How do I know if my child/adolescent has an eating disorder?

Eating disorders can be challenging to recognize because they present in so many different ways. Children and adolescents with eating disorders often present differently than adults. It is important to remember that childhood is a time of growth and development. Any weight loss in childhood or adolescence is concerning now matter what size body your child started out in. Additionally, failure to gain expected weight to stay on their own growth curve is a sign that your child may be struggling. 

Children with eating disorders may get more picky about what they are eating. You may find that your child gets restless and is moving around a lot or being more active than they usually are. They may avoid eating meals with you or not be eating lunch at school. They may start telling you that they no longer like foods that they used to enjoy. Sometimes children will express body image concerns, but oftentimes they do not. Children with eating disorder typically do not state explicitly that they are afraid of gaining weight, but instead engage in behaviors that interfere with expected weight gain. You may notice that your child seems more down, depressed, or anxious than normal and they may not want to spend as much time with their friends. They may start talking about being "healthy." You may notice that food is missing or that your child is eating food in private. It is important to remember that this is just a short list of common symptoms and behaviors. If you are concerned about your child, but their behaviors are not described here it doesn't mean they don't have an eating disorder. 

Parents will often say that they had a sense that something was going on with their child, but they were told by others that they were overreacting or that their child was just going through a "phase." Parents tell us that they wished they had trusted their instincts. As a parent, you know your child best and if you have a sense that they may be struggling with an eating disorder, trust that. It is better to have them assessed and be wrong than to have them be struggling and not getting help because you doubted yourself. 

What does HAES(R) stand for and what does it mean?

HAES(R) stands for Health at Every Size. HAES is an approach that works with people in all body sizes from a weight inclusive perspective. This means that all people are treated with respect and that weight loss is never recommended by a HAES therapist. HAES has five main principles including: 

  1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
  2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
  3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
  4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
  5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose. 

For more information about HAES, please visit the ASDAH (Association for Size Diversity and Health) website at https://sizediversityandhealth

But I want to lose weight? 

This is one of the most frequent things we hear when clients learn that we practice from a HAES perspective. Our response is always, "of course you do."  We live in a culture in which thinness at any cost is preached. We learn from an early age that thin is better and being thin protects us from dealing with weight stigma. We know that the vast majority of clients that come to see us come in wanting to lose weight, and that's ok! We want to hear all about your experience with your body and understand more about your desire to lose weight. We will help you explore this and talk about if focusing on weight loss is serving you in your life. With your permission, we will educate you about HAES and share how much misinformation is out there about weight and health. While we will never recommend weight loss or collude with weight loss efforts, we believe in body autonomy and you get to choose how you care for your body and whether you want to pursue weight loss or not. We will not judge you for it and we want to hear all about how you are feeling. 

I'm scared to go to therapy because I feel like I will never stop crying?

It is common for people to be afraid of therapy because of many different reasons including the belief that if they start talking about things that they don't usually talk about, they will not stop crying. Many people do cry when they come to therapy, but we have never had a client who hasn't stopped crying eventually! Feelings can be challenging and overwhelming and we understand that. We will hold space for your feelings and also support you in working at a pace that feels tolerable. 

I'm afraid the therapists will tell me what to eat and I won't be able to do it?

As therapists we stay aware from telling clients what to eat.  If you feel comfortable sharing, we are much more interested in how you feel about your eating than in what you are eating. We frequently work with HAES informed, non-diet dietitians who support clients in healing their relationship with food.   

My eating disorder feels very private and I feel ashamed how do I know the therapist won't make me feel even more ashamed?

We understand this fear.  There is a great deal of shame attached to eating disorders and food and body struggles. The therapy process unfolds over time and you get to decide how much you are ready to share. We know that every person comes to therapy with their own story, experience, history of marginalization and oppression, and trauma history. Therapy looks different for everyone due to our unique lived experiences. We are here to support your healing, not increase your shame.  

What about medication vs. psychotherapy? 

As therapists, we do not prescribe medication. Many of our clients are already taking medication or are interested in considering it. If medication is something you would like to consider, we can give you referrals to providers who are able to prescribe psychiatric medication. With your permission, we will then collaborate with your prescriber to coordinate care.

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