Eating Disorders: Know the Warning Signs

September 15, 2017
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Donald Erwin, Ph.D, clinical director of Monmouth Psychological Associates, and his team provide comprehensive psychological and nutritional care for eating disorder patients.

By Eileen Toomey |

You notice changes in your daughter’s behavior. She is not seeing friends as much, or her grades are suffering, or maybe her diet is different. She has alway been a great kid, worked hard at school, played sports, some would even consider her a bit of a perfectionist, but she’s 15, and everything seems to end in an argument lately, so you bite your tongue.

It could be anything from teen angst to drug use. Or it could be an eating disorder.

Eight million Americans have an eating disorder, almost 7 million of whom are women, age 12 to 25. Eating disorders have the highest mortality rate of any mental illness. The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of all causes of death for females 15 to 24 years old. Although rates of eating disorders in boys have risen, as they have in middle-aged women, it is still considered a “girl thing.”

Donald Erwin, Ph.D, clinical director of Monmouth Psychological Associates of Tinton Falls, has been working with patients with eating disorders for 36 years. He has been active in a variety of professional organizations and is often asked to conduct eating disorders prevention and awareness programs in schools. He feels that his primary focus in the treatment of an eating disorder is in helping his patients understand what is behind their troubled relationships with food and their bodies. He contends the world is becoming a meaner place.

“Let’s take a look at relational aggression,” he said, leaning back in his swivel chair in his non-descript but soothing office. “This is the girl-on-girl bullying that has developed in the last 15 or so years. It represents the quiet but vicious unspoken ways that girls are mean to each other. There is a culture of meanness that has developed because of shows like ‘American Idol’ and ‘Survivor,’ where your group betrays each other in order to achieve. I find groups of girls betraying trusted friends in order to increase their social status. It’s a competitive thing. Consider that your girl gets an iPhone in third or fourth grade so she can track 24/7 what’s going on, she can witness everything she is not invited to. When these girls are fearful, they are deprived of age-appropriate personality development and they begin to substitute things like thinness for strong personality traits.”

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Signs of relational aggression or “mean girl” bullying are often undetected by parents and educators because they are often subtle. They include manipulation such as exclusion from the group, spreading rumors, breaking confidences, or recruiting others to dislike the target girl. These negative actions are magnified by social media. Kids look at their friends’ Snapchat stories, Facebook and Instagram posts and realize when they’re being excluded.

Parents need to be compassionate not confrontational; circle in, as Erwin puts it. Ask about friends, notice changes in schedules as well as behavior. Although the exact causes of eating disorders are not known, the Mayo Clinic suggests the following factors can put certain adolescents and teens at risk: genetic and biological factors such as anxiety and perfectionism; participating in activities that encourage low weight such as ballet or wrestling for boys; low self-esteem; pressure from society; and/or bullying.

A former patient of Erwin’s, who wishes to remain anonymous (Audrey, for purposes of this article), was 16 and a junior in high school when she started restricting, the term for reducing food intake. “I had wanted more than anything to fit in, to be accepted, to be noticed, but at the same time blend in. I had always been top of my class academically, taking all honors and AP classes,” she said. She said she initially saw her perfectionistic tendencies as beneficial. “Then my perfectionism stemmed into dissatisfaction with my body, my eating habits, and my weight.”

Her friend approached her mother about Audrey’s weight loss. Shortly after, she was told by her parents that they would be bringing her to a nutritionist’s appointment. It was actually a therapist’s office and Audrey became enraged and tried to walk back to the car, but in the end she stayed and talked. She was diagnosed with anorexia nervosa. Erwin was the therapist. Eight years later Audrey can happily say full recovery is possible. Today she has achieved her ultimate career of becoming a therapist herself, working with patients with a variety of mental health struggles, eating disorders included.

A Vigil Against Hate

Eric Alcera, M.D., medical director of Hackensack/ Meridian Behavioral, is a child psychiatrist and has spoken to parents about many of the changes in behaviors Erwin mentioned. “There are traits to keep an eye on, body image, perfectionism, rigidity in the child. There is a size-weight prejudice prevalent in our society. Kids are being bullied for how they look, what they wear. When you see withdrawal, an increase in anxiety, maybe the child isn’t getting as much sleep, it is time to engage in a conversation.”

If, as a parent, you suspect an eating disorder, Alcera recommends you contact your primary care doctor. Eating disorders can be deadly, and not just for the drastically underweight. Generally your primary care doctor will give you a referral, but it is not one-size-fits-all, so he advises people do their own research also, and go with an eating disorder specialist you and your child feel comfortable with. Whether you decide on inpatient or family-based therapy, a treatment team, including a psychologist or psychiatrist and a nutritionist, needs to be assembled.

While family and friends can be a huge help in providing support, you and your child may also want to join an eating disorder support group. They provide a safe environment where you can talk freely and get advice and support from peers going through the same process. There are many types of support groups, some are led by professional therapists, while others are moderated by trained volunteers. Erwin runs a group that meets at Riverview Medical Center the fourth (not last) Saturday of every month from 10:30 a.m. to noon. To find a support group: ask your doctor or therapist, call local hospitals/universities or try the school nurse or counseling office.


This article was first published in the Health section of the Sept. 7-14, 2017 print edition of The Two River Times.

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