Eating Disorder

An eating disorder is a serious mental illness. Eating habits and one’s relationship with one’s own body change in a pathological way. Thoughts revolve almost constantly around calories, weight, and body shape. Some children starve themselves for weeks, others lose control and binge eat, and still others secretly induce vomiting after eating.

In Germany, slightly more than one percent of the population is affected. Most cases begin during puberty or in young adulthood. Anorexia often manifests around age 14, while bulimia tends to appear in late adolescence. Girls and young women are diagnosed most frequently. Eating disorders also occur in boys and men, but are less frequently recognized. In medical classification, these conditions fall under group F50 (ICD-10).

An eating disorder is more than just difficult eating habits during puberty. It can seriously harm the body and become life-threatening. Anorexia nervosa has one of the highest mortality rates among mental illnesses in adolescence because persistent underweight puts a strain on the heart, circulatory system, bones, and hormonal balance.

Eating disorders manifest in several different forms. The boundaries between them are fluid, and some people transition from one form to another over time.

• Anorexia nervosa: severe underweight due to starvation, often accompanied by excessive exercise and a deep fear of gaining even a single gram. Many people with this condition perceive themselves as too fat when they look in the mirror, even though they are significantly underweight.
• Bulimia (binge-purge disorder): recurrent binge eating episodes followed by self-induced vomiting, laxative use, or strict fasting. These episodes occur in secret and are experienced with intense shame. Weight is often within the normal range, which is why the disorder remains hidden for a long time.
• Binge-Eating Disorder: recurrent binge eating episodes accompanied by a loss of control. There is no compensatory behavior such as vomiting, laxative use, or exercise, so individuals are often overweight.

In younger children, there are also forms in which eating is severely restricted due to fear or disgust, without appearance playing a role.

An eating disorder usually develops gradually. Individual signs may seem insignificant, but taken together, they paint a picture. Watch for changes over several weeks:

• The child counts calories, avoids entire food groups, or suddenly starts cooking for others in a very controlled manner but barely eats with them.
• Meals become a source of conflict; the child eats alone, very slowly, or disappears to the bathroom immediately after eating.
• Withdrawal from friends, low mood, irritability, constant weighing, or checking their appearance in the mirror.
• Physical signs such as feeling cold, dizziness, hair loss, tooth damage, or a missed period.

Children and adolescents often hide an eating disorder for a long time and downplay their symptoms. Many initially view their behavior as a success and do not perceive it as an illness. This lack of insight into their condition is part of the picture and is not a sign of stubbornness.

If you feel that something is wrong, take this feeling seriously, even if the child insists that everything is fine.

There is no single cause. Experts refer to a multifactorial aetiology: several factors interact until an eating disorder develops.

These include a genetic predisposition, which tends to run in families. Certain personality traits, such as pronounced perfectionism, high expectations of oneself, and low self-esteem, increase the risk. The physical and emotional upheavals of puberty often act as triggers. Early dieting, ideals of slim beauty, and comparisons with images on social media intensify the pressure. Traumatic experiences such as bullying, breakups, or losses can be the catalyst. Experts believe that genetic predisposition plays a significant role in the risk of developing the disorder, while environmental triggers help determine whether and when the disorder manifests.

It is important for parents to understand that an eating disorder is not the result of parenting mistakes. It arises from a combination of many factors over which individuals have only limited control.

Eating disorders are treatable, and many people with these disorders recover. The core of treatment is psychotherapy, often in the form of cognitive behavioral therapy. It helps the child relearn how to relate to food, emotions, and their own body. This is supplemented by nutritional therapy and regular medical monitoring of weight and blood test results.

For children and adolescents with anorexia, medical guidelines explicitly recommend involving the family. In family-based therapy, parents take on the responsibility for a time of ensuring that their child eats enough again, and later gradually hand this task back. This approach makes you, as parents, an active part of the treatment, rather than leaving you on the sidelines. For bulimia and binge eating disorder, psychotherapy is the primary focus, sometimes supplemented by medication. Treatment takes place on an outpatient basis, in a day clinic, or as an inpatient, depending on the severity. Relapses are common on the road to recovery and can be managed with professional support.

Starting treatment early significantly improves the chances of a full recovery. An eating disorder that goes untreated for a long time can become entrenched and cause permanent damage to the body. If you suspect an eating disorder, it’s therefore worth seeking help from a specialist early on and not waiting too long.

Contact a professional early on, even if you’re unsure. Avoid making accusations or discussing calories or weight at the dinner table, as this can cause those affected to withdraw even further. Stay in touch, and express your concerns calmly and specifically. The first point of contact is the pediatrician or family doctor, who will assess the person’s physical condition and refer them to the appropriate specialist. The Department of Child and Adolescent Psychiatry (KJP) is responsible for a thorough evaluation.

An accessible first step is the BIÖG eating disorder helpline at 0221 892031, which can be reached anonymously and free of charge and will refer you to appropriate local resources.

Rückenwind They will guide you as parents through this time, help you make sense of your observations, and support you in dealing with your child. The diagnosis and medical treatment of an eating disorder should be handled exclusively by a child and adolescent psychiatry department or a medical or psychotherapeutic specialist.