a lock on the pantry and refrigerator, that can be very harmful for someone who is struggling with an eating disorder. I completely understand the desire to eliminate the temptation of binge foods for your child. That makes a lot of intuitive sense.

However, locking the pantry and restricting food can exacerbate the pain and suffering of living with an eating disorder. And, in fact, most providers who successfully treat people with Binge Eating Disorder actually encourage full access to binge foods to reduce the sense of restriction that often drives the behavior.

They also institute regular meal and snack times and a mix of all types of foods (including sugar and carbs) throughout the day. This treatment is consistent with how we treat people who have anorexia and bulimia, because someone who has an eating disorder needs to learn to normalize all foods and experience natural, intuitive sensations of hunger and fullness throughout the day.

Emotional pain & suffering

Almost all eating disorders are founded on emotional pain and suffering. Eating disorders are a powerful form of self-soothing and self-care for people who are in emotional pain. We have this video about maladaptive coping mechanisms to help explain this concept:

Rather than take away a person’s form of self-soothing (the eating disorder behaviors), we want to first address the emotional pain and provide new options for self-soothing. This is why therapy is almost always a part of eating disorder recovery.

Instead of locking the pantry and not buying binge foods, make an appointment with a professional who can help you get to the bottom of your daughter’s eating behaviors.

You may be surprised to know that binge eating disorder treatment often includes two key components:

1. Remove all restriction on eating and food

Treatment often includes regular meal and snack times throughout the day. Binge eating disorder, like all eating disorders, is often based on some form of restriction.

Many people eat less than they want to throughout the day and then find themselves binge eating at night to make up for the calorie deficit. By removing food restrictions and encouraging regular meal times and eating patterns through the day, including “junk” foods, we can often reduce the desire to binge eat.

In almost all cases of binge eating disorder, we need to begin by investigating why the disorder is present. What is being restricted, physically and emotionally, to create the conditions for binge eating? How can we support the person who is struggling without exacerbating this restriction with the use of more restriction like locks on the pantry?

2. Learn emotional regulation

Eating disorders are strongly associated with poor emotional regulation skills. This means that treating an eating disorder includes learning how to process feelings and emotions in real-time throughout the day. Often, when we see a person binge eating, we also see that feelings are restricted. When repressed, these feelings become overwhelming and “too much.” Food can be a comfort and a distraction.

If a person doesn’t have healthy emotional processing skills, they may turn to restriction and food as a way to cope with big feelings. This is why psychotherapy is critical for most people who recover from an eating disorder. Learning to accept and take care of our feelings is often the single most important thing we need to do to recover from an eating disorder.

Parents make a huge difference in their kids’ ability to regulate emotions. In fact, we have an emotional superhighway with our kids that can rather quickly get them on the right track for regulating their emotions in a more adaptive way. This means that instead of focusing on the physical aspects of the disorder (food and eating), you can instead focus on the emotional aspects of the disorder and make a big impact.

My advice on whether to lock the pantry

Your daughter’s binge eating is undoubtedly scary and even infuriating for you. That makes a lot of sense. I know this is hard and I am in no way minimizing your experience of her behavior.

At the same time, it’s important to know that your response to her binge eating can make a world of difference in her recovery. I hear that you are at your wits’ end and think the best approach is to lock the pantry. But before you add any more locks or change your shopping habits, I encourage you to open the conversation with her about food restriction and emotional health. Ask her how she is feeling when she goes to the pantry at night. Meanwhile, reach out to a professional who can help you navigate your daughter’s behavior.

I wish you all the best, and send you so much love as you navigate this with your family.

xoxo Ginny

See Our Parent’s Guide To The Different Eating Disorder Behaviors

Do you think that bulimia is gross? Bulimia often feels shameful, both for the people who have it and the people who love them.

A lot of people think bulimia is the ickiest form of disordered eating. But let’s try to shift our perspective to one of love. Let’s try to understand why the person who has bulimia developed an eating disorder in the first place.

Food Restriction

Binging and purging often define bulimia. But did you know that almost all people who have bulimia begin with restricting food? Most will spend hours, days, or even months and years restricting food and dieting. This restriction often meets the same level as someone who has anorexia.

A person who has bulimia rarely discusses their intense efforts to restrict their food intake. This is because they often see themselves as failures because they do ultimately eat, rather than maintaining endless restriction. In fact, there is a common belief among people in recovery that bulimia is just anorexia for people who can’t hack it.

Of course this isn’t true. Bulimia is a complex disorder driven by a combination of the restrict – binge – purge cycle. It may be the most complex eating disorder given that it often has the largest variety of behaviors.

When restricting, the body’s biological drive for food often overcomes even the most incredible willpower. The result is a binge eating episode. Many times these episodes would qualify as a normal meal for a person who was not restricting. But for someone who has an eating disorder, almost any food eaten when they are supposed to be restricting is considered “too much.” The person who has bulimia purges to overcome the biological drive to eat. This is exacerbated under starvation conditions.

Binge Eating

Binge eating varies in terms of quantity eaten. A person who has bulimia may consider a normal-sized meal a “binge” that needs to be purged. Other times, a person who has bulimia will spend weeks starving themselves. Then they will succumb to the biological need for food. They may enter a trance-like state in which they grab for any food available. This helps soothe their body’s overwhelming demand for sustenance.

Binge eating has a really bad reputation, but it is actually a life-saving activity in these cases. The body is starving, and drives the person to consume food to make up the deficit. People who binge eat often describe themselves as having “out of body” experiences while eating. They do not feel as if they are in control of how much food they eat. However, binge eating is often a return to the body. The body is demanding food, and the mind is “switched off” to accommodate the biological need.

Binge eating quantities vary by person. Binge eating is primarily defined by how the person feels about what they ate. Namely, most people who have bulimia feel deep shame about the food they have eaten.

Purging

Purge behavior is what makes most people think bulimia is gross. When a person who has bulimia goes through the restrict – binge cycle, they often feel deeply ashamed. They mistakenly believe that they lack willpower and are a failure. They fear the impact of the food on their bodies, and imagine the pounds piling on instantly.

Additionally, binge eating after restriction feels physically uncomfortable. Someone who has been restricting food for an extended period of time often seeks and even enjoys the feeling of emptiness and hollowness. When they binge eat, their stomach stretches and may become painfully distended.

In response to these physical and emotional feelings, people who have bulimia follow binge eating episodes with purge behaviors. The most common purge behaviors are vomiting, utilizing laxatives, and exercising in a specific effort to rid oneself of the calories consumed during a binge eating episode.

The purge part of bulimia can seem really gross. This is especially true of vomiting and laxative use, it’s important to remember that these behaviors are adaptive. The person who has bulimia purges because they are seeking to alleviate the pain they are feeling.

Why bulimia works so well

Over time, binging and purging becomes a powerful form of self-care. This is why bulimia is particularly hard to treat. To recover, a person must learn self-soothing behaviors that address all three stages of the disorder (restrict – binge eat – purge). Both binge eating disorder and anorexia require intensive treatment. It makes sense that bulimia, which includes both of those plus purging, is complex.

Here’s a breakdown of how bulimia can become embedded as a self-soothing condition:

Restriction – creates feelings of self-sufficiency, independence, cleanliness, and goodness. Restricting food is so common in our society that it is considered normal. Most people associate people who are thin and restrict food as having more willpower. They assume thin people are more intelligent, and “better.”

Binge Eating – is a biologically-driven response to restriction. The body craves food, and the mind is taken out of the equation so the body gets what it needs. Also, the eating itself may feel emotionally soothing, even though the person doing it feels deep shame afterwards.

Purging – can feel like the only option when a person who is driven to restrict food eats food. They feel physical and emotional discomfort based on their behavior, and the sense of shame and failure is pervasive. The best way to alleviate this pain is to purge the food, therefore (in the person’s mind) negating the binge. It’s a way to turn back time and return to a sense of “goodness.”

Reimagining bulimia

It’s true that bulimia is often thought of as the yuckiest eating disorder. But in fact it makes perfect sense when we understand the drivers that underlie the behaviors.

It doesn’t make sense to criticize eating disorder behaviors and try to control them. Instead, it really helps to accept them as adaptations that the person made in order to survive. Bulimia seems like the most natural and the only way to live for someone who is inside the disorder.

Recovery is possible, and parents can help their children recover. This requires the understanding that bulimia may seem gross, but it’s a form of self-care. The road to recovery is based on replacing eating disorder drives, beliefs and behaviors with more positive and healthy drives, beliefs and behaviors.

Restriction is the desire to be “good.” The binge is a biological need to fill oneself. And the purge is the urge to free oneself from discomfort. With this understanding, we can see how bulimia is often an attempt to provide self-care and self-love.

To understand this more, take a look at our video about Maladaptive Coping Behaviors:

Emotional Regulation

Of course, each person who has bulimia experiences it a little differently. But regardless of exactly how they experience bulimia, their path to healing is most likely through emotional regulation.

Try not to get hung up on the gross factor of bulimia. Instead, support your loved one through recovery. Help them by learning how to co-regulate during emotional storms. Help them adapt to healthy ways to soothe and calm themselves. Support them when they make a mistake or find themselves relapsing.

Bulimia cannot be controlled or shamed into submission. It cannot be hated away. Instead, it needs intense support and commitment for a person to recover into a new way of living.

If you love someone who has bulimia, then please approach them from a loving, healing perspective. Tame your ick factor with recognition of the fact that this is a person who needs acceptance and support.

There are many pathways required to heal bulimia. One essential path is that the person needs to learn new ways to love and care for themselves. Parents can help by learning and practicing emotional regulation skills.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

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Thanks to Kristen Wiig as Aunt Linda for the photo!

Dear Ginny,

My child has a problem — he overeats and sneaks food. Once he starts eating, he can’t stop, and often he eats so much that he becomes visibly miserable. I recently found out that he has been hiding food from me and sneak-eating behind my back. He’s always been on the larger side, and now he’s gaining a lot of weight. He’s getting really big and I’m scared it’s my fault! I’m so worried about his health. I’ve been buying less of his binge foods and often hide food from him in an attempt to help. What else can I do?

Signed, Scared He’s Eating Too Much

Dear Scared,

First, I’m so sorry to hear this. We live in a culture that teaches us to worry about food and weight, and I know how very hard it is to parent in these conditions. Parents are blamed and shamed for how and what their kids eat and how much they weigh. It makes sense that you’re worried about this. I understand.

Why is he eating so much food?

Next, let’s take a look at his food behavior. You are right to be concerned. Since your child overeats and sneaks food to the point of discomfort, he’s struggling with food and likely with weight, too. He may or may not have a diagnosable condition like binge eating disorder or another eating disorder.

While most people assume people with eating disorders are very thin, only 6% of people with eating disorders appear underweight. The rest are in medium to larger bodies. Let’s break down some important terms:

• Overeating is most often a response to restriction and under-eating. When eating is regular and adequate, overeating typically resolves itself. It may also be a symptom of emotional eating, or eating to soothe emotions. If this is the case, the person should still begin by eating regular, adequate meals. At the same time, they can get support in developing non-food methods of self-soothing. Keep in mind that it’s not appropriate to limit or restrict food to treat overeating because doing so typically exacerbates the problem.
• Binge eating involves eating large quantities of food in a single sitting followed by shame and self-recrimination. Binge eating, when done regularly and over time, is a symptom of an eating disorder and needs professional care. As with overeating, binge eating treatment involves eating enough food and building emotional regulation skills.
• Sneak eating is a signal that someone is feeling shame about food. As with overeating, the treatment includes eating enough food and working on emotional regulation skills. Sneaking food also indicates a relational issue that can be addressed in family therapy.

Based on your letter, I encourage you to seek professional support for your son’s eating behaviors as soon as possible. Make an appointment with a registered dietitian who practices from a non-diet approach. This is critical because any form of restriction or pursuit of weight loss can be damaging to your son’s health. Please also seek the support of a therapist who can provide an assessment for binge eating disorder.

We have a directory of non-diet professionals to help you get started: Directory

Why does my child overeat and sneak food?

The most common reason people overeat is an underlying sense of restriction or sensation that they cannot get enough food. In some cases, hunger is entirely physical. When we ignore or override hunger due to shame and/or restriction, it can become overwhelming and lead to binge eating. If your son is restricting food or feels he should restrict food this can create an unfortunate doom loop in which restriction breeds overeating/binge eating.

Binge eating, overeating, and sneak eating are usually caused by food restriction. This can mean your child isn’t eating enough food. However, even if he is technically eating enough food but he believes and/or is being told he should restrict his food, that can have a surprising result. It turns out that both physical and mental restrictions result in overeating and binge eating.

Beyond feeding hunger, overeating and binge eating can become a psychological coping method. All of us need ways to regulate our emotions. If a child does not learn healthy, adaptive emotional coping skills, they may turn to food as a way to self-soothe. This is natural and normal, but it can become destructive and harmful by perpetuating shame and driving the binge eating cycle.

Therefore, if your child has developed overeating or emotional eating as a coping method, he needs support in building alternative coping methods. But at no time should food be restricted or taken away from him. Unlike the abstinence approach in substance addiction treatment, food restriction is never a good idea when food is a coping method. There are many biological and psychological reasons for this, but science says it drives the binge eating cycle.

Surprisingly, people who struggle with binge eating disorder often recover when they are given unconditional social permission to eat exactly the type and quantity of food they want. This, combined with therapy and emotional regulation skills, often provides the foundation for recovery.

Parents and disordered eating

If a parent has restricted a child’s food choices in any way or judged a child who overeats and sneaks food, the child’s natural drive for food can become complicated and fraught with emotion. They’re more likely to develop disordered eating and weight issues. This is not our fault; we live in a dangerous culture that promotes disordered eating practices.

But once we know the truth about how this affects our kids we can dive in, learn new things, and change how we approach food and weight.

One of the most common challenges in our culture is that parents are afraid that if they have a larger child, they will be judged and criticized for their child’s weight. And indeed they might. However, weight is largely genetic and parents should not be criticized when a child is larger.

Fear of judgment can lead parents to create an environment of restriction and shame around food and eating. Unfortunately, a family attitude of shame and restriction around food is a leading environmental cause of disordered eating and weight issues.

Parents’ well-meaning concerns can lead us to restrict our child’s choices and quantity of food, which can have the unintended consequence of leading to food and weight issues. We must work to overcome our weight stigma and reject diet culture to raise healthy children.

5 Things Parents Can Do If A Child Overeats And Sneaks Food

1. Learn more about a non-diet approach to health. While counter to popular culture, this is a well-established science-backed approach to health that doesn’t focus on weight loss. You can check out my Non-Diet/Health At Every Size Fact Sheets or read this article: Data in support of the non-diet approach to health.

2. Try to understand why your child overeats and sneaks food. Most of us jump to conclusions and make assumptions about the reasons for overeating and sneaking food. It’s surprising, but the No. 1 cause of binge eating is restrictive eating. Try to eliminate food restriction (dieting) in your household. If your child is using food to self-soothe, get them support and help them build other emotional regulation skills.

3. Don’t restrict, hide, or limit food in any way. It may feel like the right thing to do, but restricting food for a child who is overeating is very likely to lead to more serious problems. Restricting food adds hunger and shame to an already complicated situation. A child who overeats and sneaks food needs less restriction, not more.

4. Serve regular, substantial meals, and eat together. The most effective treatment for binge eating is eating regular, substantial meals with other people. Serve substantial, regular meals, and eat together in a positive, relaxed setting. I know we’re all busy, but try to eat together as often as possible.

5. Get your child support. When a child overeats and sneaks food it’s a good idea to seek professional help. However, not just anyone is suited to supporting your child. Unfortunately, most professionals operate from the old paradigm, which involves a lot of weight stigma. Instead, seek professionals who practice from a non-diet perspective. They are less likely to do harm and more likely to help.

Help him heal his relationship with food

I understand that weight and overeating are significant concerns. Of course you want to raise a healthy, happy child. And the counterintuitive way to do this is to stop assuming that food restriction and weight loss are a path to health and happiness.

Adopting a non-diet approach to health will make a significant difference in your son’s eating habits. You may notice that when given full unrestricted access to food he eats even more at first, but you must be patient and understand that such behavior is a natural response to restriction. His hunger will settle down once he trusts that his needs will always be met. You must truly believe that your child’s drive to eat is natural and healthy, and you must fully support his eating patterns and body size. 

Work on your own beliefs about food and weight, and give yourself time to learn new concepts and adjust to a new relationship with food and weight.

Most importantly, please know that you are correct to be concerned about your son’s eating disorder behavior. He is currently in danger. This is not a situation that will naturally fix itself, and it will take significant effort on your part to help him. The good news is that your active involvement in supporting his relationship with food and eating will have lifelong consequences on his health and wellbeing.

The elephant in the room: weight

Finally, let’s consider your other main concern, his weight. Most parents have been told and deeply believe that they are responsible for controlling their kids’ weight, which often involves limiting and restricting food. While this is common advice, it backfires. Science says that parents who worry about and try to control their children’s eating and weight are more likely to have kids with eating and weight issues than those who don’t. The best alternative is the non-diet approach to health, which prioritizes healthy behaviors without focusing on weight outcomes.

It’s not your fault if you’ve been worrying about your child’s weight, but the fact is that it’s far better for your child’s lifetime wellness if you use a non-diet approach to health.

Your son has always been in a larger body, and he will likely always be in a larger body. Body weight is mostly genetic, which means his body size is largely out of your control. You can take managing his weight off your list of responsibilities. He will be more likely to be healthy if you are not trying to reduce his weight.

You may understandably believe that the problem is his eating and weight, but the more likely problem is the sense of restriction and shame he feels around eating and weight. You can help him by building your understanding of weight stigma and finding ways to validate your son exactly as he is, regardless of his weight.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

With all the benefits of exercise, many parents don’t expect their kids to exercise too much. In fact, over-exercising or compulsive exercising may be a symptom of something more serious going on. If you have a child who seems to exercise too much, it’s important to step in and help them find balance with movement and their body.

Signs of compulsive exercise

Compulsive exercise often starts with all the best intentions. Your child may love a sport and passionately pursue being the best they possibly can. Another child may have heard that exercise is really healthy, and they want to be as healthy as possible. Yet another kid might believe that exercise will help them lose weight, which they are desperate to do. Regardless of the reason why your child tends to exercise too much, the symptoms include:

• Exercising multiple times per day
• Feelings of guilt and shame if a workout is missed, even if it’s for good reason
• Tracking all exercise and maintaining extensive logs of exercise performed
• Exercising to burn calories or lose weight
• Wearing an exercise tracker and feeling driven to exercise more based on its feedback
• Having rigid rules about what forms of exercise “count” vs. those that “don’t count”
• Exercising even when sick with symptoms like fever, congestion, and infection
• Not being willing to skip a workout while on vacation, spending time with family, or when invited on an outing with friends
• Exercising even when clearly not enjoying the activity
• Being very rigid with exercise and exhibiting signs of stress when it’s not possible to follow their routine
• Hiding exercise from parents, family, and friends, such as doing crunches in their room behind a locked door
• Only eating after exercising, and believing that if exercise is not completed, they don’t “deserve” food
• Constantly adding new exercises to existing routine to make it longer and harder
• Following #fitspo accounts for constant fitness inspiration

Consequences of compulsive exercise

Exercising long, hard, and frequently is considered a virtue in our fitness-obsessed culture. But the surprising fact is that over-exercising is not healthy, and may even harm health.

If your child is exercising too much, they may be developing an eating disorder. While compulsive exercise is not recognized as its own eating disorder, it frequently appears alongside eating disorders.

The saying “there’s no such thing as too much of a good thing” is decidedly wrong when it comes to exercise. Compulsive exercise is a mental condition that falls under Obsessive Compulsive Disorders. It can have serious health impacts including:

• High risk of anxiety and depression
• Increased probability of eating disorders
• Decreased connection with family, friends, and peers
• Loss of menstrual cycle, leading to calcium and bone loss
• Chronic bone & joint pain
• High risk of injury such as stress fractures, etc.
• Increased frequency of illness and upper respiratory infections

Compulsive exercise often starts out for all the best reasons. But some kids are just naturally more prone to becoming obsessive about exercise. Exercising too much can hurt your child emotionally and physically, and it’s important for parents to intervene if they believe there may be a problem.

How do I know if my child has a problem?

The most important thing is to consider your child’s exercise patterns objectively. You have likely heard all the reasons they give for exercising. But take some time to look at the amount of exercise they are doing and how it is impacting their life. There’s a critical difference between healthy exercise and obsessive exercise, and you can likely sense it if you pay attention. Keep in mind that over-exercise is a core eating disorder behavior.

Here are some conditions that should make you extra-vigilant when it comes to your child’s exercise:

If they are an athlete:

A 1992 study by the American College of Sports Medicine found that more than 33% of female Division 1 NCAA athletes reported disordered eating. Obsessive exercise and dietary control are very prevalent among student athletes. Parents should be aware of whether their student athlete has a healthy relationship with exercise, food, and their body.

If they have a history of an eating disorder:

If your child has a history of an eating disorder, they need to work closely with their treatment team before engaging in any serious exercise program. Even if your child has recovered from their eating disorder, serious exercise is a potential symptom of relapse.

If they are exercising to lose weight:

Kids are surrounded by dangerous weight loss messages. It is understandable that kids want to lose weight in our society that tells them people who are thin are more valuable. But intentional weight loss fails for 95% of people, regardless of their starting weight, why they want to lose weight, or how they lose weight. If your child is exercising for weight loss purposes, you need to intervene to let them know that intentional weight loss is not healthy. It often has the opposite impact of what was intended. Intentional weight loss is also a leading cause of eating disorders.

How to help your child who exercises too much

If you believe your child exercises too much, it’s important to intervene. Remember that your goal is to raise a healthy person in both body and mind. This is not possible if they are suffering from an obsessive behavior like over-exercising.

First, gather your information. Give yourself some time to take note of your child’s exercise behaviors. Cross-reference them with the list provided above.

Next, think about your child’s behavior beyond working out. For example:

Have you noticed significant dietary changes?

Are they restricting entire food groups? Perhaps they are consuming large quantities of protein powder and protein bars, but not much else. Pay attention to their food habits and whether they have changed.

What about social changes?

Are you noticing that they aren’t as social as they once were? Perhaps their only socialization involves exercise?

How is your child’s mood?

Have you noticed that they have a lot of rigidity and anxiety around exercise? Is your child generally more grumpy or manic since they started exercising so much? Are they less available to do fun things because they are busy exercising?

Open the conversation

Once you have all of the information you can gather, open a conversation with your child. For example, “Jimmy, I’ve noticed that you’re spending most of your free time exercising, and I’m concerned.”

Don’t throw your list down on the table or demand answers. Instead, ask open-ended questions that help you have a conversation about how they are feeling about the role exercise plays in their life. For example:

• How are you feeling about how often you exercise right now?
• Do you feel anxious when you can’t fit your workouts in?
• Are you noticing that exercise sometimes interferes with other fun things in your life?
• Would you like to talk to someone about your exercise, food, and body?

The best case scenario is that they will be able to have this discussion with you non-defensively. Be curious about their experience, and look for curiosity on their end, too. Talk about the dangers of over-exercising, and agree on some reasonable expectations in terms of their exercise behavior.

If your child has a problem with compulsive exercise, it will be hard to have this conversation without them becoming defensive. For example, they may tell you that you don’t know what you’re talking about, that there’s no problem, and that you don’t support their health.

Defensiveness may be a sign that there is something going on in terms of compulsive behavior around exercise. At this point, consider bringing in a professional who can help you navigate these conversations with your child. A therapist can work with you to help you open conversations, or they can work with your child directly to identify whether there is a problem and, if so, determine treatment.

These conversations are difficult, but they are also crucial. Early, compassionate intervention by parents can help a child who is struggling with exercise compulsion get the help they need.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

So-called clean eating* is very trendy right now, inspiring people of all ages to pursue a “clean” diet. But if your child says they want to “eat clean,” be very thoughtful in how you approach it. Clean eating can actually be an eating disorder behavior.

Clean eating is a trend

The clean eating movement includes avoiding processed foods and eating raw, unrefined produce. On its surface, clean eating sounds pretty good. After all, it makes sense to each fresh fruits and vegetables as part of a balanced diet.

The challenge is that the “clean eating” trend can become dangerous for kids. Clean eating easily becomes a way to restrict food. It can also become a way to pursue “goodness” through diet, which is not healthy. Eating disorder specialists are reporting an alarming trend in eating disorders that started out as clean eating programs.

*“Clean” and “clean eating” refer to the trend, not the food itself. We do not ascribe nor give any credence to the idea that some foods are cleaner than others, or that there is any validity to the clean eating trend. It’s a dangerous sham. So please proceed with that in mind.

“At best, clean eating is nonsense dressed up as health advice,” wrote Max Pemberton, MD, in the Daily Mail. “At worst, it is embraced by those with underlying psychological difficulties and used to justify an increasingly restrictive diet — with potentially life-threatening results.”

How the clean eating trend took over

Clean eating has taken off in large part due to social media “influencers.” They have little to no nutrition training. Like most diet fads, clean eating is driven by individuals who promote a single, simple solution to health and weight. These influencers operate as preachers in the church of their favorite diet fad. Each has their own spin on the clean eating Bible, and is trying to gather as many followers as possible.

There is absolutely no evidence supporting clean eating and its many claims. But influencers have a serious impact on intelligent people who are vulnerable diet culture. Most people today believe that “healthy” equals “thin,” and that weight loss is possible with the right diet.

The real secret is that diets don’t work

The popular media and social media tell us that diets work. But nutrition science has been unable to prove that intentional weight loss is either possible or healthy. It has been impossible for researchers to demonstrate sustained weight loss or improved health on any diet for 95% of the population two years after weight loss. [1]

Despite this, powerful influencers promote clean eating diets and say they will:

• Change your life
• Give you energy
• Detox* your body
• Make you lose weight effortlessly**
• etc. etc.

There is zero valid science behind clean eating claims, but the influencers are much sexier than science, and they sell clean eating like it’s candy (except, of course, they don’t eat candy).

*Detoxes are a scam. Unless you have a non-functional liver, your body does all the detoxing it needs automatically. There is absolutely zero scientific evidence showing any value of dietary detoxes. There is quite a bit of evidence of dangerous side effects of dietary detoxes. These include dehydration, fatigue, and increased risk of infection and illness.

**Effortless weight loss typically occurs only when one is seriously ill – either mentally or physically. Otherwise, it’s freaking hard work and involves painstaking restriction and starvation.

Based on healthism

Clean eating influencers all rely on a concept called “healthism.” This is the mistaken assumption that anyone can achieve “health” (defined as a slim body), relatively easily if they simply apply individual discipline and moral conduct. [6]

Healthism can be found in almost every diet book, blog and social media account. Celebrities and influencers scream “I did it, this is how, and you can do it to!” and “If you follow my program, you can have a body just like mine!”

Healthism completely ignores the genetic and social determinants of health, which are well established in medical literature. In short, the largest predictors of health are genetics and zip code. Your genetics set 70% of your weight (just FYI: genetics account for 80% of your height, and you probably don’t think you can change that). [1]

Social determinants of health, including socio-economic status and environment, have a much larger influence on your health than anything you can do as an individual.

But the people talking about social determinants of health don’t sell diet products or get “likes” on Instagram. Healthism, on the other hand, is a consistent winner when it comes to “likes.” [2]

Clean eating linked to eating disorders

The result is that eating disorder specialists are reporting increasing numbers of people becoming sick via clean eating. It usually starts with cutting out processed foods.

Soon they cut out sugar and then animal products, which are vilified on many clean eating blogs and social media accounts. For vulnerable populations, particularly pre-teens, teens, and young adults, something that starts out as an apparently positive move towards health snowballs into a very unhealthy obsession with controlling every bite of food.

“When new clients eat clean, they are elevating certain types of food (organic, locally-sourced) as ‘good,’ while demonizing all other food as ‘bad,’” says Brittany Markides, dietitian and founder of the Choose Food nutrition counseling service, in The Independent. “This way of thinking hurts our food relationship and leads to distorted eating patterns. Because the thought that the foods they are craving are ‘bad’ is deeply ingrained, eating these foods, which are perfectly fine, causes guilt and shame.”

Social media drives unhealthy food behaviors

Social media use has been directly tied to negative effects on body image, depression, [3] social comparison, and disordered eating. [4] A particular correlation has been noted between social media use and orthorexia nervosa, an obsession with eating healthily.

One study linked Instagram use in particular to orthorexia nervosa. The study found that among almost 700 social media users who follow health food accounts, 49% showed symptoms of orthorexia, compared to less than 1% of the general population. [5]

Eating disorders are based on restriction, and clean eating is restriction. An obsession with healthy eating is called orthorexia, a disordered, unhealthy way of thinking about food. Clean eating is virtually indistinguishable from orthorexia. Clean eating is the perfect cover for disordered eating. It’s a trendy and acceptable cloak for eating disorders. Clean eating is dangerous for kids.

Sure, bring on the whole foods. Try to choose locally-sourced foods when possible. Come up with creative methods of serving whole grains, ancient grains, pulses and nuts. Serve raw veggies as crunchy snacks. But don’t cut out everything else!

Clean eating is dangerous for our kids

This doesn’t mean you force-feed your child Doritos and donuts all day. Parents should offer well-balanced meals that include fruits and veggies, pulses, nuts, grains, breads, animal products, butter and other fats, desserts, chips, and other treats. In other words, put a mix of highly nutritious foods on the table, but also offer fun foods. Not doing so leads to many unhealthy returns, including eating disorders.

If your child has already gone down the path of clean eating and seems very resistant and/or afraid to eat “non-clean” foods, then you may be encountering signs of orthorexia.

If your child cries and shows signs of anxiety when asked to eat foods that fall outside the boundaries of what they consider to be clean, please seek a qualified eating disorder specialist for a consultation so that you can get help. To get started, you can call the National Eating Disorders Association (NEDA) hotline at 1-800-931-2237.

Early intervention can make a tremendous difference in a person’s likelihood of recovery from an eating disorder.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

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References

[1] Mann, Secrets from the Eating Lab, 2015

[2] Sharma SS, De Choudhury M, Measuring and characterizing nutritional information of food and ingestion content in instagram, Proceedings of the 24th International Conference on World Wide Web, 2015

[3] Lin LY, et al, Association between social media use and depression among U.S. Young Adults, Depress Anxiety, 2016

[4] Carrotte ER, Vella AM, Lim MS, Predictors of “Liking” Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study, J Med Internet Res. 2015

[5] Turner, Lefevere, Instagram use is linked to increased symptoms of orthorexia nervosa, Eating and Weight Disorders, 2017

[6] Crawford R, Healthism and the medicalization of everyday life, Int J Health Serv., 1980

Have you ever wondered why some people purge? Purging behavior occurs on a spectrum, from people who do it only occasionally to people who do it often as part of an eating disorder.

The reasons people purge vary. Purging is sometimes a normalized social behavior. Some people purge due to physical discomfort from having a full stomach. Most attempt to use purging in an attempt to lose and/or control weight. Some feel tremendous physical and emotional discomfort after eating. Others experience great physical and emotional relief in purging. When we understand why people purge, we can better help them find other ways to manage the discomfort driving the purge.

In this article we will review the four major reasons for purge behavior:

1. Socialized purges: these are socially accepted purge behaviors that are openly discussed in society
2. Bonding purges: teens and young adults may engage in bonding with friends by purging together
3. Weight-loss purges: purging can seem like an easy way to lose weight, especially after eating more than the person perceives is appropriate and/or binge eating
4. Soothing purges: some people experience a positive soothing quality when purging

Types of purging behavior

Purging behavior includes:

• Self-induced vomiting
• Laxatives, diuretics and weight-loss medication
• Compensatory exercise

The majority of serious purging is based on the idea of reducing calories in the body based on the mistaken assumption that weight is directly based on calories digested. But it is important to understand that purging can serve a variety of purposes in our lives.

Purging behavior is often not as “abhorrent” or “disgusting” as it may seem. Most of the reasons for a purge make a sort of sense—they can serve a very real purpose in a person’s life. It is only when a person can understand the behavior that they are able to replace it with more adaptive ones.

Purging and eating disorders

Purging behavior is not limited to Bulimia Nervosa. It can also be seen with Anorexia Nervosa, Binge Eating Disorder, OSFED, and many subclinical eating disorders. Purging behavior can even be a stand-alone disorder.

It’s important to know that purging to control weight rarely “works.” The body is very efficient and can adjust to purging behavior in order to maintain weight status. Thus, many people who attempt to use purging to reduce weight find themselves frustrated because it doesn’t “work.”

Purging of all types, at any level, has been correlated with other risky behaviors. These include smoking, binge drinking, and drug use. One recent finding showed that 13% of North American girls reported purging behaviors in mid-adolescence.

Reasons we purge

There are four main reasons for using purge behavior. The goal is to help you understand why someone you love is purging and how you can help them find alternative coping mechanisms. Purging doesn’t come from nowhere—there is a reason it “works.” 

The drive to purge typically involves biological, physiological, psychological, and/or social reasons. The most common reasons for purge behavior boil down to physical and/or psychological distress, often due to social pressure from diet culture to stay thin. 

When viewed through this lens, it’s easier to bring compassion and understanding to purge behavior and help the person find new coping methods. 

Purging, like all eating disorder behaviors, should be approached with understanding and compassion. This will result in better success in supporting recovery.

1. Socialized purges

Socialized purges are socially accepted purge behaviors that are openly discussed in society. The most common example takes place at large meals like Thanksgiving. Many people will talk about engaging in vigorous exercise before or after Thanksgiving dinner. They attempt to “work off” the calories from the meal.

Many family tables feature one or more parents mentioning that they will take a little less food. They say they didn’t exercise that day, and need to compensate. Or they may take a little more food because they “were good.” They say they can eat more because they exercised or restricted food earlier in the day. This is called “compensatory behavior” and is a form of calculation in which food is “earned” with the appropriate behavior.

People regularly say things like:

• I’m going to have to put in some extra miles tomorrow after all these cookies
• I shouldn’t be eating this, but I’ll go to the gym to make up for it
• I skipped breakfast so that I could indulge tonight
• I’ll have to skip breakfast tomorrow to make up for this meal
• I can eat this cupcake because I burned 500 calories on the treadmill today
• I’m off to burn 500 calories in spinning class so that I can enjoy dessert tonight.

This is socially normalized behavior, but it is also eating disorder behavior. Parents should be aware that when socialized purges are normalized, we open the door to eating disorders.

We should eliminate socialized purges and any form of food or exercise compensatory behavior from our children’s lives. Food should never be “earned” or “worked off.” It should be enjoyed and appreciated as a critical element of life.

2. Bonding purges

It is not uncommon for teens and young adults to engage in bonding with friends by purging. This may involve group vomiting, drinking laxative teas, skipping meals, and exercising after eating a meal.

Friendships are often the places where people first engage in purging behaviors. They become normalized and attractive as a result. Through friendships, people feel a sense of critical belonging and understanding. When purging becomes a part of a friendship it can become a “sticky” behavior that is done together and can spread to other friendships or become a solo practice.

The most common social example of this is sororities. Large groups of sorority sisters will share purge behaviors and “secrets” about how to purge. Many will stop doing these purge behaviors once they leave the social circle. But the baseline behavior is already normalized and reinforced, and some inevitably continue to use purging after they graduate. Socialized purges leave a person vulnerable to future mental health conditions including depression and anxiety.

Additionally, even “mild” purging behavior is correlated with high-risk behaviors including binge drinking, smoking, and drug use.

If a person is engaging in bonding purges, they may not have a diagnosable eating disorder. But all purging behavior is still a significant concern. A percentage of people who engage in bonding purges may develop additional eating disorder symptoms and behaviors.

Early intervention can make a significant impact. If you believe your child is engaging in social purges, get some coaching and support to find out how you can help them stop.

3. Weight-loss purges

We live in a society that is best described as Diet Culture. This means we have normalized and encouraged dieting for generations. But dieting is linked to higher lifetime body weight and significant health complication, including eating disorders.

Purge behavior can seem like an easy way to lose weight without cutting down on food eaten. However, purging, like all forms of weight control, does not benefit health and carries significant complications.

The desire to achieve a lower body weight is pervasive. It is especially pernicious among teenage girls, the population most vulnerable to developing eating disorders. Dieting is the most powerful predictor of an eating disorder.

Diet culture as a reason we purge

Diet culture promotes low body weight at any cost. There are countless diet programs available to support people who want to pursue intentional weight loss. But our bodies are finely tuned to maintain their own healthy body weight. This is regardless of what we would like that weight to be. Any restriction causes a healthy and intense hunger response. This often results in binge eating or eating beyond the point of physical comfort.

Often when a person is binge eating, they are driven by extreme bodily needs. In fact, restricting food is the No. 1 reason for binge eating. When binge eating, people enter a state of emotional disconnection. It’s as if the body turns the mind off so that it can take over and get what it needs.

While binge eating, a person is typically not aware of how much they are eating. Nor are they able to stop themselves. Once a person has “succumbed” to their natural biology and eaten food in response to their hunger, they may turn to purge behaviors to compensate. This can relieve both the physical discomfort and the emotional distress of “over” eating.

Even people who maintain very restricted diets and eat very little food may engage in purging. They believe it is necessary to maintain their diet and/or low weight. In this way, purging can become a part of maintaining a diet. It may occur even without binge-eating episodes.

For example, someone who is on a calorie-restricted diet may eat very little but still purge. They want to “get rid” of any calories that they believe put them over their daily goal. Someone who is on a carb-restricted diet may attempt to purge after a carb-laden meal. But they will not necessarily purge after a no-carb meal.

Purging for weight loss

Purging for weight loss can seem like a “smart” way to manage the pressures of maintaining low body weight. It appears to solve problems for the strict dieter who occasionally or often goes beyond the boundaries of their diet.

Purge behaviors can become dangerously compulsive. They often coexist with Binge Eating Disorder, Anorexia Nervosa, and OSFED, or become chronic in the form of Bulimia Nervosa.

When a person is engaging in purge behavior they need intensive care. Ideally, they need providers who understand the dangers of diet culture and work from a non-diet perspective.

Providers should not be weight-conscious or promise that a person will not gain weight in eating disorder recovery. They should definitely not promise weight loss. These approaches are outdated and often deepen the underlying reasons for purge behavior.

4. Soothing purges

This may surprise you. Many people who develop chronic purging behaviors experience a positive soothing quality to the action of purging. Eating disorders, especially Bulimia Nervosa, can be described as Maladaptive Coping Mechanisms, which are subconscious methods to soothe anxious feelings.

Bulimia has been linked to underlying problems with impulsivity. This can be defined as urgency, sensation seeking, lack of premeditation, and lack of perseverance.

Lacking self-soothing tools

People who develop Bulimia tend to lack the ability to self-soothe or calm themselves when upset. To compensate, they seek external behaviors such as purging, substance use, and self-harm. These behaviors are sought on a subconscious and incredibly urgent basis. This is why purging behavior can sometimes be described as “addictive,” since it engages a response similar to addictive substances.

People who have Bulimia are more likely to engage in self-harm behavior. They harm at rates between 25 and 75 percent reported in various studies. Just like Bulimia, self-harm may seem like a strange way to soothe oneself. But they are both surprisingly consistent as coping behaviors. 

If you believe your child is using purging to self-soothe, it’s best to get some support and coaching. Most parents benefit from strategic ideas that will increase their child’s motivation for recovery. Aggressive approaches with someone who is using purge behavior to self-soothe typically backfire. 

Treatment for purging behavior

The reasons for purge behavior are different for everyone. But all people who purge will benefit from professional support so they can build adaptive coping mechanisms. These adaptive methods will help them process discomfort, pain, anxiety, and fear without purging.

They offer new ways of emotional soothing that don’t involve using external agents like food, alcohol, and drugs. Recovery typically involves learning new skills and developing a social network that supports ongoing treatment.

Treatment for soothing purges should come from a place of compassion and acceptance. A person in recovery should feel supported as they explore the reasons behind their purge behavior. Only then can they begin the process of replacing their eating disorder behavior with more adaptive coping methods.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

Wellness diets promote a form of foodphobia, the fear of food that leads to restricting entire food groups and categories. Foodphobia is often an early symptom of and eating disorder behavior. It can be hard to recognize because avoiding certain foods has been marketed as wellness. For example, many wellness diets promote a foodphobia of carbohydrates, fats, and animal products. They point to these food products as leading to weight gain and disease.

The food industry has continued to deliver tastier, cheaper, and more easily available food. As the food industry markets highly-palatable food, celebrities and social media influencers promote wellness diets. These are part of the $70 billion diet industry. Wellness diets lean heavily on the belief that some foods are “bad” while others are “healthy.” By extension, wellness diets promote the idea that people who follow their restrictive diets are “good” and people who don’t are “bad.” Wellness diets are the luxury brands of the diet industry, appealing to wealthy and primarily white audiences.

Diet trends have come and gone, but never have there been so many Foodphobic elimination-based diets as there are now. These diet programs, include Whole30, Paleo, Keto, etc. They institute food rules and promote Foodphobia in the pursuit of weight loss, which they call “wellness.” They each prescribe a different food elimination plan and list of “bad” and “good” foods.

Diets in disguise

Make no doubt about it: Paleo, Whole30, Clean Eating, and other wellness programs that promote eliminating certain foods are diets. Foodphobia, the fear of food, is a weight-loss tactic that promises that restricting entire food groups will result in weight loss and health improvement. However, there is no long-term (+2 years) evidence that these diets improve health, and there is evidence that almost all efforts to lose weight result in weight cycling, which is not healthy.

Foodphobic diets

Here are some examples of Foodphobic diets. These all promise weight loss by saying that particular foods cause weight gain and are not healthy. The goal of eliminating those foods is to become both thin and better than average:

• The Paleo diet promises a “cleaner” body by eliminating grains, beans, soy, dairy, and certain vegetable oils.
• The Whole30 diet promises to reset and heal your relationship with food by eliminating dairy and legumes.
• Detox diets promise to cleanse the body toxins by eliminating almost all foods except juices and raw vegetables. (It is important to note that as long as we have a functioning liver, our body naturally removes toxins.)
• Vegetarian/Vegan* diets suggest that weight gain is caused by hormones injected in livestock. They promote eliminating all meat products and all animal products, respectively.
• Clean Eating diets promise weight loss by eliminating any food that has been processed beyond harvest.
• Grain-free diets promote the idea that a multitude of human health problems can be linked to eating grains. They promote eliminating grains entirely from our diets.
• Fasting diets promote health by eliminating all food from our bodies for various periods of time.

*I recognize that there are strong ethical reasons to limit animal products, but there is also a strong association between these diets and wellness diet marketing. They are also correlated with eating disorders.

Not healthy and not a path to wellness

Each of these diets claims that the secret to full health and wellness lies in the food we eat. They all claim science and data to back up their claims, but their most powerful tool is marketing. Billions of dollars are spent on slick marketing campaigns and even full-length “documentaries” to sell us on these diets.

This is dangerous for people who are susceptible to eating disorders. Eating behaviors can be a way to subconsciously pursue worthiness and goodness. These programs make it easy for eating disorders to hide in plain sight. It’s hard to recognize an eating disorder when it’s been marketed as a wellness program.

FYI: the science sucks

All of these popular diet trends fail in the same way: they do not hold up to scientific scrutiny. The human body is incredibly complex, but these programs reduce us to machine-like components. Science does not fully understand how eliminating elements, from calories to individual nutrients, impacts our long-term health.

Even the programs claiming significant science fail when held to basic scientific standards. Check out this article about the problems with health claims made in the What the Health documentary. This can be applied to all Foodphobic diets: Debunking What the Health, the buzzy new documentary that wants you to be vegan, Vox.

Foodphobia, the fear of food, and wellness diets restrict entire food groups in the pursuit of weight loss. They hide their weight loss goals behind health messages, which makes them more compelling and dangerous.

Wellness books hide their true purpose

A huge part of the diet industry is hundreds of thousands of books, blogs and websites. These are typically written by thin individuals who promise that there is way to have their genetically-predetermined body type. The greatest danger in diet books lies in their denial that they are selling diets at all.

Until the a few years ago, diet media was open. Suzanne Somers proudly titled her book “Get Skinny.” Nothing qualified Suzanne Somers to provide eating advice except the fact that she is thin, gorgeous, and famous.

Diets are not effective. Whether it’s Suzanne Somers restricting calories or a wellness influencer touting green smoothies. Diets do not result in lasting weight loss. Not a single form of weight loss has been scientifically proven to last.

But that doesn’t deter diet books, magazines, blogs, celebrities, and social media influencers from promoting wellness diets. Moralistic claims now shroud weight loss claims. We’re told that we will be better, smarter people if we follow them.

The trouble with wellness

Today, there are few books saying they will help you “get skinny!” But weight loss is always an expected result of wellness diet programs that eliminate calories, nutrients and entire food groups.

Today’s moralistic diet claims are one of the most dangerous elements of modern diet industry marketing. They create a wide-open pipeline from diet to eating disorder. At least Suzanne Somers’ book was open about its weight loss goals. It didn’t pretend to be anything but a diet. Today, we say we’re seeking “wellness” to hide weight loss goals under the guise of wellness. Because of our fatphobic culture, we still want what Suzanne promised. Most wellness diets are promoted by people who look like and have the genetic predisposition to look like Suzanne Somers. Thin.

Those of us who are susceptible to eating disorders can find hundreds of ways to justify Foodphobic, highly controlled eating patterns at our local bookstore.

Diet books written by “lifestyle gurus” promise not just weight loss, but also a total life makeover. They can also masquerade as cookbooks (vs. diet programs). These diet cookbooks promise to make us better people based on the food we eat, how we prepare it, and from where it is sourced.

No matter how they position themselves, they are still sold in the diet category and essentially promote the restriction of food intake. This means they still follow the universal rule of dieting – the most common outcome of dieting is weight gain.

Foodphobia and eating disorders

Foodphobic diets are just the latest of many marketing efforts designed to support diet culture and sell books, products, coaching programs, and more. Dieting is the single greatest predictor of eating disorders. These Foodphobic diets, which sell themselves as lifestyles and NOT DIETS are particularly dangerous. Many people don’t realize they or their loved ones are struggling until an eating disorder has taken hold.

Foodphobic diets are the perfect foil to hide eating disorders in plain sight. Many people unknowingly engage in eating disorder behaviors by jumping from program to program. They alternate between the different wellness programs, continuously reducing their list of “safe” foods.

All diets – whether they include counting calories, adding complicated food rules, removing items from the diet or restricting oneself to juices for periods of time – exert significant stress on the body, raising cortisol levels and leading to long-term negative health impacts.

The current list of popular diets are being sold as “wellness” and “healthy lifestyles.” But make no mistake: any restrictive eating program that promises weight loss is prescribing eating disorder behaviors.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

This quiz will help you find out if your child has an eating disorder. While eating disorders have a lot to do with eating and weight (obviously!), they are mental disorders. This means that the diagnosis really requires behavioral and mood symptoms that go beyond eating and weight. In fact, the significant majority of people who have eating disorders hide in plain sight. Additionally, many eating disorders can look “healthy” according to popular opinion about how people “should” eat. The fastest-rising type of eating disorder is Orthorexia, which is an obsession with “healthy” food.

Take the quiz: Does my child have an eating disorder quiz

Maybe you have noticed that your child has been behaving differently around food lately. Maybe you’ve noticed changes in how your child eats. Or maybe you just have a sneaking suspicion that your child is keeping something secret from you. The bottom line is that if you have landed on this page, then you have some concerns about your child’s eating patterns. That’s a significant reason to be concerned and take some action.

Does my child have an eating disorder quiz

This quiz will help you hone in on your concerns about whether your child has an eating disorder. This quiz cannot take the place of a medical and psychological evaluation. It’s only designed to help a parent whose “spidey senses” are tingling to determine the next course of action.

No online quiz can take the place of a parent’s intuition that something is wrong. So even if you don’t get a clear result, an evaluation could be helpful. It may not be an eating disorder. It may be something entirely different. But you should listen closely to your instincts that something is going on with your child. Please seek help from someone who is qualified to help you figure out what it is.

Take the quiz: Does my child have an eating disorder quiz

What type of eating disorder does my child have?

Although there are technically five distinct eating disorder diagnoses, it is important to note that many cases do not neatly fit into a single diagnostic category. In fact, different types of eating disorders share many behavioral and psychological characteristics.

Your child may receive a more straightforward diagnosis such as anorexia or bulimia. Alternatively, they may fall into one of the various subtypes that fall under the umbrella of Other Specified Feeding or Eating Disorders (OSFED). OSFED encompasses a range of variations including over-exercise disorders, anorexia at a higher weight, purging disorder, and orthorexia.

Regardless of your child’s specific diagnosis, it is crucial to remember that treatment can be beneficial. Your child will need to learn how to live a life free from their eating disorder, and the support of parents and family can make a significant difference in the recovery process.

The distribution of eating disorders among individuals is as follows:

Does my child have OSFED?

47% of cases fall under Other Specified Feeding and Eating Disorder (OSFED). This category applies when the behaviors associated with an eating disorder do not meet the specific criteria for other established types. It is essential to note that OSFED is equally severe and dangerous, despite its classification.

Does my child have Binge Eating Disorder?

22% of cases involve Binge Eating Disorder (BED). This disorder typically involves a cycle of restriction and binge eating, where an individual limits food intake and then engages in episodes of excessive eating.

Does my child have Bulimia?

19% of cases are classified as Bulimia (BN). Bulimia is characterized by a cycle of restriction, binge eating, and purging behaviors, which may include vomiting, laxative use, and over-exercise. Trauma is often closely linked with bulimia.

Does my child have Anorexia?

8% of cases are diagnosed with Anorexia (AN). This eating disorder is characterized by significant weight loss, restriction of food intake, and a low body mass index (BMI). However, if an individual exhibits all the symptoms of anorexia but does not meet the criteria for a low BMI, they will be diagnosed as OSFED.

Does my child have ARFID?

5% of cases are categorized as Avoidant Restrictive Food Intake Disorder (ARFID). Unlike other eating disorders, ARFID is not primarily associated with body image concerns or a desire to lose weight. Instead, it involves food avoidance and restriction, often due to sensory issues.

Common signs of an eating disorder

As I mentioned, there are many types of eating disorders, and they may include some or all of the following behaviors:

• Restricting food
• Binge-eating food
• Purging food using vomiting, laxatives or exercise
• Intense fear of gaining weight
• Inaccurate self-image in terms of body weight and shape

How this quiz can help you spot the signs of an eating disorder

Sometimes a parent can recognize these obvious signs in a child. However, more often, the signs are subtle and hard to spot for three main reasons:

1. Secrecy: It is common for a child who has an eating disorder to hide their major symptoms. Parents are often not aware they exist.
2. Diet Culture: Our society applauds weight loss and efforts to control the body through food restriction. Parents can miss critical eating disorder behaviors because they fall under socially-acceptable dieting behavior.
3. Denial: Both people with eating disorders and the people who loved them can get stuck in a denial trap. None of us wants to see our child suffer, and mental disorders, especially eating disorders, carry a lot of stigma that can get in the way of diagnosis and treatment.

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See Our Parent’s Guide To The Different Eating Disorder Behaviors

The textbook definitions of eating disorders mainly relate to how a person eats food. For example, someone who has an eating disorder typically restricts food, binge eats, and/or purges in an attempt to negate caloric intake. A person who has an eating disorder is often dedicated to hiding these eating symptoms in order to avoid detection.

For example, a person who restricts food may excuse their lack of appetite at home with assurances that they ate “a ton” at a friends’ house or elsewhere. A person who binge eats may only binge eat when alone. Most people who purge their food do so in the privacy of the bathroom.

In this way, parents who use eating-based symptoms as a way to watch for eating disorders may miss important signs.

Weight alone is not a symptom of an eating disorders

Many people mistakenly assume that a person who has an eating disorder is dangerously underweight according to BMI measures. This is actually false – the vast majority of people who have eating disorders are not medically underweight. Even those who do become underweight with their eating disorder typically hide their bodies, making it difficult to recognize the severity of the disorder. Parents should not rely on body size to indicate an eating disorder.

With this in mind, here are three defining features of eating disorders that can more reliably help parents recognize there is a problem:

1. Attention to appearance

A classic symptom of an eating disorder is an obsession with the body. However, body obsession, like eating behaviors, may be difficult to spot if you’re looking for obvious signs like a child who openly says bad things about their body. Most people who have eating disorders automatically keep their obsessions undercover.

What parents can look for is overall changes in how much attention a child is paying to their appearance. For example, if your child has always dressed quickly and without a great deal of attention to details, consider that your baseline. When a previously-relaxed child begins spending hours selecting outfits, observing themselves in the mirror, and suddenly won’t leave the house without makeup, there may be cause for concern.

A person who is suffering from an eating disorder may also make a statement with their clothing and makeup, so a sudden switch to grunge, goth, or punk, especially in combination with changes in relationships described below, may be cause for concern.

Our society assumes that it is “normal” for teenagers, especially girls, to become obsessed with their appearance during adolescence. But just because something is “normalized” does not mean it is healthy. Body hate and obsession with appearance are not “normal” or healthy teenage behaviors.

2. Change in food patterns

It is not unusual for an eating disorder to begin with a dietary change. If your child goes on a diet, which is defined as restricting food and/or increasing exercise with the purpose of reducing body weight, then you have reason to be concerned. Almost all eating disorders begin with a diet, and there is good reason to discourage your child from ever dieting.

Here’s an anti-diet crash course: 1) diets result in weight gain; 2) diets cause health problems; 3) dieting is directly associated with eating disorders. A teenager who diets moderately is 5x more likely to develop an eating disorder than a teen who does not diet. 

Even if your child does not go on a diet, you may observe restrictive food patterns. For example, a switch to vegetarian or vegan, or a self-diagnosed food sensitivity, particularly to “whole foods” or foods containing carbohydrates (e.g. gluten-free) may be an indication of a disordered relationship with food.

This is a complicated topic. Not all people who eat this way have eating disorders, but many people who have eating disorders report that restrictive diets such as these were their first foray into disordered eating.

Another food pattern to watch is food rituals. Food rituals indicate an obsession with food and rigid behavior around food, both of which are symptoms of eating disorders. Food rituals may include carefully planning, procuring and cooking meals, requiring certain conditions in order to eat, or avoiding eating in certain environments, such as at restaurants, parties, and in public. Your child may also begin eating in a peculiar manner, such as eating in a circular pattern, cutting food into tiny pieces and arranging them on the plate, and other unusual methods of eating.

3. Change in relationships

Eating disorders are emotional disturbances and are often accompanied by changes in relationships. Often a child will withdraw from family activities that they previously enjoyed. Parents may also notice that their child is not as comfortable talking to and being with the family.

While it is true that most adolescents will become less child-like with their families as they grow up, aversion, complete withdrawal, or signs of anger and constant irritation should not be considered normal. They may indicate an underlying tension that needs to be addressed in the family, or they may be the sign of an emotional disturbance in your child.

Eating disorders require a level of secrecy that force changes in friendships and important relationships. Emotional intimacy is a threat to eating disorders, so people generally put space between themselves and friends, coaches, family members and community members with whom they were close before the onset of the eating disorder. Very often, parents assume these relational changes are “normal,” but it is worth considering whether the distance is because of a deeper emotional disturbance.

What parents can do

Parents should remain alert to changes in behavior, specifically around a child’s appearance, eating, and relationships. Even if the cause of these changes is not an eating disorder, they still warrant parental attention.

It can be counter-productive to approach a child with a direct question like “do you have an eating disorder?” Most will say “no.” Instead, try to gently and non-threateningly ask your child about whichever eating disorder behaviors you are observing. For example, if your child is spending more time in front of the mirror, ask how they are feeling about their appearance. If they are requesting a gluten-free diet, ask them for details about why they are making that decision. If they create a circle on their plate and always eat counter-clockwise, ask them why they enjoy eating that way.

In a healthy child, gentle questions like these will not result in a large response. The child will respond easily and unselfconsciously. The question will not seem like a big deal to them. If this is the case, and if you have no other reason for concern (e.g. troubling behaviors) then continue periodically asking questions with genuine curiosity so that you can better understand your child’s state of mind.

If your child responds explosively or angrily to a gentle and reasonable question, then wait a while and try again. In this way, you can test your child’s sensitivity to the topic. In general, a child who is not struggling will not exhibit high sensitivity when you ask a question about their behavior. A child who is struggling will have an over-sized reaction to questions. This is very simplified, of course, but it may help you to look for patterns in this way.

If you sense something is wrong, then find a qualified family therapist. Get some references and conduct an initial interview with the therapist to find out whether it’s someone who you think can help you and your child talk about this sensitive topic. Tell the therapist about your concerns, and ask whether they feel qualified to help you navigate the process.

Wait for (or create) a relatively calm, relaxed moment in the household when you are alone with your child. Tell your child that you are concerned about your communication, and that you have found someone who can help you get on the same page as parent and child. Don’t make this about the specific behavior, and don’t get pulled into a debate or argument. Calmly say that the appointment is on Tuesday at 5, and you’ll pick them up after practice.

You may feel like going psychotherapy is a big deal, but think of it this way: if your child started limping, you would take them to a physical therapist to get an assessment and treatment. Even if your child said the limp doesn’t bother them, you would still make the appointment. And if the therapist says everything is “normal,” you rest easy knowing that you did the right thing as your child’s parent and health ambassador. If the therapist says there is work to be done, you dive in and figure out how to help with recovery.

When we remove the stigma around having a child who has an eating disorder, we are much more effective in helping them recover.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

Eating disorders are complex conditions that involve genes, psychology, and the environment, but whether they are a type of addiction remains up for debate.

Some feel strongly that eating disorders are distinct from other types of addiction, but I believe it is helpful to at least look at the similarities and consider their overlap. Additionally, many people who have eating disorders also suffer from other addictions, including substance abuse, compulsive shopping, gambling, and sex addiction, so I think it’s helpful to explore the similarities.

It is becoming apparent that eating and drug disorders share a common neuroanatomic and neurochemical basis.

Gold & Star, Eating Disorders chapter 27

Eating disorder “addictions”

Addictions are characterized by how a person feels and responds to their addictive behavior or substance. This includes:

• Feeling compelled to do something
• A preoccupation with doing something
• Persistently doing something despite negative consequences
• Relapse despite a deep desire to stop
• Craving the action when not doing it

Here’s how you can line up eating disorder behaviors with the list of addictive behaviors:

• Feel compelled to restrict, binge, and/or purge food
• Are preoccupied with body weight, the next meal, or a desire to feel complete emptiness
• Persist in eating disorder behaviors even when families beg them to stop and they are shown evidence of negative consequences
• Commit to ending the behavior, only to repeatedly relapse
• When abstaining from behavior, crave the “high” that the behavior created

The “addictive” neurobiology

“The constellation of behaviors we call addiction is provoked by a complex set of neurological and emotional mechanisms that develop inside a person,” says Gabor Maté in his book In the Realm of Hungry Ghosts: Close Encounters with Addiction. Addiction research has found biological, chemical, neurological, psychological, medical, emotional, social, political, economic, and spiritual contributing factors.

From a neurobiological standpoint, addictions engage the brain’s attachment, reward, and incentive-motivation systems. The engagement of these systems reduces the rational thinking and impulse control areas in the cortex.

There are four dominant brain systems involved in addiction, all of which exhibit signs of being out of balance compared to non-addicted brains:

• The opioid attachment-reward system
• The dopamine-based incentive-motivation apparatus
• The self-regulation areas of the prefrontal cortex
• The stress-response mechanism

The purpose of an addiction

Many people who struggle with addictions also suffer from co-existing mental disorders including depression, anxiety, post-traumatic stress disorder, attention deficit hyperactivity disorder, autism spectrum disorder, and obsessive-compulsive disorder. Additionally, these conditions, as well as addiction, often coexist with eating disorders.

Eating disorders and addictions may appear like “bad habits,” but they are much deeper than a habit. They are firmly entrenched behaviors that we use to moderate our inner state of being. They can literally rewire the brain and nervous system, bringing a sense of calm and peace that is otherwise unattainable.

Dismissing addictions as “bad habits” or “self-destructive behavior” comfortably hides their functionality in the life of the addict.

Vincent Felitti, MD

Addictions serve an important purpose in the life of the person who is addicted. Most importantly, the addiction gives the person a temporary sense of relief. Unfortunately, the relief is short-lived. The long-term impact of continuing to use the addictive behavior or substance is continued, often increasing dependence on the addiction.

Personality traits

Several personality traits are found among people who become addicted to substances or behaviors. These traits stem from genetic and neurobiological conditions that create psychological impacts including:

• Poor self-regulation
• Lack of basic differentiation
• Lack of a healthy sense of self
• A sense of deficient emptiness
• Impaired impulse control

These traits may pre-date the addiction, and they often become more entrenched and obvious as the addiction continues.

Social traits

Eating disorders and addictions don’t exist in a vacuum. They arise in a society in which the addictions begin as something that is socially acceptable, even honored and praised. But there is a critical tipping point. At that point, a person who was doing something socially acceptable like shopping, having a drink after work, or going on a diet, slips into disordered behavior. People who are addicted exhibit the following social behaviors:

• Loss of integration into family and culture
• A sense of exclusion, isolation, and powerlessness
• A sense of shame and the belief of being inherently “bad”
• Utilizing deception and manipulation, regardless of the consequences, to pursue the addiction

Seeking peace

People who have addictions are seeking something outside to soothe their inner state of mind. But this is not obvious to most people. The paradox of addiction is that a person is seeking something to curb their insatiable emptiness, yet they will never feel sated as long as they are stuck in the addiction. It’s never enough because the emptiness is inside.

What characterizes an addiction? Quite simply this: you no longer feel that you have the power to stop. It seems stronger than you. It also gives you a false sense of pleasure, pleasure that invariably turns into pain.

Ekhart Tolle

A person craves eating disorder behaviors because they believe it soothes their deep sense of lack and emptiness. And yet eating disorder behaviors never actually soothe because it is not what they really need.

“The addict is never satisfied,” says Gabor Maté. “His spiritual and emotional condition is one of impoverishment, no matter how much he achieves, acquires, or possesses. In the hungry-ghost mode, we can never be satiated.”

What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood.

Alice Miller, Breaking Down the Wall of Silence

The fear within

Many people who have an eating disorder believe the eating disorder is a harmless, even healthy, friend. But in order to recover from an eating disorder, a person must decode the language the eating disorder used to communicate.

An eating disorder can mask a deep pain in the psyche. At some point, the person learned that they must not speak of this deep pain, and thus they adopt an eating disorder or other addiction in order to manage their deep discontent. The pain must emerge in some way and, for some, it is through eating disorder behaviors.

Addictions displace a person’s ability to truly feel emotions and express them in a natural, healthy way. The longer a person remains in an eating disorder, the further underground their vulnerability burrows. Recovery requires a person to bring their vulnerability into the light and see that the eating disorder was a maladaptive coping mechanism.

Not a choice

When a person is addicted to a behavior or a substance, they are not in charge. They are not making a choice. Even though the behavior hurts them, they are compelled in unseen and unobserved ways to keep doing them. They firmly believe it is the only way they can survive. To imagine a life without an eating disorder is incomprehensible. Their sense of self, their sense of worth, is innately connected to the disorder.

Finally, eating disorders share addiction’s central dilemma: “if recovery is to occur, the brain, the impaired organ of decision making, needs to initiate its own healing process,” says Gabor Maté. “An altered and dysfunctional brain must decide that it wants to overcome its own dysfunction: to revert to normal—or, perhaps, become normal for the very first time.”

Luckily, this does happen. Full recovery is 100% possible. Many people have made a full recovery from eating disorders. They have gone beyond abstaining from eating disorder behaviors and achieved full sobriety. Don’t ever lose hope!

See Our Parent’s Guide To The Different Eating Disorder Behaviors

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In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté provides comprehensive and deeply compassionate insight into addictions and the people who live with them. The main focus of the book is substance abuse, some behavioral addictions are also explored, including Maté’s. However, Maté does not directly address eating disorders in any of his books.

It seems like almost everyone has used Fitbit or another fitness trackers – they seem harmless, so how do they contribute to eating disorders?

The truth is that Fitbit and other fitness trackers can easily contribute to eating disorders. Tracking can start out being fun and healthy. But it’s too easy to become compulsive when tracking every step and meal. In fact, most people will stop using a fitness tracker after a short period of time. It’s just not that interesting to them. But for someone who has eating disorder tendencies, a fitness tracker can quickly become compulsive.

There have been pedometers on the market for decades. But when Fitbit entered the market it created a stir because it came as a bracelet that would buzz when the user achieved a certain number of steps. It quickly launched a full-scale app to track steps, calories, weight, and more. The software app includes serious gamification to improve engagement and create an addictive pattern in heavy users.

About Fitbit

Fitbit was launched in 2007, and by 2008 it was a huge hit. It seemed like everyone was wearing a Fitbit, displaying the black bracelet on their wrist as a sign of health and fitness. The company introduced an expanded dashboard to track calories and weight, plus sensors to track heart rate, temperature and sleep.

The company went public in 2015, and reached $9.7 billion in revenue and 29 million registered users. Today it has 85 million registered users. Of those, 31 million use their Fitbit app at least once per week. (Business of Apps)

Tracking exercise & food

Fitbit and other fitness trackers can seem like a fun way to track exercise and food. Users can set up their own profile, including their body weight, and set personal weight and fitness goals. They can track their behaviors and get rewarded with badges and alerts when they achieve goals. The psychological rewards are high when the phone app whistles and dings to celebrate goal achievement.

A physical tracker can count your steps through the day. But it’s the software that makes fitness trackers so addictive. You can log your food, water, and sleep habits. Every time you meet a goal, your phone buzzes and lights up. And it’s also gratifying to see the dashboard view of how “good” you have been this day, week, month, etc.

Fitbit taps into our obsession with our body’s activity and weight. And we love the feedback that tells us we are “good” and even “great.” Think of sticker charts for kids. Fitbit takes that basic human drive for approval and puts it into overdrive.

The combination of buzzing, lights, emails and phone notifications give you a charge of energy and the confidence that you’re succeeding. And that is exactly what Fitbit intends. It’s called the “gamification.” Those bells and whistles are purposely designed to make us become addicted to the feedback. Fitness trackers are almost custom-made for eating disorders, because they reward eating disorder behaviors in a tangible, concrete way.

Fitbit gamification

Gamification is a technique technology developers use to incentivize and increase use of their software. It capitalizes on the human response to competition, achievement and collaboration to make apps more “sticky,” meaning you’re incentivized to spend more time on them. Gamification is important because the more time you spend on an app, the greater the app’s chance is of making more money from you as a user.

You may be familiar with some of these apps, which heavily rely on gamification to increase user engagement:

• Duolingo
• Instagram
• Headspace

Fitbit is a champion of gamification. The app pushes encouragement, badges, and messages about goal achievement on a near-constant basis.

And, of course, Fitbit tracks weight loss and rewards users for every pound they lose.

The message “You’ve reached a new low!” should tell us everything we need to know about Fitbit.

Because of gamification, Fitbit addiction can begin in just one day of use. You can set our own goals and track everything you do through the day so that you can feel in control of your health. If you miss a goal, you can feel like a failure, and if you meet every goal, it feels like success.

Fitbit & perfectionism

Many people who have eating disorders also have perfectionistic tendencies. And the Fitbit is extremely appealing to perfectionists who want to do the right thing. Succeeding at Fitbit is possible if you are rigid/disordered in your eating and exercise behaviors. And Fitbit can make you feel as if you are doing a great job meeting your health goals. Even if those goals are disordered.

In fact, Fitbit has some warnings for people who do not meet minimum calorie requirements, but this is in fact a great incentive for someone who has an eating disorder. Rather than craving the message that they’re in the green for calories, which means they’ve had “enough,” they seek the message that they’re in the yellow and haven’t had “enough.”

The goals are easily twisted, and they add pressure to exercise even when we feel sick or tired (or both!).

It’s all too easy to rely on Fitbit to gauge whether you are hungry or need to move rather than check in with your own body for more accurate information. This places the Fitbit in a place of authority over us, even while making it seem as if we are in control. We can quickly become dependent on the reward of seeing that we “beat” our goals that day.

Fitbit can drive eating disorders and disordered behaviors. This is because of the gamification of the platform, not its validity. In fact, Fitbit is part of a class action lawsuit based on a study that found “the company’s popular heart rate trackers are highly inaccurate.” (CNBC)

Why Fitbit is dangerous for eating disorders

Fitbit supports the distorted view that health is best achieved by counting, tracking, and controlling our bodies. The fact is that our bodies are finely-tuned and able to moderate themselves if we listen to them. When we try to control our bodies, we are at risk of eating disorders.

The belief that bodies should be controlled by minds is at the heart of eating disorder behaviors, which are almost always based on the idea of restricting food in order to achieve goodness and worthiness.

Fitbit use is designed to be addictive, pushing the user to pursue excessive exercise and minimal calories every single day.

It may be a fun, benign tool for many people. But remember that about 10% of the population has, had, or will have an eating disorder at some point in their lives. Fitness trackers like Fitbit are like a guidebook for eating disorders. It’s very likely that the company’s most engaged users have eating disorder tendencies.

If your child who has an eating disorder, or is in recovery or recovered from an eating disorder, and is wearing a Fitbit or other fitness tracker, this is a dangerous sign. Work with your child’s treatment team to compassionately discuss the role of a Fitbit in your child’s life, and explore options for eliminating Fitbit use.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

Eating disorders are about much more than food and weight, and yet, our most recognizable symptoms come in the form of food and weight. This is why there are some food behaviors that parents should treat with extreme caution while their child is in recovery.

Skinny Teas are heavily marketed on social media platforms, and it is very easy for your child to be convinced that these products are safe, effective, and healthy ways to maintain the weight your child wants to attain. Skinny teas use peer-based advertising to exploit social media channels. Our recommendation is that under no circumstances should parents allow their children to purchase or consume skinny teas. Skinny teas can be considered eating disorder behavior.

To present the reasons why we are reposting a powerful Instagram post from Dana Suchow (@danasuchow).

HERE’S WHY I HATE SKINNY TEAS:

1. SKINNY TEAS LIKE @fittea @flattummytea @skinnyfit.me ARE LAXATIVES
For many people with eating disorders, laxatives are used to purge calories. Using laxatives for weight loss is DANGEROUS. Not only do they dehydrate you and can make you really sick, but it’s a scientific fact that diets don’t work, and all these teas will do is lay the groundwork for a full-blown eating disorder.

2. SKINNY TEA COMPANIES TROLL EATING DISORDER HASHTAGS LOOKING FOR INFLUENCERS
I have been approached MULTIPLE times by skinny teas (and I know @nourishandeat and other big accounts have too). They start their email off with “Wow we love your IG and what you stand for..”

LOLLLL if they actually read my IG they wouldn’t go near me with a ten-foot pole.

But these companies troll curvy influencers and body positive influencers because they want to market their products as an “all natural way to love your body.”

3. PEOPLE PROMOTING DIET TEAS HAVE BEEN PAID IN CASH OR FREE PRODUCT
Do not trust anyone promoting these products. As someone who has been approached multiple times, I know what’s in it for influencers $$$.

And on that rare occasion, someone is promoting it on their own accord, don’t trust them either because they are using a tea with laxatives to lose weight. Whether they know it or not, this is dangerous behavior that is NOT self-love.

4. YOU WILL NOT LOSE WEIGHT FROM A TEA
Sorry ¯\_(ツ)_/¯ but you won’t.

People talk all the time about “bloat.” And sure, a laxative is going to get rid of “bloat”…until you have to poop again. Cuz hello you have a body that takes in nutrients and expels waste to keep you alive. So unless you lose weight through other ways, all this tea is going to do is give you a shitty at home colonic (no pun intended) and the next time you eat, that ridiculous “bloat” y’all talking about (that’s just food in your gut) will come back.

Oh & they also have ZERO TRANSPARENCY with their ingredients!

Lol, can you tell I hate skinny teas?

Dana “Hotpants” Suchow is a Speaker, Activist, and Event Producer. Since overcoming bulimia and compulsive exercising that resulted in permanent injuries, she has become a champion for women’s rights, eating disorder issues, and body positivity. You can follow Dana on Instagram @danasuchow ❤️

See Our Parent’s Guide To The Different Eating Disorder Behaviors

The diet industry makes billions of dollars promising to help us lose weight. Meal replacement shakes are one of many extremely profitable products selling weight loss under the guise of health and fitness.

For our children who are susceptible to eating disorders, these meal replacement shakes can be dangerous. With a stated goal of gaining “health” and “nutrition,” our children can use meal replacement shakes, powders and supplements to pursue weight loss without realizing they are eating disorder behaviors.

Unless our children are on a nutritionist-prescribed meal replacement program, there is almost no justification for spending our money on meal replacement shakes, and there is a good reason not to allow them in our homes due to their weight loss goal. When our kids want a shake, let’s empower them to make them at home using whole foods, not supplements and powders.

Reasons people say they need a meal replacement shake (plus what to say if your child says these things to you):

1. I’m too busy to eat: Eating is an essential part of life. It goes along with breathing, drinking water, and sleeping. It is essential, restorative, and wonderful. If you don’t have time to eat, then there is a life-balance problem at stake. Let’s assess your lifestyle and find a way to fit in a healthy amount of time for eating. Let’s talk to your therapist about what we need to work on to help you have time to nourish your body.

2. I don’t feel like eating: This could be a sign that an eating disorder is taking hold of the brain and sending disordered hunger and satiety signals. The body has a natural desire to eat real food. When natural food cues and the desire to eat fade, it’s worth exploring what is going on with the natural body-mind communication pathways. Let’s talk to your therapist about the fact that you don’t feel like putting food in your body and find out some ways to nourish your body that feel good for you.

3. I’m trying to lose weight: Your body is a perfectly balanced organism, and you don’t need to control it or diet. Dieting often leads to weight gain and eating disorders. Your body naturally adjusts and changes throughout life, especially during adolescence. Let’s schedule an appointment with a nutritionist who can help us understand what your body needs and reassure you that the healthiest thing you can do for yourself is to eat intuitively and not diet.

4. It’s healthier because I get all my vitamins and minerals: Getting vitamins and minerals through artificial means (vs. whole foods) has not been proven to be scientifically beneficial. There is no evidence that vitamin supplements make any impact on good health. Eating a whole, balanced diet is enough to keep the body fully nourished in all ways. Let’s talk with a nutritionist who can help you build a balanced meal plan that provides you with everything you need.

Multi-billion dollar companies sell shakes and nutritional supplements using “real people” on social media

The diet industry makes $70 billion per year. Beachbody, which sells Shakeology, makes $1 billion per year selling weight loss products. These businesses are growing fat off our fear of fat. When their products don’t result in lasting weight loss, rather than blame the products, we have been conditioned to blame ourselves for lack of willpower.  The better your child recognizes the marketing muscle behind the weight loss industry, the better he or she will be able to withstand the environmental factors that can contribute to eating disorder development.

Multi-Level-Marketing (MLM) companies like Beachbody deploy a workforce of independent contractors who are trained and paid to convert friends and family members to a shake-based diet plan. Social media is a prime location to sell the “I did it, so can you” message. These image-based #beforeandafter #weightloss messages can be incredibly triggering for anyone susceptible to an eating disorder.

Responding to diet industry advertising

We see advertisements promoting ineffective weight loss products everywhere. The screenshots of promotional sliders on the Shakeology website (screenshots obtained on 5/8/17) are a template for almost every diet marketing message being circulated right now. That weight loss is good for you is assumed, and the messages are shrouded in a cloud of good health and fitness fallacies. For each of them, we have provided an Intuitive Eating rebuttal below, so that you can build your conversational skills around diet culture with your kids.

But I love shakes!

Most of our kids love shakes and smoothies. And why wouldn’t they? Shakes and smoothies are smooth, creamy, and sweet. This is not about never having shakes – it’s about avoiding meal replacement formulas that are sold for the purpose of causing weight loss.

Encourage your child to explore whole-food-based smoothie recipes because they are delicious and nutritious, but not because they will help with weight loss.

There are literally thousands of homemade healthy shaken recipes that are absolutely appropriate snacks and treats for our children. Real Simple has a good selection here.

Follow the advice of your child’s nutritionist

Some eating disorder recovery plans include meal replacement shakes. We are not demonizing all meal replacement shakes. Nor are we making a medical statement about your particular child’s nutritional needs. Your child’s nutritionist, your child’s therapist, and you yourself know what’s best for your child’s health. The purpose of this article is to raise a flag about companies that promote meal replacement shakes for weight loss purposes and to suggest that you look carefully if your child independently decides to adopt a meal replacement shake diet.

See Our Parent’s Guide To The Different Eating Disorder Behaviors

by Angela Wurtzel, MA, LMFT, CEDS

I work with many people who have both eating disorders and self-harming behaviors like cutting. The way I see it, it is a way for someone to use their body as a way to communicate.

Whether they are burning, cutting, or picking at themselves, or bingeing, restricting or purging food, it is often symbolic of some deeper issues. Of course, there are different degrees of this – sometimes it’s just a bad habit, like nail biting, but sometimes it’s more serious.

The body as a communication tool

The body is a powerful communication vehicle, so when I work with a child or adolescent, we address the disorder empathically in that way. We look at why they feel compelled to use their body to communicate or expunge some sort of feeling. Then people can start to understand the purpose of their behavior in a different way.

Like eating disorders, self-harm and cutting are very deep-seeded, core issues. Every person that I’ve worked with has their own story, their own history, and background that leads them to find the unconscious solution of relief in self-harm.

Through therapy, I help people piece together their psychological puzzle. Typically people have already been in treatment, and they have improved a bit, but they still have urges and compulsions, and they know something still isn’t quite the way it should be. In therapy, I help them understand their urges more deeply and with more insight so they can adapt and change and sustain the changes over time.

Psychodynamic Theory vs. CBT

I work psychodynamically, which is quite different from Cognitive Behavioral Therapy (CBT). A lot of the young women I work with have been in and out of facilities and through various therapies, including CBT. And those therapies are part of their recovery, yet when my patients arrive at their next adventure of therapy they are typically seeking a deeper look at relationships and communication, which is when a psychodynamic approach works really well.

A lot of the work we do in psychodynamic therapy is looking at communication patterns. We look at understanding who they are as individuals and their role within the family. We want to work out what they want to do in life, and what might be holding them back.

A lot of my work with young women, whether it’s self-harm or an eating disorder, is to help them put what’s behind their actions into words. We seek to uncover the underlying anxiety.

About anxiety

I encourage young women to look deeper when they are pursuing anxiety-driven behaviors like self-harm. Seek to understand the deeper anxiety. If you are anxious about your body, look deeper. What else is going on?

Next, we can work to develop emotional regulatory skills so they can manage their emotional, psychological and physical world. Not that anxiety can be completely eliminated, but you can learn to understand and manage it in a constructive manner.

Symptom-free but still work to be done

When someone is in the midst of self-harming behavior, it’s all they think about. Once they get to the other side, they discover a whole other world of anxiety and living.

The beauty of eating disorders, cutting, and self-harm is that they protect them from dealing with larger issues of anxiety. It allows them to focus all of their anxiety on their bodies and food.

After a while, they begin to recognize the underlying issues, and then it’s not the symptoms we’re dealing with. It’s everything that drove the symptoms to surface in the first place.

What to do

If as a parent you believe that your child is self-harming, whether they have done it once or 50 times, then you should understand that your child is desperate to communicate, to expose something unconsciously.

The best possible thing you can do is to step up and say “I’m going to take care of you by taking you and our family to someone who can help us with this.”

I really encourage parents to seek outside, professional, experienced help with self-harming and eating disorder behaviors, since it can be very troubling for a parent to deal with the fear and anger that is natural when you discover that your child is intentionally harming herself.  Finding a helpful professional who can accurately assess self-harm and differentiate it from suicidal tendencies is very important.

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Angela Wurtzel, MA, LMFT, CEDS, specializes in the psychotherapeutic treatment and guidance for women and men of all ages working to overcome eating disorders, self-injury, and compulsive shopping. With over 20 years of clinical experience, Angela’s expertise lies in the emotional and personal development of each person she works with. Angela combines a high level of clinical skill with understanding in a safe, empathic environment. She helps individuals to identify underlying emotions and find words to express feelings without using the body as a means to harm oneself. Angela assists her clients in achieving lives free from destructive tendencies. Website

See Our Parent’s Guide To The Different Eating Disorder Behaviors