Around 1.25 million people in the UK have an eating disorder, with 4.3% of 11- to 16-year-old girls, 20.8% of 17- to 19-year-old girls and 5.1% of boys the same age living with one in 2023. Hospital admissions have increased by 84% in the past five years, according to figures released last year by the Royal College of Psychiatrists and they have the highest mortality rate among all psychiatric disorders.
According to Beat, the UK’s eating disorder charity, it takes an average of three-and-a-half years for someone to get treatment after their symptoms first begin. Meanwhile, Bupa has found that 76 per cent of parents wouldn’t feel confident in their ability to spot the signs of a mental health condition in their child.
This is unsurprising – eating disorders can be hard to spot. Fewer than six per cent of those living with one are medically underweight and the issues manifest in many ways, from anorexia and bulimia to binge-eating disorder and OSFED (other specified feeding or eating disorder), when someone’s symptoms don’t quite fit the description of the more common disorders.
Here, our experts explain how to spot the signs your child or teen is suffering:
THINNING HAIR: Although a change in weight can be a clear sign of an eating disorder, it is by no means the only indicator. Kerrie Jones, a psychotherapist and founder of eating disorder treatment clinics Orri explains that there may be other physical symptoms too. “These can include having chapped lips and looking pale and tired. Hair can thin, periods can stop or become less regular for girls, and for some, dental issues can arise from vomiting. These are signs that someone is nutritionally deficient and requires professional help.”
Specialist dietitian Nichola Ludlam-Raine adds: “Low body fat and malnutrition can also cause children to feel cold even in warm environments, which is common in anorexia.”
INSOMNIA: Your child might struggle to fall asleep or stay asleep and they may wake up extremely early. Research has found that those with anorexia spend more time awake during the night and have more nights without sleep.
Nichola says: “Sleep disturbances can be linked to malnutrition or the mental stress of restrictive eating or purging behaviours. Your child might also be finding it difficult to concentrate.
“Aside from an eating disorder, insomnia could indicate stress, anxiety, or even medical conditions like hyperthyroidism, so don’t jump to conclusions – encourage your child to visit the GP with you”.
RIGID ROUTINES AROUND MEALS: Research in 2020 found 15 per cent of eating disorder sufferers also have obsessive compulsive disorder (OCD). “Becoming extremely rigid or controlling with meal times, food portions, or food types can indicate obsessive behaviours around food, often seen in anorexia or orthorexia,” says Nichola.
Kerrie adds: “You may notice changes in how they eat with ‘rituals’ developing at the table such as cutting food into small pieces, moving food around the plate, hiding food in napkins or under the plate or over-chewing or taking a long time to eat.”
Your child may even fill up on liquids such as water, diet coke or caffeinated drinks as a way of managing their appetite. Kerrie says that as a parent, it’s important to be mindful of how you talk about food.
“By labelling foods as ‘good’ or ‘bad’, you’ll risk exacerbating someone’s fixation on the nutritional content.”
WEARING BAGGY CLOTHES: Noticed that your child or teen is wearing bigger or baggier clothes than usual? Nichola says this oversized clothing may be to hide their body. “This could be for a variety of reasons, whether due to dissatisfaction with their appearance or to conceal their weight loss.”
WITHDRAWAL FROM SOCIAL ACTIVITIES: Does your child seem to be avoiding social situations? Nichola says they might particularly avoid situations involving food such as parties or dinners. “They may require lots of reassurance or information about what will be happening and when, especially around food plans,” adds Kerrie. “You may observe that a previously outgoing person prefers to spend an increasing amount of time alone – perhaps you hear them moving around a lot, looking flushed if you wander in and defensive if you ask what they have been doing, or you may notice they are suddenly going out alone to walk the dog more frequently.”
OVER-EXERCISING: While your child or teen may simply be a keen athlete, Nichola says it can be a red flag. “Excessive exercise, especially when done in secret or with an obsessive focus on burning calories, is often seen in both anorexia and bulimia.”
Kerrie adds that this is a key sign of a condition known as anorexia athletica, when exercise becomes the priority above anything else – friends, family, work and socialising. “Exercising despite feeling exhausted or being injured, being hyper-aware of the food and its nutritional content, and using exercise as a means of ‘purging’ what they eat or drink are common behaviours.”
Often, those who live with an addiction to exercise struggle with low self-esteem or self-worth. “This is masked by the euphoric (but fleeting) sense of achievement when exercising,” she says.
FREQUENT STOMACH COMPLAINTS: Whether it’s bloating, stomach pain or constipation, tummy-related issues are common in children with an eating disorder. Research found 98 per cent of those living with them have at least one gastro complaint, with Irritable Bowel Syndrome (IBS) being the most prevalent.
“This can result from restrictive eating, binge eating, or purging,” says Nichola. “But they could also indicate food intolerances, IBS or anxiety.”
BEING OVERLY SELF-CRITICAL: Is your child or teen becoming more introverted or self critical, lacking confidence? Kerrie says: “You might notice that they’re making increasingly frequent, negative comments about their body weight or shape. “For some, the reflection they see in the mirror may be completely different to who you see in front of you. “You might catch your child checking their reflection, grasping or touching parts of their body.”