As children reach their pre-teen and teenage years, many become increasingly concerned about their weight and appearance. This concern is a normal occurrence, but it can sometimes result in damaging disorders involving crash diets, excessive exercising, over-eating and a distorted perception of the child’s appearance.
Nicole Swain, Psy.D., pediatric psychologist at Children’s Hospital, discusses children and their evolving body image, and what parents can do to help.
Q: What can I do to boost my child’s body image and self-esteem?
A: At the pre-teen and teenage stage in a child’s life, it is important for parents to be accepting and supportive, providing positive messages, and encouraging other qualities that keep looks in perspective. It is important to:
- Accept and understand. Recognize that being concerned about looks is as much a part of the teen years as a changing voice and learning to shave. You know that in the grand scheme of things your daughter’s freckles don’t matter, but to her they might seem like a huge issue. Avoid criticizing your children for being concerned about appearances. As they grow, concern will stop dominating their lives.
- Give lots of compliments about looks and personality. Provide lots of reassurance about children’s looks and about all their other important qualities - like your son’s generosity to his younger sibling or the determined way your daughter studies for her test. As much as they may seem not to notice or care, simple statements like “you’ve got the most beautiful smile” or “you are such a hard worker” really do matter. Compliment them on other physical attributes such as strength and energy, as well as what’s inside, too.
- Set reasonable boundaries. Be patient, but also set boundaries on how much time your children can spend on grooming and dressing. Tell them it’s not OK to inconvenience others or let chores go. Limits help children understand how to manage time, be considerate of others’ needs, share resources, exercise a little self-discipline and keep appearances in perspective.
- Be a good role model. How you talk about your own looks sets a powerful example. Constantly complaining or fretting over your appearance teaches children to cast the same critical eye on themselves. Almost everyone is dissatisfied with certain elements of their appearance, but talk instead about what your body can do, not just how it looks.
Q: What is an eating disorder and what are common variations of eating disorders?
A: Eating disorders are serious clinical problems involving self-critical, negative thoughts and feelings about body weight, and food and eating habits that disrupt normal body function and daily activities. While more common among girls, eating disorders can affect boys, too. They’re so common in the U.S. that one or two out of every 100 children will struggle with one, most commonly anorexia or bulimia.
Anorexia nervosa is characterized by an extreme fear of weight gain and a distorted view of body size and shape. As a result, people strive to maintain a very low body weight. Some restrict their food intake by dieting, fasting or excessive exercise. They hardly eat at all and often try to eat as few calories as possible, frequently obsessing over food intake.
Bulimia is defined as habitual binge eating and purging. Someone with bulimia may undergo weight fluctuations, but rarely experiences the low weight associated with anorexia. This disorder can involve compulsive exercise or other forms of purging food they have eaten, such as by self-induced vomiting or laxative use.
Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight while those with bulimia may be a normal weight or even overweight. Binge eating disorders, food phobia and body image disorders are also becoming increasingly common in adolescence. Eating disorders require professional treatment by doctors, therapists and nutritionists.
Q: How can I tell if my child has an eating disorder?
A: It can be a challenge for parents to tell the difference between a child’s normal self-image concerns and warning signs of an eating disorder. Children with eating disorders do show many abnormal behaviors and physical signs.
A child might be struggling with anorexia if he or she becomes very thin, frail or emaciated; becomes obsessed with eating, food and weight control; weighs himself or herself repeatedly; counts or portions food carefully; only eats certain foods, avoiding foods like dairy, meat, wheat, etc.; exercises excessively; feels fat; withdraws from social activities, especially ones involving food; becomes depressed or lacks energy; and feels cold often.
A child with bulimia will show signs that include fear of weight gain; intense unhappiness with body size, shape and weight; making excuses to go to the bathroom immediately after meals; only eating diet or low-fat foods (except during binges); regularly buying laxatives, diuretics or enemas; spending most of his or her time working out or trying to work off calories; and withdrawing from social activities, especially ones involving food.
Q: What other disorders are caused by issues with body image?
A: Other disorders caused by a distorted body image include compulsive exercise, Body Dysmorphic Disorder (BDD) and binge eating disorder.
Compulsive exercise (also called obligatory exercise and anorexia athletica) is best defined by an exercise addict’s frame of mind: he or she no longer chooses to exercise but feels compelled to do so and struggles with guilt and anxiety if he or she doesn’t work out. Exercising takes over a compulsive exerciser’s life because he or she plans life around it. Although compulsive exercising does not have to accompany an eating disorder, the two often go hand in hand. Because exercising too much is bad for a person’s health, it is important to be sure your child is not suffering from an addiction to exercise. Some warning signs of compulsive exercise include not skipping a workout even if injured or sick; seeming anxious or guilty when missing even one workout; constant preoccupation with exercise routine or weight; significant weight loss; skipping activities with friends or responsibilities to make more time for exercise; and basing self-worth on the number of workouts completed and the effort put into training.
Body Dysmorphic Disorder (BDD) is a condition that involves obsessions, which are distressing thoughts that repeatedly intrude into a person’s awareness. With BDD, the distressing thoughts are about appearance flaws. BDD is often called “imagined ugliness,” because the appearance flaws usually are so small that others consider them minor or don’t even notice them. A person with BDD fixates on these imperfections, and the obsessive thoughts distort and magnify the flaw. Because of this, a person with BDD may feel as though he or she is too horribly ugly or disfigured to be seen. A teen with BDD may avoid going to school, quit a part-time job or just stay home all the time. BDD can lead to depression, and in severe cases suicidal thoughts, if left untreated.
Binge Eating Disorder is characterized by a person having a loss of control over how much food he or she is eating, feeling unable to stop. People with this disorder binge frequently—at least twice a week for several months. At first, food may provide feelings of calm or comfort, but later it can be the focus of strong guilt and distress. Most binge eating occurs while a person is alone. While most people with other eating disorders (like anorexia and bulimia) are female, an estimated third of those with binge eating disorder are male. Signs of a binge eating disorder include a child eating a lot of food quickly; eating during emotional stress; feeling ashamed by the amount of food eaten, finding food containers in a child’s room; and an increasingly irregular eating pattern.
Q: How do I approach my child if I think he/she has an eating disorder?
A: If you suspect your child has an eating disorder, it is important to intervene and help your child get diagnosed and treated. Children with eating disorders often react defensively and angrily when confronted for the first time. Many have trouble admitting, even to themselves, that they have a problem.
Trying to help when someone doesn’t think he or she needs it can be hard. As hard as it might be, getting the professional assistance needed, even if your child resists, is the best help you can give as a parent. Approach your child in a loving, supportive and non-threatening way when your child feels comfortable and relaxed and there are no distractions.
Your child may be more receptive to a conversation if you focus on your own concerns, and use “I” statements, rather than “you” statements. For example, steer clear of statements like “you have an eating disorder” or “you are obsessed with food,” which may only prompt anger and denial. Instead, try “I imagine that it’s very stressful to count calories of everything you eat” or “I’m worried that you have lost so much weight so quickly.” Cite specific things your child has said or done that have made you worry and explain that you want your child to see a doctor to put your own mind at ease. If you still encounter resistance, talk with your doctor or a mental health care professional about other approaches.