Much has been made of escalating mental health problems among school-age children since the pandemic upended their lives, forcing families to navigate a “new normal” for which there was no playbook. Mental health issues are complex and can rarely be attributed to a single factor, but there has been a striking increase in child and adolescent mental health diagnoses in the past three years, including a startling uptick in eating disorders. According to clinical psychologist Dena Cabrera, Psy.D, the numbers are “disturbing,” with a 70 percent spike in hotline phone calls and a doubling in the number of hospitalizations since the onset of the pandemic.
The ADHD Connection
Estimates suggest that about 30 million people in the US suffer with eating disorders—20 million females and 10 million males. As Cabrera explains, an eating disorder is not a behavioral issue but a serious, complex mental illness to which girls with ADHD are particularly vulnerable.
In fact, girls with ADHD are four times more likely to have an eating disorder than those without ADHD.
There is also a strong inherited predisposition for eating disorders, with approximately 60 percent being genetically driven and the remaining 40 percent being environmentally influenced. “We definitely live in an environment and culture that believes thinner is better,” explains Cabrera. “They think ‘If I can just be thin, everything will be okay.’” In reality, the opposite is true. Eating disorders are a serious mental health concern that “have among the highest mortality rates of any mental illness,” says Cabrera.
Types of Eating Disorders
There are several types of eating disorders, the most common of which are summarized here:
- Anorexia: Those with anorexia have significant issues with body image and an intense fear of fat and gaining weight. They restrict their food intake and have difficulty sustaining enough energy for what their bodies need.
- Bulimia: In this form of the disease, sufferers binge large amounts of food within a short period of time and then compensate with recurrent inappropriate behaviors, such as vomiting, over-exercising, or taking laxatives or diet pills.
- Binge Eating Disorder: These kids suffer from a loss of control, eating large amounts of food within short periods of time, rapidly and beyond fullness. They have a tremendous amount of shame and embarrassment and often hide food to eat in secret.
- Avoidant/restrictive food intake disorder (ARFID): Kids are extremely picky eaters who may avoid food because of textures, lack of interest or appetite, or fear of throwing up. These inappropriate actions are in no way related to what the child believes about his or her size, weight and/or shape.
The following are warning signs of a possible eating disorder:
Mood and behavior changes. Tweens and teens with an eating disorder may become anxious, depressed or change their behavior in other ways. For example, a child who may have been doing well in school may begin to do poorly, fail to complete homework, become socially avoidant or isolated (“I feel lonely and disconnected.”), or make excuses not to eat.
Inflexible thinking and rules about food and dieting. Kids may begin to adhere to specific food or exercise schedules, make excuses for not eating, eat in secret, or go on their first diet to lose weight. If they are constantly reinforced or rewarded for losing weight, they may take their behaviors to an extreme and begin compulsively eating, dieting, and exercising.
Decreased eating. Make sure to distinguish between an eating disorder and decreased eating because your teen’s stimulant medication is suppressing her appetite. While stimulants can be extremely helpful for ADHD regulation, they are easily abused. Cabrera warns against using them to treat kids who are underweight, malnourished, or lack an appetite to eat healthily.
Significant change in growth. Growing adolescents are supposed to follow a particular pediatric growth curve. Be aware if there is a significant variation up or down from the normed percentile for age, weight and height.
Using food as a regulator. Cabrera explains that eating is often a way to deal with various symptoms and difficulties of ADHD. Kids may use it as a regulator to self-soothe, something to focus on when bored, or part of a craving/seeking process.
If you see signs of a possible eating disorder, get help sooner than later, even if it’s just to have your child evaluated to make sure they’re healthy. As for long-term recovery, Cabrera suggests focusing on their behavior patterns with food, nutrition, and exercise and how they’re doing socially and academically. Are they back to doing what they love to do and engaging in their lives? When your kids start talking about things other than food, weight, and shape, you know they’re starting to re-engage.
This article is based on an ADDitude webinar, Mental Health Out Loud: Eating Disorders and Body Image Among Teens, by Dena Cabrera, Psy.D., a clinical psychologist, certified eating disorder specialist and the co-author of Mom in the Mirror: Body Image, Beauty and Life After Pregnancy. Eve Kessler, Esq. a retired criminal appellate attorney, is Executive Director of SPED*NET, and a Contributing Editor of Smart Kids.