Restrictive Eating Disorders in Teens

Restrictive eating disorders can cause serious physical, psychological, and emotional issues in growing teens. In this article, we’ll explore the signs, symptoms, and treatment options for these disorders and give parents some helpful insights for navigating their teen’s recovery. 

Introduction to Restrictive Eating Disorders

A restrictive eating disorder is characterized by limiting certain foods, food groups, or overall calories to an extreme degree. Restrictive disordered eating isn’t always caused by distorted body image or concerns about weight gain; many people with restrictive eating disorders aren’t concerned with losing weight but rather have an intense fear of certain food textures, tastes, or smells.  

Let’s examine the most common types of restrictive eating disorders.

Anorexia Nervosa 

The most well-known restrictive eating disorder is anorexia nervosa.

Teens with anorexia severely restrict their food intake to alter their weight, size, or appearance. 

The DSM 5 diagnostic criteria for anorexia include the following: 

• Restriction of energy (calorie) intake leading to a significantly low body weight
• Intense fear of gaining weight or having a larger body type, even if they are significantly underweight
• Distorted perception of body size and shape or denial of the seriousness of being underweight1

Avoidant/Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder (ARFID), sometimes called selective eating disorder, is characterized by restricting the amount or type of food eaten. Unlike anorexia, restrictive eating in ARFID isn’t caused by body image disturbance or a fear of gaining weight; people with this disorder aren’t trying to lose weight. People with ARFID often have intense food-related fears, like choking or throwing up. They may express an intense dislike for certain foods or food groups and avoid eating foods with certain textures, smells, or tastes 2.

While some people with ARFID experience weight loss due to their eating habits, many others are at an average or above-average weight. Many people with ARFID have nutrient deficiencies and other health issues because they consume only a small number of foods.  

Health Consequences and Complications

Restrictive eating disorders can have a detrimental impact on a teen’s physical, mental, and emotional health. Many health complications associated with these disorders are life-threatening without appropriate treatment. 

Potential complications of restrictive eating disorders include the following:

• Significant weight loss
• Difficulty regulating body temperature
• Dizziness or fainting
• Slow heart rate
• Low blood pressure
• Gastrointestinal issues, such as nausea, vomiting, or constipation
• Electrolyte imbalances
• Loss of bone density
• Dental erosion
• Cardiovascular issues
• Permanent organ damage

Most of these health issues improve with better eating habits and nutrition. However, recovering from a restrictive eating disorder is a psychological and emotional process as well as a physical one. Eating disorders are mental illnesses with deep-rooted underlying causes. Treatment for restrictive eating should address the psychological aspects of the disorder as well as the nutritional deficiencies it causes.

Coping Strategies for Loved Ones

Friends and family are the primary support system for teens experiencing any eating disorder, including restrictive ones. Loved ones should be involved throughout each stage of treatment and recovery. It’s important to gain awareness and learn coping and communication skills that will help your loved one navigate treatment and life after treatment.

Tips for supporting a person with restrictive eating disorder

Offer support during meal times.

Sit with your teen during meals, and have family dinners as often as possible. Keep conversation lighthearted; avoid topics that might create additional stress for your teen. If they become overwhelmed, encourage and remind them to use the coping skills they have learned during treatment. 

Create predictable expectations around meals and snacks.

Try to keep consistent meal and snack times each day. Ensure that all components of your teen’s meal plan are readily available to minimize the amount of changes or substitutions to the plan. 

Avoid talking about dieting or weight with your teen. 

Talking about dieting and weight loss, and referring to certain foods as “good” or “bad” can be a trigger for teens in eating disorder recovery. Likewise, it can be detrimental to your teen’s recovery journey to talk about or criticize another person’s appearance, eating habits, or weight. Instead, parents should focus on the qualities and behaviors they admire in others, such as kindness, patience, or thoughtfulness. This helps reinforce the idea that your teen is valued and worthy regardless of their body size, eating habits, or weight.

Self-care strategies for caregivers

Caregivers play a vital but challenging role in their loved one’s recovery. Parents and guardians should remember to prioritize their own mental and physical health as they navigate their child’s treatment. 

Individual therapy can be a helpful tool for caregivers. A therapist can provide you with a safe space to discuss your fears and frustrations. You can also learn skills to cope with and manage your emotions as you navigate your child’s treatment and recovery process. 

Attending parent support groups, whether in person or online, offers the opportunity to connect with other caregivers going through a similar experience to your own. Community and support are vital in helping you feel less alone through the ups and downs of your child’s eating disorder journey.

Physical signs and symptoms of restrictive eating disorder

Restrictive eating disorders affect every system of the body, which can lead to a variety of diverse symptoms. 

Some physical signs of food restriction include:

• Significant weight loss or being underweight
• Frequently feeling cold
• Dizziness or fainting
• Nausea, bloating, or stomach pain
• Fatigue
• Low energy levels
• Soft layer of hair on the body (lanugo)
• Hair loss and/or changes in the density or health of the hair
• Thin and brittle nails
• Abnormal lab or EKG results

Emotional and behavioral symptoms of restrictive eating disorder

Restrictive eating disorders can manifest in your teen’s behavior and emotions as well as their physical appearance.

Behavioral signs like those listed below will often be present before physical symptoms: 

• Avoiding calories, certain foods, or food groups
• Preferring to eat alone
• Eating only a small variety of foods
• Lack of flexibility around food
• Avoidance of social gatherings involving food
• Hiding food
• Sneaking food when no one is around
• Fear of choking or vomiting
• Cutting food into tiny pieces 
• Tearing apart foods that would normally be eaten whole, such as toast or pizza
• Excessive use of condiments or seasonings
• Calorie counting or weighing food
• Frequently leaving the table during mealtimes
• Inability to recognize the seriousness of their weight loss
• Expressing a desire to lose weight or change their body shape, even if severely underweight
• Wearing oversized or baggy clothing
• Believing that their illness is not severe enough to be considered an eating disorder

Many teens with restrictive eating disorders experience mood changes related to malnutrition. They may be quick to become angry, sad, or overwhelmed. This will often improve as their bodies become better nourished and begin to heal.

Helping a teen recover from a restrictive eating disorder can be a stressful experience for parents. However, the support and guidance of a treatment team can help parents make informed choices about their child’s health. 

Magnolia Creek offers residential and partial hospitalization programs to help your teen take the next steps in their recovery journey. Each teen at Magnolia Creek receives individualized, evidence-based care in a compassionate, home-like environment.

To learn more about treatment at Magnolia Creek, contact us at 205-678-4373.

References

1. https://www.nationaleatingdisorders.org/anorexia-nervosa/
2. https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/