If your teenage daughter has started saying she already ate at a friend's house, night after night, and it began around the time you started weight care, that timing can make you doubt what you are seeing. Consider seeking help if a child's behavior or emotions last for weeks or longer, cause distress for the child or the family, or interfere with how the child functions at school, at home or with friends. That test asks nothing about how a change began, any one of its three parts is enough, and you can check each of them.
Is the change in her real, or are you inventing it?
To judge whether the change is real, start with the adults who see her often: ask her teacher how she has been behaving at school, which you cannot see from home, or ask another adult who often sees her.
The weeks are the part you can count without anyone's help. If the dinners at the friend's house have gone on for weeks, that alone is reason to consider seeking help, whatever set them off, and your weight care does not change the count.
Telling the moods of normal development from a change that may be cause for concern can be hard. All children are sad, anxious or irritable at times, and in most cases these are typical developmental phases, though in some children the same behaviors may point to a more serious problem.
For an older child, the signs that she might benefit from an evaluation include losing interest in things she used to enjoy, having low energy, spending more and more time alone and avoiding social activities with friends or family, and dieting or exercising excessively or fearing weight gain.
Did your weight care set this off?
Whether your weight care played any part is not something you can decide at home: the exact cause of eating disorders is not fully understood, and research suggests a combination of genetic, biological, behavioral, psychological and social factors can raise a person's risk. Social factors are part of that mix, and so are genetic and biological ones. Eating disorders are not a choice.
When the person with anorexia is young, therapy may involve the whole family, and the family is seen as part of the solution instead of the cause. If your first instinct is to change things at home and wait, weigh it against this: detecting and treating an eating disorder early is important for recovery.
Her looking well rules nothing out either. Eating disorders can affect people of all ages and body weights, and even someone who appears healthy can have one and be extremely ill, whether she is underweight, at an average weight or overweight. Judge by how long the change has lasted, whether it distresses her or the family, and whether it disrupts her days, since none of those depends on how she looks.
If you have had an eating disorder yourself, tell whoever manages your weight care about it as well (see A past eating disorder belongs in your weight-care medical history).
What else to look for besides missed meals
Look for secrecy around food and for exercise that has become intense, as well as for the meals she misses. Signs of the common eating disorders include:
- Anorexia nervosa: extremely restricted eating, intense and excessive exercise, intense fear of gaining weight, and a distorted body image or self-image.
- Binge-eating disorder: eating alone or in secret to avoid embarrassment, feeling distressed, ashamed or guilty about eating, and dieting frequently, possibly without weight loss.
- Bulimia nervosa: the same signs as binge eating, plus behaviors meant to get rid of food after binge eating, which are throwing up, taking laxatives, exercising excessively and fasting.
Someone showing any combination of these signs may have an eating disorder and should talk to a health care provider, and for her that means her pediatrician or family doctor. Because frequent dieting can happen without weight loss, an unchanged scale is no reassurance.
Behaviors seen with anorexia include refusing to eat around other people, and her dinners now happen where you cannot see them. Others include going to the bathroom right after meals, cutting food into small pieces or moving it around the plate, and exercising all the time, even when the weather is bad, she is hurt or her schedule is busy. Some of these happen at your table or in your house, so you can see them without asking her anything.
None of this tells you whether she has an eating disorder. It gives you a description to take to her doctor: each thing you have seen, and roughly since when.
When it cannot wait for an appointment
If she talks about wanting to hurt herself or someone else, or her behavior is unsafe, get help immediately. Call 911 if anyone's life is in danger. Short of that, the Suicide & Crisis Lifeline takes calls and texts at 988, and you can use it yourself when she is struggling or thinking about suicide. If she has attempted suicide, call 911 right away and do not leave her alone, even once you have called.
Her body can make it urgent too. Over time, anorexia nervosa can lead to serious health consequences, including low blood pressure, slowed breathing and pulse, and damage to the structure and function of the heart, and it can be fatal. In bulimia nervosa, an electrolyte imbalance, meaning too low or too high levels of sodium, calcium, potassium and other minerals, can lead to a stroke or heart attack.
Passing out or fainting, trouble breathing and a fast heartbeat that does not slow down all need emergency care in a child, so if she has any of them, take her to an emergency room now or call 911.
Anorexia can also, over time, leave her feeling faint, dizzy or weak. If she feels that way but has not passed out, and for everything else you have seen, phone her pediatrician's office now and ask for the soonest appointment they have. Being too focused on weight, over-exercising and limiting food are reasons to talk to her doctor, and getting medical help right away can make an eating disorder less severe.
Who does the assessing, and what it involves
A mental health professional who works with children does the assessing, and her pediatrician or family doctor can refer you to one. Describe her behavior to her pediatrician, along with what you have observed and learned from talking with others, and ask for a referral to a mental health professional with experience and expertise in evaluating and treating children.
Her doctor may also run checks of their own. To make a diagnosis, a provider may use a medical history, a physical exam, and blood or urine tests to rule out other possible causes, plus other tests, such as kidney function tests and an electrocardiogram, to see whether an eating disorder has caused other health problems.
Much of the evaluation comes from the adults around her. A comprehensive evaluation of a child's mental health usually involves an interview with a parent about her developmental history, temperament, relationships with friends and family, medical history, interests, abilities and any earlier treatment, information from her school, such as test scores and reports on her behavior, and, if needed, an interview with her for testing and behavioral observations.
From the results, the professional helps determine whether her emotions and behavior are related to changes or stresses at home or school, or may indicate a disorder they would recommend treating. That is the question about your household you could not decide at home, and helping to answer it is part of what the evaluation is for.
A family can play a crucial role in treatment, encouraging a family member to seek help and giving support along the way, and research suggests that family-based treatment can improve eating disorder treatment outcomes, particularly for adolescents. When you meet possible treatment providers, ask whether they involve parents in the treatment, and if so, how.
NicoCares treats only people 18 or older and is not an emergency service. Her evaluation goes through her pediatrician or family doctor, and the urgent signs above go to 911, 988 or an emergency room, never to a message. While this goes on, your care team still answers questions about your treatment in Spruce, the messaging app NicoCares patients use.
