Category: Teenager With An Eating Disorder

If you have a teen who has an eating disorder, then you probably know that getting enough sleep is a key component of their care. But it can be hard to get any teenager to get enough sleep. And when you add on the disruption created by an eating disorder, it can feel like just one more thing on your list.

Sleep and mental health

Getting enough sleep is a cornerstone of mental health. And while of course a person can recover without getting enough sleep, recovery will likely be easier with sleep hygiene.

There are three essential components of mental health: eating, sleeping, and relating. Parents are able to support mental health by ensuring these three components are fulfilled.

Eating: We support our kids’ mental health by serving consistent, enjoyable meals and supporting them in getting enough fuel for their bodies and minds. 

Sleeping: We support our kids’ mental health by establishing healthy sleep habits and boundaries to promote sleep hygiene.

Relationships: We support our kids’ mental health by being in a positive relationship with them, supporting their peer and other relationships, and offering them psychotherapy for additional support.

Teens and sleep

Science has shown that teenagers are not lazy or obstinate when they stay up late. They are actually driven by melatonin levels to stay up later in the night and awake later in the morning than either children or adults. And unfortunately this night-owl behavior is coupled with a biological need for the teenage brain to get 9-10 hours of sleep per night.

It goes without saying that most of our teens don’t get even close to 9-10 hours of sleep. Even teens who are able to fall asleep at midnight are likely only getting 6-7 hours of sleep to accommodate early school start times. 

A lack of sleep increases impulsivity, anxiety, and depression. And all of these are associated with eating disorders.

Adolescence is a time when the human brain undergoes a massive “pruning” effort to transform the child’s brain into an adult brain. This pruning is part of the maturation of the prefrontal cortex, which is the area responsible for planning, prioritizing and controlling impulses.

A lack of sleep isn’t the sole cause of mental disorders, but many studies have found that it is correlated with mental disorders.

“Sleep loss problems are linked with brain areas that control emotional processes and risk-taking,” says Wendy Troxel, a clinical psychologist and senior behavioral and social scientist at RAND. “Sleep problems and behavioral and mental health problems are linked.”

How to help teens get enough sleep

A lack of quality sleep has a profound impact on our kids’ health, cognition, and behavior. But what can we do about it?

If you’re like many parents navigating eating disorder recovery, then the thought of getting your child through recovery may seem like a heavy enough burden. The idea of adding on a sleep routine can feel unlikely or even impossible. 

But setting boundaries around sleep is something you can do. Just like eating enough, eating regularly, and going to therapy, sleep is important for recovery. We can’t force our kids to get the sleep they need, but we can create the conditions that make sleep more likely. 

1. Make a family plan

It is important to make sleep a priority for everyone in the family. It just won’t work to tell your teen who has an eating disorder that they need to sleep, but nobody else does. That will feel punitive and is unlikely to work.

Discuss the importance of sleep, and agree that as a family, every member needs to improve his or her sleep hygiene. This foundational agreement is the only way you will be able to successfully implement the following recommendations.

2. Turn off electronics

According to the National Sleep Foundation, “ninety percent of people in the U.S. admit to using a technological device during the hour before turning in, and children often use electronic media to help them relax at night,”

The problem with this trend is that using electronic devices is physiologically and psychologically stimulating and can adversely affect sleep. Yes, all of us believe that we do not fall into the category of people who find electronics disruptive, and all of us believe that our devices help us fall asleep, but the science shows that simply isn’t true.

Using TVs, tablets, smartphones, laptops, or other electronic devices before bed delays your body’s internal clock (a.k.a., your circadian rhythm), suppresses the release of the sleep-inducing hormone melatonin, and makes it more difficult to fall asleep. This is largely due to the short-wavelength, artificial blue light that’s emitted by these devices.

The more electronic devices that a person uses in the evening, the harder it is to fall asleep or stay asleep. Besides increasing your alertness at a time when you should be getting sleepy, which in turn delays your bedtime, using these devices before turning in delays the onset of REM sleep, reduces the total amount of REM sleep, and compromises alertness the next morning. Over time, these effects can add up to a significant, chronic deficiency in sleep. (National Sleep Foundation)

As a family, determine a time at which all electronics must be powered down. All the way. Not left sitting next to you so that you can see texts coming in. You may need to make it physically difficult or impossible for anyone to access the electronics at night.

Here are some options: 

1. Shut down the wireless from 10 p.m.-6 a.m. That may seem early to you, but if your teen has to be at school at 8, that means they need a bedtime of 11 p.m. at the latest.

2. Purchase a time-based safe. This can keep your phones locked up until the morning. 

3. Create a charging station in the house in which all electronics are stored for the night. 

Remember that all members of the family must participate in the activity of powering down – it can’t be something that only the kids have to follow. Your teenager with an eating disorder should not be targeted as the reason for the new sleep habits.

3. Sleep hygiene

Bedtime rituals can be very helpful in signaling the brain to “power down” and prepare for sleep. Each person will have their own ritual, but the important thing is to talk about them as a family. For example, one person may enjoy a shower or a bath. Another may enjoy a cup of something warm and soothing.

Have books and physical reading materials available for everyone. Book-based entertainment is enjoyable but non-stimulating and therefore not disruptive to sleep. Get everyone proper sleeping clothing and invest in nice sheets and pillows so that everyone feels happy in their beds.

Begin turning off lights as the night wears on. Lights signal our brains to stay awake, so gradually turn off and dim household lights to help signal sleep. The best sleep hygiene involves going to sleep and waking up at the same time every day. Based on age and temperament, establish ideal bedtimes for each family member.

4. Avoid overwork

At this point, you may be wondering if this type of sleep program is unrealistic. Perhaps your child tells you they need to remain available for texts and do homework until midnight. If this is the case, then look at your child’s schedule. Enough sleep should be considered non-negotiable for every family member, especially when there is an eating disorder.

You may be surprised to hear that eating and sleeping should be the priority in your home. All other activities should come only once those two fundamental needs are well-met. And the third essential need? Socializing and enjoying life!

Consider reducing your child’s extracurricular load and your expectations so that they are able to complete homework well before 10 p.m. 

If your teen is not able to complete all school and sports activities by 10 p.m. then they are overworking. Our teenagers’ brains cannot handle the strain and may develop serious disorders as a result of chronic overwork.

Our culture has created a dangerous precedent in which some teens are going non-stop from 7 a.m. to 11 p.m. every day. And then they begin their relaxation and socializing, both of which are very important. As a result they often stay up well into the morning hours.

This interferes with sleeping, eating, and enjoying life. It is not healthy by any standards. In many cases, our teenagers are working harder and doing more than adults. We simply must edit our teens’ lives to raise healthy kids.

Getting support

I realize that adding sleep hygiene can be a daunting task when you’re already dealing with a teen who has an eating disorder. If you feel these steps are impossible in your family, then please consider getting some support from a therapist or coach. They can help you set and hold boundaries to support your own and your family’s mental health.

See Our Guide For Parenting a Teenager With An Eating Disorder

Parenting a teenager who has an eating disorder is not easy. Eating disorders are complex illnesses that must be treated comprehensively. Since most eating disorders begin during adolescence, parents are on the front lines of treatment and care. But few feel prepared to handle it.

When an eating disorder shows up in your teenager, it’s important to know that it doesn’t happen in a vacuum. Eating disorders are biopsychosocial disorders, meaning they combine biology, psychology, and social factors. The impact of social factors on eating disorders may be one of the reasons we see so many of them develop during the teenage years. After all, teens are probably under the most intense social pressure out of any age group.

Here are three key things about parenting a teenager with an eating disorder you should know:

1. Adolescence sucks

It is important to understand, and truly connect with, how difficult it is to be an adolescent today. Every teenage cohort believes they have it rough. But this group of teens is correct when they say they are under unique pressure.

The main things that have changed for today’s teenagers include:

• Social media: every misstep, angry outburst, and embarrassing behavior and experience can be chronicled. Brutal comments and endless opportunities for comparison are an integral part of the platforms.
• Parental pressure: parents are more engaged in teens today. And this means that teens feel more pressure to perform and succeed than before.
• Higher mental illness: teens today have higher rates of all mental illnesses, including anxiety and depression. This is not just caused by the fact that we’re measuring these things more. Statistics show that it is an actual effect, and our kids are suffering more than we did.
• COVID-19: obviously, parents did not grow up in a time of COVID-19. And the specific impacts of the pandemic are yet to be measured. But we can clearly anticipate lifelong effects.

Maybe you had pretty good adolescence, but chances are that even if you did, you still struggled at times. Maybe you have forgotten about the really hard year in the midst of good ones. Or maybe the last two years of high school were great. But you’ve forgotten the terror of the middle school years. Chances are good that if you look closely, you will uncover your own challenges during adolescence.

A rough time in life

During adolescence, our emotions are all over the place. We are also biologically driven to separate from the people who we love and trust most – our own parents. This leads to seemingly ridiculous power struggles. these struggles are an integral part of developing into independent adults. And they’re hard.

Then you add on the elements of today’s society. There’s increased pressure for school performance, extracurricular activities, getting into the right college, looking good, and feeling happy. And, of course, social media makes it all harder. Sure, some of it is fun, and our kids enjoy themselves some of the time. But never forget that the years between 10-20 are rife with stress and anxiety. And both stress and anxiety are heavy contributors to eating disorders.

Tip: Help your teenager feel safe and secure at home. This will reduce their stress and anxiety, which contributes to eating disorders. Keep in mind that when your teenager says “life sucks,” it may be true. It doesn’t mean you have failed as a parent, it just means the world is tough on teenagers. Yours likely needs your love and support.

2. Eating disorder behavior is prescribed as “good”

Eating disorders are scary, but most of us can recognize the behaviors of an eating disorder. In fact, they are prescribed and recommended in our culture. They include:

• Obsession with weight and shape: there are very few people in our society who are not a bit worried about or concerned about their weight and shape. Weight control is promoted in healthcare, schools, the media, and almost everywhere. This obsession drives a +$70B industry.
• Restriction: if you’ve ever been on a diet, then you have restricted your food. Diets prescribe eating disorder behavior.
• Binge eating: when the body is starved of food, such as when restricting, it will demand fat- and sugar-filled calories. Thus, restriction is the precursor to binge eating. And almost everyone who has been on a diet can relate to the insatiable drive to eat high-calorie food.
• Purging: when the body becomes over-full, or when you are worried that you have eaten “too much,” you might feel as if you need to purge the food from your body. Not everyone turns to vomiting, using laxatives, and other purge behaviors. But most people who have tried to control their weight can relate to the urge to do it.
• Over-exercise: excessive exercise is seen in our society as healthy, but it is not. In fact, it can be a form of purging. Many people feel they must exercise when sick, feeling run-down, or injured. Rather than a sign of health, this means exercise has become compulsive.

Sound familiar?

Most of these eating disorder behaviors probably sound familiar to you. In fact, you may use some of them yourself. Teenagers are in the throes of developing their identity and have very little impulse control. Thus, they are susceptible to eating disorders. And it’s no surprise – our society literally prescribes eating disorder behaviors every day.

The normalization of eating disorder behaviors also means that recovery can be hard to measure. As long as eating disorder behaviors are prescribed, parents struggle to define “health” for their kids.

Tip: Prohibit eating disorder behaviors in your home. That means nobody should be restricting, weighing themselves, or pursuing a particular weight and shape. This may be a big shift for you. Check out our article on the non-diet approach to health.

3. Mental healthcare is expensive and hard to get

When you have a child with an eating disorder, you seek out the best path to care. And at that point, you realize that there are many paths, and it all seems to be up to you. The challenge with a mental health crisis is that mental healthcare is patchy, expensive, and hard to navigate. Finding care can be surprisingly difficult.

Going through your insurance provider may be very challenging. Your provider may limit eating disorder treatment only to extreme “medical” cases. And even then, care may only extend through a minimum of weight restoration, which falls far short of full eating disorder recovery.

Insurance companies are technically required to cover mental health. But it’s common for claims to be denied or held up. It’s also common for the best therapists to require direct payment. This is because they frequently don’t get paid by the insurance company. Even good coverage may limit your treatment options.

It’s a challenge to get care

There is a good chance that you will need to pay out of pocket to provide your child with comprehensive eating disorder care. Treatment requires a team of an experienced dietitian and therapist over a period of months to years. This can get very expensive, very quickly. In many cases, even if you choose to pay out of pocket for treatment for your teenager with an eating disorder, the best therapists may not have openings or may not be physically nearby your location. This adds to the burden of care, further complicating recovery.

Tip: I’m afraid I don’t have a solution to our lack of good mental healthcare. Have compassion for yourself as you navigate the system. And get as much support as you can. Also, know that your behavior matters. You can help your child recover. Parenting a teenager who has an eating disorder is hard. But the fact that eating disorders are partly social means that parents actually have a tremendous opportunity to impact recovery.

See Our Guide For Parenting a Teenager With An Eating Disorder

By Alejandra Sandomirskiy, high school sophomore

How do peers, cultural messages, and the media impact a person’s body image? How do you think people should handle the impact of peers, cultural messages, and the media?

As I scroll on social media, I often come across body shaming and misleading advice. While we may encounter judgement, becoming aware of the toxicity can impact the way we process its message.

When exposed to the negativity of peers, cultural messages, and the media, we start to focus entirely on our insecurities, disregarding our best qualities. However, understanding the inaccuracy of these portrayals can remind us of our individuality and improve our body image.

Cultural messages

With the rise of technology, cultural messages have become intertwined with the world of social media. The posts we see contribute to our desire for the “perfect” lifestyle and body, perhaps explaining the correlation between time spent on social media and a person’s self worth.

In a study researching the effects of Facebook on college students, those who spent more time on the app were “more likely to link their self-worth to their looks” (Simmons).

However, most of what we see on both social and print media is fake: pictures are posed and the use of filters and photoshop can be undetectable. It is unrealistic to compare our natural bodies to those of influencers and peers when we only see selective images of them.

If we distance ourselves from toxic magazines, television shows, and social media, we can form healthy habits and explore new interests without the opinions of strangers.

Online beauty contests

Additionally, critics of social media compare it to a beauty contest. On platforms where images of ourselves are aesthetically displayed, competition is bound to happen.

As people strive to obtain “likes” on their posts, the “line between a ‘like’ and feeling ranked becomes blurred” (Simmons).

As a result, people may take risky measures to achieve the body they long for. Skipping a meal occasionally may seem harmless, but this mindset can lead to eating disorders and lifelong body image problems.

Striving for peer validation can worsen people’s body image by linking popularity to appearance.

Peer comparison

We may find ourselves jealous of our peers’ bodies, or even frustrated as to why we cannot obtain their figure. Comparing ourselves to someone our age may convince us we are unhealthy or doing something wrong.

At the same time, we fail to consider that no matter what lifestyle choices we make, our bodies are genetically different.

Moreover, the lifestyle category of social media consists of a “disproportionate number of images” that “reinforce a thin ideal” (Mecca).

Influencers promoting restrictive eating can cause eating disorders and feed into the cultural message that “thin equals healthy.” Similarly, people with no knowledge of nutrition often promote unhealthy eating habits while guaranteeing inaccurate results.

Fighting back

To combat the impact of peers, cultural messages, and the media, we must understand the intent of cyberbullies and credibility of content.

When people body shame others for their entertainment, it is our responsibility to report hateful comments. In conversation, calling out others on their use of harmful language can make them reconsider their actions.

Doing research rather than listening to strangers or peers can give us more accurate information on how to care for ourselves. Likewise, following creators who promote body positivity and healthy lifestyles can make social media a more positive influence.

In order to create a community of support and self-love, we must embrace our body and those of others. In our lifetime, our bodies will allow us to travel, visit loved ones, make new friends, and create lasting memories.

The human body is a complex yet unique system that makes these opportunities possible, and it is our responsibility to love and care for ours.

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About Alejandra

Alejandra Sandomirskiy is a sophomore at Thomas S. Wootton High School in Rockville, Maryland. She’s a member of the Student Eating Disorder Awareness Association (SEDAA), which is dedicated to raising awareness about eating disorders and helping to build positive self-esteem among boys and girls. In her free time, Alejandra enjoys exercising, playing the piano, and hanging out with friends and family. She also enjoys camping and going on hikes.

See Our Guide For Parenting a Teenager With An Eating Disorder

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References

Mecca, Allison. “The Impact of Media, the Thin Ideal, and the Power of You.” Eating Disorder Hope, 7 July 2020, http://www.eatingdisorderhope.com/blog/impact-media-thin-ideal-power-of-you. Accessed 6 Apr. 2021.

Simmons, Rachel. “How Social Media Is a Toxic Mirror.” Time Magazine, 19 Aug. 2016, http://www.time.com/4459153/social-media-body-image/. Accessed 6 Apr. 2021.

Following is an excerpt from the book By Their Side: A Resource for Caretakers and Loved Ones Facing an Eating Disorder. The book is filled with personal anecdotes and helpful advice for parents who are facing a child’s eating disorder diagnosis and recovery.

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An eating disorder? I didn’t even know what an eating disorder was! But what I did know was that something was not right with my child. Actually, something was terribly wrong!

A missed diagnosis

Her lips were blue—why was that? The pediatrician said the erratic behavior, crying, defiant reactions, odd immaturity, and withdrawal were just hormonal and that this, too, would pass. She actually commented on Sten’s weight loss and how she must have taken good care of herself that summer at camp.

“You look good,” she told Sten.

The pediatrician was wrong. It did not pass.

I have lived a colorful life, seen some of the worst the world has to offer, and experienced the best. Gifted with wisdom, experience, street smarts, and a strong female psyche, I was afraid of little. But this? This confused me.

I did get scared. I was afraid. I could not tap into my own wisdom for answers, and my forty-two years of experiences did not offer me any peace.

My young daughter, at thirteen years of age, was just as confused as I was. Neither of us had experience with anorexia, and neither of us knew the destructive, self-loathing force we were about to face!

The fog of guilt

For two years, I lived in a fog of guilt after my child was diagnosed with an eating disorder by a specialist and then hospitalized. I constantly questioned myself, wondering how in the world my child could have this problem: No, not my child. I know her better than anyone else on the earth. She’s complex, but no way could she have a mental disorder!

I’m a great mother. What did I do wrong? I have given all of myself to raising children. Our family is good, well respected, and resourceful. We functioned as a perfectly healthy family. I’m a really loving mom, and I have a grounded marriage and great kids. How could this have happened?

Well, it did happen, and sadly, I lost my confidence those two precious years to self-ridiculing guilt. All those things I’d wondered were from my misguided perspective on how I viewed my healthy life.

Keeping secrets

I was tight lipped about my daughter’s illness because I thought it would protect her from others’ judgment. I did not want her to be labeled. I was also hesitant to admit to my child’s illness, so I did not confide in friends or family.

I did not want to put this type of pain on my siblings, mom, or dad, so I pushed them away, acted strong, and thought I could fix my daughter’s issues because . . . for God’s sake, I was her mom.

I was scared. Scared to death of losing my child to anorexia, scared of losing my own self, and scared of life imploding around me. Internally, I was sad and constantly obsessing. I blamed my husband, I blamed family genetics, I blamed athletics and unprofessional doctors, dietitians, and teachers. I was lonely but wrote the loneliness off to being misunderstood.

My marriage was almost destroyed, and the way I handled—or should I say neglected—my other two children had moments of negative dysfunction. By being secretive about the illness, I was protecting my child’s reputation—or so I thought. Really, maybe I was worried about my own!

My feelings were real, but it was my perspective that kept the guilt alive. The guilt was about me! There was no need to air all our dirty laundry, but there was a desperate need to ask for help.

Asking for help

Then, finally, I realized there was no shame or weakness in asking for help. So I did. It was at that point that the hard work of healing began and I refocused my energy. I asked for help from friends, family, and professionals.

Just like my child and my family, I, too, began learning coping skills. That was twelve years ago.

Today, after family counseling and intense honesty, we are comfortable being not a perfect family but an honest, loving family. With hard work, our marriage has made it, and it is more robust and based in truth than before.

Yes, we had bruised hearts, and it hurt like hell—really hurt. But with commitment to genuine, unconditional love, we healed. And yes, there is scarring, but we’ve learned how to address the past blamelessly and honestly.

We were forced to dig deep into our psyches and sincerely lean upon our faith. Our love and respect for one another is far greater than it was a decade ago.

The aftermath of an eating disorder

Today, we are great together. We know more about who each of us really is and accept the differences, all while working to prop up one another’s hopes and dreams.

Our daughter, who battled a severe eating disorder for eight years, just graduated college and is living in another state, having fun, working full time, being social, interesting, and responsible, and enjoying a healthy life. There was a moment in time when her success was against all odds. But she beat the odds; we beat the odds, and we are better people for it.

Are we perfect? Absolutely not! There is no perfect. But we have forgiven each other, and we have forgiven ourselves.

—A once-scared mother

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By Their Side: A Resource for Caretakers and Loved Ones Facing an Eating Disorder provides an excellent overview of what loved ones need to know about caring for someone who has an eating disorder. Written by a collection of families, friends, and healed advocates, it includes stories of what it’s like to love someone who has an eating disorder as well as helpful information about eating disorders and treatment options.

See Our Guide For Parenting a Teenager With An Eating Disorder

Eating disorders are not well understood, isolating, frustrating, and painful. And that goes for the person who has it as well as the people who love and support that person. When a child develops an eating disorder, parents can easily become overwhelmed by treatment, fear, and frustration. It can help to hear stories from other parents who have gone through the recovery process.

This eBook was written to provide a mother’s perspective of her daughter’s eating disorder recovery. This eBook is provided courtesy of Recovered Living, a recovery coaching service that, from this mother’s perspective, was a critical element of her daughter’s recovery from an eating disorder.

Following are a few excerpts from the book, but it’s well worth reading in its entirety for more details and perspective.

What I learned about recovery

“(To me) owning recovery involves eating, feeling emotions, building relationships and participating in life – everything an ED denies.”

“My daughter was told that recovery is harder than she could imagine … and supporting her in her recovery has been so much harder than I imagined, too. I can see why those who recover can accomplish anything they choose in life because I think I could tackle most things now and I’m only the support person.”

“My daughter initially struggled until she found a recovery coach who stated outright that becoming fully recovered was possible. For her, the knowledge of being able to recover was the foundation to her decision to commit fully to recovery, but even then the pull of the ED was still very, very strong.”

“Learning to own recovery includes allowing feelings to be felt; good and bad.”

“Real recovery comes from being able to emotionally step back in life; a life the ED is accustomed to numbing them from.”

My own relationship with food & weight

“I previously thought I had a good relationship with food, but I was silently a watcher of my weight and a dieter, although I never openly dieted or talked about my weight. I hadn’t realized that my own self-esteem was tied to the size of my clothing.”

“… for me, addressing my own issues around food, body image, and weight has been crucial.”

“Eating what I want, doing what I want, and being me, without judgment based food eaten and what the bathroom scales say, is freedom – just like I want for my daughter.”

“I could never imagine going back to how I was before, which is how so many other mothers I know live. The sense of freedom is very liberating.”

Walking on eggshells

“I have never walked on so many eggshells in my life since an ED took up residence in our home!”

“… no one told me we did not need to walk on eggshells. Only after we found her recovery coach did I learn that this behavior was actually the ED exerting control over the whole family …”

“If an ED had its way, it would zip everyone’s lips. Talking can help draw my daughter our and temporarily away from her ED because she can’t withdraw and be present in a conversation at the same time.”

Siblings and friends

“It has been tough on (her brother) and early in her recovery he did ask a few times if he was ever going to get his sister back.”

“… there aren’t many teenage girls who have the fortitude, maturity or innate wisdom to stand by a friend when an ED is pushing them away.”

“… for my daughter, a big part of her second half of recovery has been about building new friendships and connecting with people who contribute to her growth and joy.”

What I learned about treatment

“Recovery involves learning and learning leads to growth. (This is) why having a recovery coach specialized in ED recovery has been vital for my daughter, as no one else could provide this type of expertise.”

“My experience shows a person in ED support needs to be specialized in the area, not dabble in it as part of their job description, because ED work is a career path that has chosen them and not the other way around. Having a recovery coach or therapist who has recovered themselves is also a prerequisite in my opinion …”

“I joined a Facebook group set up to help mothers navigate recovery, but within a couple of months I realized it was more harmful than helpful because the group embraced a victim and sympathy mentality which I likened to a “stagnant pond” environment where nothing positive could grow from.”

“Fortunately my daughter’s recovery coach offers her own online support group and this makes a real difference. It is free to attend and has been gold.”

See Our Guide For Parenting a Teenager With An Eating Disorder

Being on a team is awesome, but it’s also true that student-athletes should be monitored for eating disorders. While moderate exercise is very healthy, student-athletes may struggle with anxiety, depression, and eating disorders during their athletic careers. This is most likely due to the the stress of participating in sports in today’s hyper-competitive environment combined with the fact that coaches and parents are rarely aware of how to spot eating disorders.

As parents, we need to be aware of the dangers, signs, and symptoms to help our kids thrive as student-athletes, both on and off the field, court, track, etc.

Mental health and student athletes

Anxiety, depression, suicidality, self-harm, substance abuse, and eating disorders are all on the rise for all teens and young adults. Almost 50% of Americans under the age of 18 experience mental illness before turning 18 (Pew Research Center, 2019). Exercise and the belonging of being on a team are positive for mental health. Yet many student-athletes find themselves suffering from food and body issues.

“Despite the well-documented benefits from exercise and sports participation on mental health, some athletes will at times experience psychological, emotional, and behavioral problems.”

Mann, et al, 2007

“The professional consensus is that the incidence of anxiety and depression among scholastic athletes has increased over the past 10 to 15 years,” said Marshall Mintz, a New Jersey–based sports psychologist who has worked with teenagers for 30 years (The Atlantic). A study by the National Athletic Trainers’ Association discovered that many adolescent student-athletes reported higher levels of emotional disruption and mental illness compared to non-student-athletes. (Neal, et al, 2015)

What makes student-athletes vulnerable to eating disorders?

Student-athletes have some great assets in terms of belonging and healthy exercise. But they can also suffer in a highly-competitive environment. This is especially true when the athletes are held to body standards and/or wear body-conscious uniforms. Such sports include running, girls’ volleyball, gymnastics, and swimming.

Here are a few reasons why student-athletes may struggle with mental health:

1. Athletics become the primary identity

Many student-athletes build their identity around being athletic. They often build their entire sense of self and worth around their athletic performance. Athletics become the way they seek and receive positive feedback from parents, peers, and important adults like coaches. This is a risky way to identify yourself. An injury or poor performance can leave an athlete feeling bereft and worthless.

2. Fear of falling behind

Athletics is based on being either a “winner” or “loser.” And this may be motivating for some. But others can become obsessed with numbers and performance metrics. The more games won, points scored, and medals received, the greater the fear of not performing as well next time. This leaves student-athletes in a constant state of fear. They fear of letting their team, their coach, their parents, and their peers down. It becomes impossible to imagine not giving everything they have to their sports performance. They may sacrifice food, sleep, grades, physical health, and mental health to the high-stakes game of winning.

3. Unrelenting intensity

High school sports were once confined to the season, but now most student-athletes compete year-round. They put in 2-3 hrs of practice every day (sometimes more) on top of schoolwork. Many don’t get home until 7 or 8 p.m., at which time they must complete several hours of homework. This schedule continues without a break as long as they want to stay competitive. But this schedule requires a 12-hour workday before homework. With homework, student-athletes are working 15-18 hour days. This is more than 75 hours per week. That’s many more hours than most adults work.

4. Pleasing parents

Most parents don’t mean to push their kids too hard when it comes to athletics. Most do it subconsciously in an attempt to support their child. It’s wonderful when a child is naturally athletically talented, and usually, the child enjoys their sport tremendously in the beginning. But as they continue, many kids will keep playing even when they don’t enjoy themselves. Because they know how much their parents love their athleticism. Since their identity is wrapped up in their sport, they worry that they are not lovable without their sport. They also know how much their parents have sacrificed in both time and money for them to succeed so far. It’s hard to stop playing when you know how much your parents have invested in you.

5. Dangerous coaches

Coaches often spend more time with student-athletes than any other adult, including parents. They might be great at achieving athletic goals. But few coaches have any training in mental health and teenagers with eating disorders. They tend to make massive and devastating mistakes when it comes to the emotional caretaking of our student-athletes. Coaches are incentivized to win, and their focus is on that outcome rather than any individual player’s health. In fact, coaches may ignore physical injuries and obvious mental distress. Their goal is to maintain a key player on their team, so they may make questionable choices for an individual. Coaches often criticize student-athletes and engage in emotional manipulation to meet their winning goals. And, of course, coaches want their student-athletes to look the part, which means lean and muscled. In some sports, weigh-ins lead to explicit weight goals. In others, coaches never need to explicitly state weight goals. They just make comments to make it clear that student-athletes must maintain a certain physique in order to be a part of the team.

6. Body-conscious uniforms

Uniforms can either increase or soothe body consciousness. The most challenging uniforms when it comes to body issues are swimsuits, leotards, and the briefs worn for volleyball and running. In these uniforms, a student-athlete who is gaining weight has nowhere to hide. Many will simply drop out of a sport rather than continue to watch their bodies change in plain view. The uniforms perpetuate the concept that there are particular body types that are “built” for particular sports. They promote the concept that anyone who doesn’t “look good” in the uniform should not participate.

7. Dedication and perfectionism

The very same characteristics that make someone a great athlete also make them “good” at eating disorders. Great athletes are dedicated and passionate. They tend toward perfectionism and don’t shy away from following a “no pain, no gain” mentality to succeed. These qualities also makes them very good at controlling their food intake and engaging in disordered eating and eating disorders. The number of sub-clinical eating disorders in student-athletes are virtually impossible to measure. These behaviors appear “normal” and “healthy” in the student-athlete population. But they are not. It is often only when they put their athletic careers behind them that student-athletes recognize how deeply disordered they were when they were competing.

Signs of student-athlete distress

No parent wants their child to suffer mental distress or get an eating disorder. And yet it often comes with the territory of being a student-athlete. It is possible to compete without suffering health consequences. This requires that we monitor student-athletes for eating disorders and other mental illnesses.

Following are the major ways an athlete may experience stress, as described by Ray and Weise-Bjornstal (1999):

Affective signs and symptoms: anxiety, anger, guilt, depression, shame and feeling sorry for oneself.

Behavioral signs and symptoms: sleep disturbances, restlessness, aggressive behavior, alcohol or drug abuse, sulking, crying, poor performance, absenteeism, and clenched fists.

Biological or physiological signs and symptoms: muscle tension, increased heart rate, indigestion, stomach spasms, pain, and headaches.

Cognitive signs and symptoms: frustration, worries, distortion, exaggeration, unrealistic performance expectations, self-defeating statements, and self-handicapping.

Interpersonal signs and symptoms: withdrawal, manipulation, and argumentation.

Sensory signs and symptoms: tension, nausea, cold sweat, clammy hands, pain and butterflies in the stomach.

If your child is a student-athlete, you should monitor for these signs and be aware of their serious risks. Don’t wait for your child to ask for help. Schedule a professional consultation with a therapist who has experience working with student-athletes. If possible, maintain a regular relationship with a coach, therapist, or physician who can periodically evaluate your child’s mental health. You need support in optimizing their environment for their mental health.

At some point, our student-athletes will no longer compete in their chosen sport. Our goal as parents must be to help them maintain enough of a sense of self, and enough positive mental health, that when they stop competing, they still feel worthy of love and attention without the prospect of winning a single medal or point ever again.

See Our Guide For Parenting a Teenager With An Eating Disorder

Many families who have a child with anorexia will hear about Family Based Treatment, or FBT. It is an evidence-based treatment and for anorexia. Here’s one family’s story:

By Anonymous

My daughter had a brain tumor at age two. It caused morning vomiting through age 6.* She survived due to early intervention. This included craniotomies and physical therapy.

She was diagnosed with social anxiety at age 6. She refused to drink water at school because she did not want to use the bathroom at school. I remember her telling me about a teacher who commented negatively on her snack of a cupcake. She also had a paraeducator telling her that sugar is as addictive as cocaine.

These are some of the memories I have that help me make sense of the anorexia. It seemed to develop in a matter of weeks.

We compiled a list for the doctor:

• Changes in diet (won’t eat whipped cream, butter, regular cheese, ham)
• Cooks, but doesn’t eat what she makes
• Eats really slowly and seems to play with food more than eat. After she eats, it looks like a mess (food all over the place)
• Eats really small portions
• Feels guilty after eating (cries)
• Fascinated by cooking shows and recipes, but doesn’t eat
• Does jumping jacks after eating
• Smells like fingernail polish remover
• Moody and Emotional
• Seems cold and wears big jackets all the time
• Sleeps a lot
• Wants me to take her to the gym all the time
• When she takes off her big sweatshirt, I’m shocked because she’s very thin

My husband and I met with the doctor first. He asked us if we have a scale in the house. We do. He told us to take it out of the house. Once it’s gone, she notices it is missing and I say it’s broken. It has been “broken” ever since.

Visiting the doctor

That night, I tell my daughter that we are going to see the doctor. When I check her phone I find that she has visited a website that tells her how to “cheat the doctor.” I’m devastated. I’m angry. She just got the phone a few weeks ago, and this is what she’s looking up? This is the moment I am certain that my daughter has an eating disorder.

The doctor meets with my daughter and evaluates her. He tells her she needs to gain weight. At home, she spends hours crying. He calls later and says she needs blood work and an EKG. He gets her admitted to the hospital. We feel relief. The children’s hospital doctors tell me that my daughter is very ill. She must be hospitalized for at least 5 days, but maybe a few weeks. She is told she must eat or she will get an NG tube. There is no negotiating or pleading, this is just the way it is.

Family based treatment for anorexia

Anorexia nervosa is a monster and it has a stronghold on my daughter. It also has a 20% mortality rate (often suicide). This is the highest for any mental illness, so I’m scared to death of it taking my daughter’s life.

She’s 13. The best chance of recovery from anorexia is Family Based Treatment, or FBT. This includes intensive meal support, and we parents oversee three meals and three snacks daily. I check for hidden food (sleeves, cheeks, pockets, trash can, etc). I check that food is eaten and swallowed (mouth check before leaving the table).

After leaving the table, she has to sit with the family and play a game, watch TV or do homework. She is not allowed to use the bathroom (for fear of purging or flushing food she somehow hid). We can’t let her go to her room, because she does jumping jacks to compensate for the meal she just ate.

So much sadness

Our daughter is suffering and there is a lot of crying and sadness.

We have to encourage her to eat at a decent pace (ideally less than 30 minutes). She wants to cut her food in tiny pieces. She’ll move it around her plate and let it fall to the floor. We make her eat it at a swift pace. She is not allowed to plate her food and must eat everything on her plate. In fact, everyone at the table has to clean their plate.

We band together as a family, my husband, myself and my 10 year old. We fight the monster (anorexia) that wants to starve my child. My child who has anorexia can not help with grocery shopping or food preparation. I black out the calorie content of any prepared package food I serve to her.

She tells me about low fat alternatives and wants to eat vegan. We do not allow this, but we allow her to choose 3 foods that she can refuse to eat. The food she chooses to reject are tomatoes, bananas and eggs.

Pulling together as a family

Every week, we attend family based therapy. At the beginning of each session my daughter is weighed. If she puts on 1-2 pounds, we parents are applauded, and my daughter cries the rest of the session. If she does not put on weight, she smiles and we work with the counselor to develop new strategies.

I learn that is difficult for an adolescent to put on weight. So I buy high calorie snacks and nutritional drinks to help with the weight gain. The counselor tells us that we cannot only serve “safe” foods (pop-chips, salad, whole wheat pasta with lean chicken). We must also serve “fear” foods (caramel, chocolate, soda pop and pizza). We give her fear foods when we are feeling strong enough to take on the monster. Sometimes I trembled after those meals.

The impact of family based treatment for anorexia

My younger daughter misses eating pizza and ice cream with her older sister. She seems sad as her older sister’s personality changes for the worse. At one time, my younger child told me she wished she could die. I realize it is really important to get her out of the house away from the disease. Trouble is, she doesn’t want to leave. Perhaps she is scared of losing her sister?

Personal fallout

The stress gets to me and I see a counselor for anxiety. I see a medical doctor for anxiety medication and an occupational therapist. I developed Irritable Bowel Syndrome and suffer from frequent back aches.

The only part of my life that is a break from the disease, my job, is something I felt forced to resign from. There were so many appointments (individual counseling, nutrition therapy, family counseling and medical). And my manager felt I wasn’t pulling my share of the weight at work. FMLA would have protected my job during this period of intense caregiving. But before I knew of the illness, I switched jobs. I was still on probation when she was diagnosed.

After eight months of FBT, the family counselor thought it best for the me to send my daughter away for therapy full time. I felt some relief at the thought of a break, but my daughter started gaining weight after we talked about “sending her away”.

Sometimes I find moldy food hidden in slippers or spit in trash cans and I cry. Will the anorexia take my child’s life?

We share very little about the disease with friends, for fear of adding to my daughter’s stress. Our goal is to avoid exposing her to the potential stigma associated with mental illness. We feel very isolated.

The recovery from anorexia with family based treatment

We sign up to be volunteers at the local food bank. She enjoys volunteering and we make it a routine. She wants to play volleyball, go to the gym, or play softball. As she gains weight, she is allowed to practice softball for an hour a week. Hours are added back based on her recovery.

Eventually, 13 months in, she hits her fear weight and she doesn’t cry. She asks us to buy her candy. The monster seems to be gone.

At a healthy weight

Now it is 17 months later and my daughter is much better. At her last medical visit she was a very healthy weight. Her fear foods are no longer and we don’t supervise every meal. She can play softball everyday after school and she can participate in PE class.

She still has problems making and keeping friends. Recently, when she broke with a good friend, we caught her drinking from our hard alcohol. Now we lock our alcohol in a safe. We have made contact with a counselor at school who would love to help her. She is refusing further counseling, so we decide to limit her freedoms instead.

I cringe at every mention of “clean” or “healthy” food or trendy diets. I just wish we, as a society,  could focus on teaching our children to enjoy food and love their bodies. I’m tired of this anti-obesity campaign. It could kill my child.

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* A recent study conducted by USC found that pediatric brain tumor patients face increased risk of interpersonal and emotional distress.

• 25% of respondents reported that the patient had trouble making and keeping friends
• 20% reported that the patient feels isolated and alone.

Interpersonal and emotional distress has been correlated with teenagers with eating disorders. So while this child’s childhood illness is not a stand-alone “cause,” it is an important part of this family’s anorexia story.

See Our Guide For Parenting a Teenager With An Eating Disorder

by Therese Roeser

I was raised in a home where there seemed to exist a great deal of permission around food.  There was a large variety of food available in our pantry and refrigerator. Friends would flock to our house to eat “sugary” cereal and “junk” food.  In addition, appealing, balanced meals were served on a predictable schedule.

However, my mother was at times on a diet or “watching it.”  When she plated our dinners, she served herself noticeably less food than the rest of us. At lunch, she would sometimes eat “diet” food typical of the 80s: grapefruit, cottage cheese, canned tuna, rye krisp crackers and diet shakes.  One of my older sisters would also diet from time to time. It was not discouraged. My father ate pretty erratically and, after dinner, would spend a lot of time eating snacks while standing in front of our pantry. He had a larger body and believed strongly in fasting.

So there was this idea that young children had permission to be normal eaters and to just exist in their bodies but all bets were off for adults. They needed to control what they ate.

The summer before I began high school, I experienced my first episode of depression and, for the first time, experienced a significant loss of appetite. It felt like a funny blessing…this state, this apathy toward eating, that my family members had been trying to achieve just sort of fell into my lap.  So, I began to hone it by “healthying up” my diet. At the same time, my depressive symptoms began to lift as I became more engrossed in my restriction.

As my weight changed, my size became an important part of my self-esteem. I was becoming a skinny girl! This was something new I could be good at!

My family was not overly concerned. I think that my parents normalized my restrictive behavior as a “phase girls go through” or just normal initiation into womanhood. In my family, as in many, a slender body was admirable and preferred.

My body continued to noticeably change and it became my primary focus. It was apparent to the few friends I had that I was not just dieting. I became reluctant to socialize because I did not want to be pressured to eat or for my behaviors around food to be scrutinized. I grew more irritable and sensitive. I needed my behaviors; I relied on them to assure me of my attractiveness, likeability, and success, essentially my worth as a person. They defined me.

My days became a series of rigid eating and exercise rituals. My skills, passions, and dreams dwindled in favor of my behaviors. My parents vacillated between denial and alarm. My father insisted that I was merely “athletic” and had remarked that it was better for me “to be underweight than the alternative.”  My mother, on the other hand, expressed genuine concern over my body, which was now “clinically” anorexic. She took me to the pediatrician who was dismissive.

On the one hand, I felt that I had safely slipped under the radar. Another part of me, however, desperately wanted someone else to take over and rescue me.

The August following my freshman year in high school, I reached my lowest weight. It was a number much lower than I had ever anticipated reaching. On the one hand, I felt a rush and, on the other, I was terrified by how far this had gone.

My sister confronted me about my behaviors as well as the state of my health. She comforted and reassured me, and she talked with my mom about my eating disorder since I was not ready to do so. Later that month, I began outpatient therapy and nutritional counseling.

Over the course of this initial recovery period, my mother accompanied me to a weekly eating disorders support and psycho-education group for several weeks.  She even took me to listen to a lecture by Joan Jacobs Brumberg.

My family always supported my eating during recovery. However, I wish my parents knew that fatphobia, which continued in our family, was a huge barrier to recovery.

During this recovery period, I began to binge. Biologically and psychologically, this made some real sense. My body and brain were starved. My family, therapist, and dietician were overjoyed that I was eating again. However, I was still trapped by my feelings about weight and food.

I wish my parents had known that an eating disorder was more than a weight-based illness.  After I reached my “target weight,” my treatment stopped. My underlying anxiety and depression were never recognized or treated.

For the next several years, my weight fluctuated greatly and much of my eating remained compulsive albeit at a less severe level. What remained constant and unresolved was the sense that I was deprived and could never get enough. The eating disorder served a larger purpose in my life and now there was a void.

While away at college, I yearned to be “normal.” I hoped to recover the untainted relationships I once had with my body and food before the onset of my disorder. I started a recovery group, and we all believed the solution to our problems lay in being able to change how we viewed and used food or how we felt about our bodies. What we didn’t consider was the why in the equation. Why did we maintain our behaviors? How did they serve us and what did they represent?

During my senior year of college, I sought the help of a therapist and a dietician again. I was no longer clinically ill but I still didn’t exactly feel comfortable in my own skin and eating would, at times, cause me to feel guilt, shame or self-reproach. This period of therapy gave me more stability, and I went on to complete a Masters degree in Social Work.

My first year out of graduate school, I suffered from my second episode of depression. With the help of a psychiatrist over a period of several years, I started to understand more of the “why” in my eating disorder. I discovered that I used my behaviors to manage my depression, stress, and anxiety. When circumstances or emotions became seemingly unmanageable, my eating disorder provided constancy and refuge.

Through therapy, I slowly started to see myself as much more than a jumble of pathology and failures. I came to witness my strength, competence, and value as a human being. I started to trust myself again.

I stayed well through the pregnancies and births of my two children. When my son was diagnosed with autism, I felt terrified, powerless and as though I had failed in life. Once again, I slipped back into some of my old behaviors. I channeled all of my pain and exhaustion into destructive eating patterns. This went on for about 6 months when I began to see a psychologist and registered dietitian that specialized in eating disorders.  

They encouraged me to uncover my faulty thinking and challenge it. They helped me to find my voice again, to state my needs, to ask for help and establish my boundaries.  Mostly, they taught me the incredible value of self-care. I cannot nourish and nurture others if my own well is depleted.

I used to imagine how things might have been different for me if my family was different, if I weren’t so driven or if I wasn’t a woman.  As I began to understand myself more clearly, I accepted that the development of the eating disorder was part of my life history. It is a mental illness that I work to keep in remission. I don’t blame myself for its having existed much like one would not blame oneself for having had cancer or asthma.

In the beginning, the function of the eating disorder was to comfort and soothe myself. It relieved a lot of the stress and anxiety in my life. For me, the eating disorder was a compass giving me direction while bypassing the difficulties of the present. It also gave me a false sense of success. My behaviors became my automatic “go-to” anytime I experienced a difficult emotion and needed to retreat. They were coping mechanisms.

For a long time, I strove to be “cured” because I was so ashamed of ever having had an eating disorder. Learning to see recovery as a process and treat myself more gently and less critically has helped me maintain forward momentum.

The loving support of my husband, my family, and my very closest friends truly help me to remain grounded.  My two children are my main reason to be well. I strive to have energy and a love of life that I can share with them. I have discovered joyful movement in a variety of way: walks, yoga, swimming, dancing and lifting weights. I do not abide by any exercise routine or schedule, though.  I fully embrace intuitive eating. I take medication to treat my mood disorder and I still see a psychiatrist and therapist in addition to my general practitioner. I also make a lot of irreverent and fun artwork.

As a parent, I feel it’s important to eat with your children and enjoy the same foods together.  So my kids see me eating pizza, ice cream, hamburgers, etc. I follow the Ellyn Satter philosophy on eating: parents decide what is served at a meal and the time of the meal while the individual child determines what and how much of each food they will eat.  We also talk about how bodies change as we get older and we all grow at different rates and have unique bodies. One of my favorite books to read is “Amanda’s Big Dream.”

Recovery for me is about trying my best to stay truly engaged in life, all the while learning more about myself.

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You can see Therese Roeser’s recovery artwork on her Instagram account, @healingcrayons

See Our Guide For Parenting a Teenager With An Eating Disorder

Do you want to improve teen body image? It’s possible, and every parent can make an impact on their teen’s body image. First, you need to understand that having bad body image is completely understandable given our society. But parents can help!

Here are six things you can do to improve teen body image:

1. Understand diet culture. Dieting has a 95% failure rate and is directly lined to eating disorders.
2. Adopt a Health at Every Size philosophy. This states that we should pursue health behaviors without weight loss as a goal.
3. Stop dieting and controlling your weight. Parents who diet are more likely to have kids who are dissatisfied with their bodies.
4. Stop speaking badly about your body. Kids pick up on how parents feel about their bodies, and will develop negative body image as a result.
5. Talk about media literacy. Observe and discuss the impact of traditional and social media on our society.
6. Monitor social media. Maintain some oversight into and maintain time limits on social media activity.

There is no way to be “perfect” when attempting to improve teen body image. This is as much an art as a science. But parents can definitely help just by showing up and learning a little bit.

Body hate and an obsession with appearance are not “normal” teenage behaviors

First, we need to address the fact that most people think it is “normal” for teens to feel bad about their bodies. This is especially true for our teenage girls. We have normalized body hatred and an obsession with appearance in teens. But we must never mistake body hate as “normal,” because such normalization is how eating disorders hide in plain sight.

Normalization is the process through which ideas and actions are made to appear culturally “normal.” The fact that something has been normalized is an entirely different thing than being normal as in “healthy.”

We live in a culture that has normalized body hatred, and poor body image. This includes feelings of despair and anguish over the appearance of one’s body. When we hate our bodies, we believe they are flawed. Believing that the body is flawed, especially when one is physically healthy and able-bodied, makes us vulnerable to eating disorders.

What is actually “normal” from a health standpoint is body acceptance. True health occurs not based on a number on the scale. Health is only possible when we believe our body is fundamentally good. We take better care of our bodies when we accept them.

Advertising body hate

Normalization in our culture is driven and controlled by advertisers who are trying to sell products. Rule No. 1 when marketing a product is that we must first create a market. The way we create a market is to create a problem that must be solved.

Advertisers know that marketing a diet that will cause extreme hunger and discomfort is not effective. But marketing a diet that says it will make you more attractive, and then saying that being more attractive is the key to happiness and success, is very effective.

Advertising a skin cream that looks and feels like every other cream on the market is not effective. But advertising a skin cream that says it will make you more attractive, and then saying that being more attractive is the key to happiness and success, is very effective.

This is the formula for all beauty and diet advertisements.

Marketing messages impact body image

Our children are exposed to powerful marketing messages from childhood. These messages serve to build the market for beauty and diet products. They also pave the way for body hate. These messages serve to convince our children that their bodies are flawed, and that a person cannot be happy and successful unless they are perfect. This perfection is promised as a result of buying beauty and diet products.

Marketing is sneaky

Luckily for marketers, none of us thinks that we are easily manipulated. We believe that we are pursuing beauty and weight loss for our own reasons. But it’s not true. We are incredibly susceptible to beauty and diet marketing, especially teenagers with eating disorders. Our assertion that we can’t be manipulated by marketing means, ironically, that we are more easily manipulated. We are exposed to these messages and they most definitely influence us. But we assertively deny that they have any influence over our behavior.

Social media is bad for body image

Social media is fun. Our teens spend a lot of time on social media. Most parents don’t really know what their kids are doing on social media. We didn’t grow up with social media. A lot of us don’t use social media the way our kids do. Unlike TV, which is easily observed by parents, social media can be hard to monitor and control. This creates a perfect storm for our kids.

Several studies have found that social media has a severe and negative impact on body image. One study found that the more time girls spent on social media, the more likely they were to suffer from body hate, disordered eating, and eating disorders. [1]

Social media feels “real”

One problem with social media is that it feels “real” in a way that traditional media does not. Most of us can dismiss Seventeen magazine models as “fake.” But when we see “real” Instagram influencers our brains believe that we can and should look like them. Since it’s part of our society, social media promotes diet culture and a thin beauty ideal. But it doesn’t feel as toxic as traditional media.

Social media promotes disordered eating

The other problem is that many people use social media to encourage and reinforce disordered eating and eating disorders. Major influencers promote “Skinny” laxative teas, restrictive eating, and over-exercising. Residential eating disorder treatment centers have reported that at least 50% of their patients are using social media to support their eating disorders.

Body image, disordered eating, and eating disorders

Body hatred and an obsession with appearance are both part of the eating disorder behavior spectrum. People with eating disorders believe they are flawed and must correct their flaws by restricting food. Once they start restricting food and send their body into starvation mode, they may develop symptoms of restriction including binge eating and purging.

Parents can improve teen body image

Parents can improve teen body image. We can open our eyes to the powerful forces of advertising and social media, and learn to talk to our kids about body image. We can help our children open their eyes to the idea that their bodies are perfectly fine as-is. We can help them understand that they do not need to shrink, control, alter, or otherwise mess with a body that is already perfect.

See Our Guide For Parenting a Teenager With An Eating Disorder

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References

[1] Facebook Photo Activity Associated with Body Image Disturbance in Adolescent Girls

Do you kind of hate your teenager? Do you sometimes wonder how it’s possible that the sweet little toddler you loved so much has turned into a monster? Are you out of ideas for how to make things better – or at least not so bad – at home?

The good news is that you don’t have to hate your teenager. The bad news is that it’s going to require significant effort on your part. You may think that they are the one who has a problem. But if you want things to improve, it’s up to you to take action.

Please understand, parents are not to blame for kids’ behavior. Our kids are their own people, with their own temperament, their own experiences, and their own free will. But when parents complain about their children, they have two choices:

1. Keep complaining and feel hopeless about ever getting along with a difficult teen.
2. Look inward and see what changes we can make ourselves to improve our experience of the relationship.

When we choose the second path, there is a chance for change, both in ourselves and in our kids.

But remember, this is not coming from blame. It is not meant to suggest that you haven’t tried your very best and given your child everything you could so far. It’s just that if you kind of hate your kid, then what you’ve been doing isn’t working so well for you. Read on if you want to consider one possible way things could get better.

You are not a bad parent, and this isn’t about love

If you kind of hate your teenager, you may feel like a bad parent. You may think that your feelings of dislike for your teenager mean you are unsuited to parenting them. And you may cry out in pain because you love your child so much, and you just can’t figure out what went wrong.

When our kids act out and infuriate us, it’s not because we didn’t love them enough, and it doesn’t mean they don’t love us. But it does mean that your relationship needs help. And if you’re reading this article, then it means that you are motivated to improve it. You’re motivated to translate your love into the sort of behavior that will build a deep and loving relationship with your child. That’s a good place to start!

Remember that we can’t change other people, but often when we change ourselves and our behavior, we change the way people respond to us. This is the key to rebuilding a relationship with a child who drives you crazy. Recognize that you can’t control or fix your child into treating you better. But you can change the way you behave, and you may see some positive results.

4 tips for improving a relationship with your teenager when you sort of hate them

1. Get professional support

This is going to be challenging. You need someone on your side, but not just a cheerleader or someone on whose shoulder you can cry. You need those people, too. But for serious work, you need a professional who can guide you towards a healthier relationship with yourself and your family. A therapist, counselor, coach, or another person will hold you accountable for your part of the dynamic while gently guiding you towards more productive behavior.

2. Work on your boundaries

A teenager who behaves angrily and hatefully toward their parent is struggling with roles and security. Maybe your boundaries were overly-harsh, and they feel penned in and trapped. Maybe your boundaries were too porous, and they don’t know where you end and where they begin. All of us thrive in relationships that have good boundaries, but a lot of us never learned how to set and hold boundaries with the people we love. Learning to establish appropriate boundaries will improve your relationship.

3. Learn about attachment

All of us have an attachment style. This is based on how we were parented. And while about 56% of adults have a healthy (“secure”) attachment style, the rest have less-secure attachment. Attachment is nobody’s fault. It’s something that happens to us before we have any free will. And even the most loving parents may have less-secure attachment. And even secure parents can raise kids who have a less-secure attachment style. Less-secure attachment can result in a teenager whom you kind of hate. And one of the most important things you can do to rebuild your relationship is to learn about attachment and move towards greater security.

4. Rebuild your relationship

Remember that if you hate your teenager, it means your relationship – that means both of you, and possibly your whole family – needs some relationship repair. Even if it seems like your child is the problem, relationships are, by definition, interconnected. This means that everyone involved plays a role. And the good news is that if you work on yourself and your role, there’s a good chance that your relationships will improve. Perhaps not magically, easily, or quickly. But over time, and with effort, parents can usually rebuild relationships with angry teens.

Bad behavior is a reflection of the relationship

One of the hard lessons we need to learn as parents is that “bad behavior” in our kids is not a result of our child being “bad.” It’s more often a reflection of the state of our relationship.

From a parents’ perspective, it often seems like the child has a problem. Perhaps they are “too stubborn,” or “a jerk.” But a child’s behavior towards their parent is almost always an attempt to communicate.

Unfortunately, a lot of the time our kids’ “communication” seems rude, condescending, and tests our boundaries. But these behaviors are always our kids’ attempt to get our attention and ask for our help.

It makes sense to blame our teens for bad behavior. It also makes sense to feel angry and ashamed when our teens act out. But if we actually want to stop hating our teens, the only possible path forward is to look inward and seek to change our own behavior, which is often the only way to change our family dynamics.

Why teenagers are so difficult

While hormones and maturation tell some of the story of why teens are difficult, they miss a major element: parental attachment. Without a healthy and secure parent-child attachment, teens become increasingly difficult to parent as they age.

How do you know if you and your teenager lack healthy attachment? Well, the most obvious sign is that you don’t like them very much, and they don’t seem to like you, either. If you’re struggling to like your teenager, then it’s time to work on your attachment relationship. This is within your control and it’s something you can do without your child’s active involvement. But it will be hard, so it’s best to find a therapist or coach who can help you understand what’s going on and what you can do to change your dynamic.

You don’t have to hate your teenager

It may seem impossible, but you don’t have to hate your teenager. You don’t have to white-knuckle your way through adolescence. More importantly, if you build a more secure attachment, you will find that life is much easier.

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See Our Guide For Parenting a Teenager With An Eating Disorder

There are many options available for treating a teenager who has an eating disorder, including residential treatment. Obviously, this is a big decision for most fmilies, so we asked Zanita Zody of Clementine, a residential treatment program for adolescent girls aged 13-18, some questions about residential treatment for eating disorders.

We did not receive payment for this article, and it is not an endorsement of any facility. Each family should evaluate treatment options on an individual basis.

Q: What is the hardest part about residential treatment?

A: There are a few common challenges that adolescents may face when they enter residential treatment. Being away from the familiarity of home and their friends and families can certainly be difficult, especially since many of them have never spent any significant amount of time away from home.  

It isn’t unusual for the girls to call their parents the first few nights, begging and bargaining to be given one more chance at success in outpatient or a lower level of care. If this happens, the best thing you can do is to remain a united front, not only as parents or caregivers but also with the treatment team and the work that is being done in the program.  

If your children see you waiver, it will make it harder for them to commit. With the best of intentions, one of the worst things you can do is tell them to give it a week or two, and then you will reevaluate.  Of course this may be true, but if they have a finite period of time, their energy will be spent on getting to that date rather than doing the work.  

Instead, keep any conversations about coming home that she wants to have brief and reiterate the need for treatment with loving conviction. That is no easy task for most parents so you should also call the treatment team to let them know what is happening so they can help redirect or address these conversations and make sure you are using your own support system (e.g., each other, therapists, friends) to get through the transition.

Q: What will you do if my child can’t adjust or seems to be getting worse?

A: You will be aware of any challenges your child is having in the adjustment along the way. The single largest barrier to adjustment is often perceived ambivalence or promises of a reevaluation of premature discharge from you.

For this reason, it is imperative that you are aligned with the treatment team and communicate this consistently to your child. If you have any concerns or questions, express that to your team, not her.

Remember that while the treatment team is the expert on the treatment of eating disorders, you are the expert on your child. If you all work together as a team, your collective wisdom becomes an extraordinary resource for recovery.

Q: What happens if my child is crying/inconsolable while staying there?

A: We will do everything we can to comfort and support her while also acknowledging that sometimes people are just sad, that the sadness won’t last forever, and that no matter how they feel the team will continue to show up and support them. We will also involve you to the extent that it is helpful for everyone involved and our shared goal of supporting your child’s process in treatment.

Q: What is your approach to food and eating?

A: We try to make the eating environment as similar to what a typical home environment might be like as we possibly can. This means that the kids do not choose their own meals or know what they will be eating days or even hours in advance.

After all, how many of you tell your kids on Monday what they will be eating for breakfast, lunch and dinner for the remainder of the week? Instead, the meal is announced shortly before mealtime and as the chef is finishing up preparations. Kids are allowed to choose their own snacks each morning for that day.  Again, this is consistent with what a child might do at home.

We have a full-time chef that prepares most of our meals. Our menu is on a four-week rotation and all meals are eaten together as a group with staff at a single dining table.

Our menu consists of a variety of foods. While we absolutely agree that some foods are more nutritionally dense than others, we do not believe that there are any good or bad foods. Instead, we want your child to be able to make flexible choices around food.

For example, if she is out with friends and everyone is getting ice cream, we don’t want her eating disorder to choose whether or not she can have it too but instead, we want her to choose based on considerations such as her current hunger cues or her food preferences.

Q: How will you know that my child is getting better?

A: There are multiple indicators of recovery. Of course, there are quantitative measures like weights, vitals and lab values. But the less tangible indicators are often the most important signs that the deeper “core issues” are being addressed.

In general, one might use the umbrella of flexibility to consider these indicators. As a teenager with an eating disorder begins to heal and recover, we often see them demonstrating increased flexibility across multiple domains such as nutrition, relationships, unpredictability, and academic pursuits.

Q: What happens when my child leaves your treatment program?

A: The continuum of care is so important for success. We will start discharge planning from the time of admission and this includes supporting you in the identification of qualified and appropriate step down programs and outpatient providers wherever you live. We are a team and will be throughout the entire process!

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Zanita Zody, Ph.D., LMFT is the Clinical Director of Clementine Portland. She has extensive experience in outreach, prevention and intervention efforts focusing on the full range of DSM-defined eating disorders, subclinical disordered eating, and associated comorbid conditions. In addition to being a licensed marriage and family therapist, she holds a Ph.D. in Child Development and Family Studies.

See Our Guide For Parenting a Teenager With An Eating Disorder

If you determine that attending a treatment center is necessary to keep your child safe and begin the healing process, you may consider a locally based day program rather than sending your child to a residential treatment center. I toured a day program based in Santa Monica, Rosewood Centers for Eating Disorders, to find out how it works.

We did not receive payment for this article, and it is not an endorsement of the facility. Each family should evaluate treatment options on an individual basis.

Rosewood is located in an office park in Santa Monica, California. It has two wings, one for adults, and one for adolescents ages 12-17. There are three kitchens with dining rooms: one for adolescents, one for adults, and a demonstration and experiential kitchen in which teens can learn cooking skills while simultaneously facing some of their food fears in a safe environment.

Rosewood offers three levels of care for teenagers with an eating disorder: Extended Day; Partial Day; and Intensive Outpatient. The average length of stay in each level of treatment is around 30 sessions, which means 30 days of treatment. This means that if a teen comes six days per week, each level will be complete in about five weeks, but timing will vary based on schedules and individual response.

Prior to joining any program, teens need to complete a comprehensive health exam in order to identify any underlying conditions. They will also meet with an intake coordinator for a thorough assessment to determine what level of care is appropriate, and to answer any questions the family may have.

“When working with adolescents, we are looking at the entire family system,” says Jennifer Reeder, Manager of Intake and Outreach. “Our goal is to provide a safe environment for our clients to heal their relationship with themselves, food, and their support system, and help parents with education, modeling, and support.”

Each child will be assigned a therapy team, which will include a psychiatrist, personal therapist, family therapist, group therapist and registered dietitian. The psychiatry is conservative and seeks, when possible, to avoid stimulants and controlled substances because when a person has an eating disorder it’s hard to judge exactly how medications will impact the body.

The treatment modalities used in psychotherapy include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT) and Acceptance and Commitment Therapy (ACT), all of which have been shown to be very effective in eating disorder stabilization. The nutrition approach is Health at Every Size and Intuitive Eating.

“Our philosophy is that we want to gradually take the stress and anxiety away from food and eating so that while the child is at home, the parents can work on the relationship,” says Reeder. “We can monitor the food, and model healthy relationships to food with the client so that parents can serve a purely supportive role during the initial stages of treatment.”

Rosewood is in-network for many insurance plans and will work directly with insurance providers to ensure maximum coverage for the child.

All programs include:

Food: teens receive lunch and snacks catered by a trusted provider based on a meal exchange program. Clients bring their own dinner.

Parental involvement: Family or support system members are invited to join teens for a family meal. On Thursday evenings, the support system brings meals. This is weekly, followed by a multi-family group on a rotating schedule. Psycho-education around eating disorders is provided. A Registered Dietician runs dietary education. There are also family movement and family process groups. Parents also come in for weekly family therapy sessions.

Schoolwork: teens complete 1-2 hours of schoolwork M-F when needed. Teachers typically use online web-based portals to assign schoolwork. Staff will communicate with the school to review student progress and will supervise study, assignments, and tests.

Extended Day Treatment

This is a highly structured 11-hour day program that includes individual, group and experiential therapy, Monday-Saturday. This is typically the first level of treatment for adolescents who have eating disorders.

Focus: teens get support to rebuild self-esteem, develop healthy coping skills and treat co-occurring conditions.

Partial Day Treatment

This is a 6-hour day program that includes individual, group and experiential therapy, Monday-Saturday.

Focus: teens practice their skills; learn how to prepare meals, order in restaurants and function in social eating situations.

Intensive Outpatient

This is a 4-hour per day program that includes individual, group and experiential therapy that runs Monday-Saturday.

Focus: teens expand their focus to body image, mindful eating, and experiential therapies.

Post Treatment

Once an adolescent completes all three levels of care, Rosewood will make a recommendation to a local treatment team, which will typically include a psychiatrist, therapist and registered dietitian. It is strongly recommended that the parents continue with family therapy as well, to maintain the progress gained during treatment.

Inpatient Treatment

Rosewood also has an inpatient treatment center for eating disorders located in Wickenburg, Arizona. If a teen’s eating disorder symptoms do not stabilize while attending the day programs in Santa Monica, his or her treatment team will discuss whether an inpatient solution may be a better fit.

See Our Guide For Parenting a Teenager With An Eating Disorder

Talk to almost anyone about teenagers, and you’re likely to get an eye-roll. Teenage angst is a joke, something to be laughed at. But parents would do better if they looked at teenage angst as a sign of pain, especially if your teen has an eating disorder.

Parenting teenagers isn’t easy. But adolescence is a critical time during which teens can adopt maladaptive coping behaviors that can stay with them for life. Teenage angst can be an early sign of disorders and addictions, and early intervention can really help.

It seems like nobody likes teenagers

The common rant about adolescents is that they are selfish, annoying, and dangerous. Many parents who have adult children talk about their kids’ teenage years with jokes about how difficult it was to have teenagers in the house. Most parents who have young children hear horror stories about how their sweet little angels will turn into monsters when they enter adolescence.

In our society, it is common to use the word “teenagers” as an insult, and very few people question this assumption. Many parents talk about just holding on and “getting through” their kids’ adolescence. They roll their eyes and make jokes about their kids’ emotional outbursts, moodiness, and general behavior.

As parents, we must ask why we criticize our teenagers for the very behaviors that they must practice in order to become fully-formed adults. Our teenagers are desperately trying to identify who they are separate from their parents, which leads to sometimes difficult behavior, but they are not diabolical monsters.

Adolescence is a time during which our kids find out who they are while still in the safety of our homes. Their behavior is biologically driven. It is not a conscious attempt to annoy us. Our teens are not trying to drive us crazy – they are trying to grow up.

As our teens battle hormones, emotions, and a strong drive to rebel, they still need our unconditional love. The ultimate parenting challenge is to love your child through their teenage angst.

What is teenage angst?

Teenage angst can take several different forms. Some common ones include:

Moodiness

Mood swings are a normal part of life for people of all ages, but they are more extreme in adolescence. These ups and downs are a natural part of growth and development.

Social orientation

Many teens are oriented towards their peers rather than their parents. This means that they seek peer approval, not that of their parents, which means it is harder for parents to influence teens.

Dangerous behaviors

Dangerous behaviors including self-harm, substance abuse, eating disorders, and suicidality can all show up in teens. Dangerous behaviors are often linked to the teenage belief that they will live forever or, alternatively, that their life doesn’t mean much. They can also be a cry for help, a way to seek attention and care.

Anxiety and depression

Teenage angst can also be a sign of the most common and very serious mental health disorders: anxiety and depression. Both anxiety and depression are on the rise in our society. Anxiety and depression can negatively impact a teenager’s natural development. Anxiety and depression can be managed, but the sooner they are addressed, the better for your child’s long-term prognosis. Both anxiety and depression are frequent precursors to many other mental disorders, including eating disorders and substance abuse.

Don’t ignore teenage angst

Some parents find that adolescence the most difficult parenting stage. They decide that the best way to handle it is to ignore teenage angst. But ignoring your teenager’s withdrawal, risk-taking and moodiness can lead to dangerous consequences. The fact is that even as our teens act like they don’t want us in their lives, they desperately need our attention. As they explore the world, they need to feel safe at home. They will not say this to us directly. Instead they will act it out with behavior.

Pay attention to your teen and watch for problematic behaviors. Early intervention can help your child get back on track. It can also save your relationship with your child and make parenting easier.

Don’t reject your teen

It is very common for our kids to criticize our clothes, homes, cars, voices, and the entire state of being during adolescence. Many parents take this criticism personally and feel rejected by their kids. When we take our teenagers’ rejection to heart, we may feel compelled to reject them in return.

Teenagers have a way of pushing all of our buttons. All of the soft spots we have left over from our own adolescence can come to the surface and cause us to revert to our immature selves. As a result, many parents reject their teenagers at a time when their teens desperately need their acceptance.

Parental rejection is devastating for a child of any age. And even things like making jokes about your teen’s behavior, rolling your eyes when you talk about your teenager, or dismissing your teen as overly dramatic can feel like rejection.

Set boundaries with your teen

Some teenage angst is not dangerous or worrisome. It’s just annoying. Teenagers are designed to push against boundaries. It is entirely healthy for them to test rules and expectations. The safest place for them to explore their power is within the home.

This is why so many parents of adolescents become exasperated. It can feel as if every single request we make becomes a battle. Even simple, seemingly reasonable requests can become a debate with a teenager.

The first thing to know is that we mustn’t take these battles personally. Our teenagers are practicing their adult skills. It is natural and normal to test out what we can get away with. But no matter how difficult it is, we must still maintain our boundaries. Even as a teen rants about curfew, we must hold firm and state our boundary explicitly and without wavering.

Think ahead ten years – our teens will be in the workplace, and they need to understand that not all rules are flexible. This can be exhausting and requires a high level of resilience and commitment on our part.

Repeat yourself

The best way to handle boundaries is to repeat the same non-negotiable statement, no matter what your teen says or does to try and change your mind. For example, “I expect you home tonight at 10.” Your teen may yell at you, tell you that other people don’t have to be home until midnight, beg you to reconsider, etc. Stand firm on your boundary as you originally set it. “That may be so, but I expect you home tonight at 10.”

Perhaps you will consider changing the boundary during a calm conversation at another time, but you should not change the boundary on the fly just because your teen is throwing a tantrum.

Helping your teen grow

Our job as parents is to help our kids grow, and that doesn’t end when they hit puberty. The human brain isn’t fully formed until the mid- to late-twenties. And no human ever stops needing their parents’ approval and love. If you’re frustrated by teenage angst, it’s completely normal. But it’s also really important that you find a way to relate to your child so you can help them through this difficult transition in life. This is especially important if your teenager has an eating disorder. Your guidance and support through recovery will make all the difference.

See Our Guide For Parenting a Teenager With An Eating Disorder

When people call a teenager’s dangerous behavior “a cry for help,” they say it as if it is not really serious. It’s just a cry, after all. Or they may say a teen is “just looking for attention.” And the suggestion is that they do not deserve the attention they seek. That the very act of seeking attention is somehow inappropriate.

There is a pervasive idea in our society that our children’s cries when they are babies are signals that we should heed, but that as they age, their cries are something we can brush off as feeble, unnecessary and even annoying attempts for attention. When an infant cries, we respond with care, love, and attention. We give food, cuddles, and warmth. When a teenager cries out by developing dangerous behaviors, we tend to respond with criticism and avoidance.

Teenagers who have eating disorders, suicidality, and substance use may be crying out for love and attention. They may be signaling a distress level that is deeply intense, and they are not aware of any other tools for gaining the love, attention, and affection they need.

If your child is crying out for help and looking for attention, give it to them. Pay attention to the cries. Attend to your child with the support they need.

This is a wonderful video in which Wentworth Miller discusses what it was like for him as a teenager:

See Our Guide For Parenting a Teenager With An Eating Disorder