Eating disorders are serious conditions that begin in adolescence and carry physical + psychological consequences for decades. Turkish pediatric psychiatry data show 3% prevalence in 12-18 yr girls and 1% in boys — with a 40% rise post-pandemic.
Early diagnosis matters not only psychiatrically but also for growth and future adult height.
Types (DSM-5)
Anorexia Nervosa (AN)
- Body weight <-2 SD or BMI percentile below p5
- Intense fear of weight gain
- Distorted body image
- Cessation of menses (girls) — low leptin → GnRH suppression
- 2 subtypes: restrictive, purge
Bulimia Nervosa (BN)
- Recurrent binge eating
- Compensatory behaviors: vomiting, laxatives, excessive exercise, fasting
- Duration ≥3 months, ≥1×/week
- Weight typically normal to slightly elevated
- Self-esteem heavily tied to weight + shape
Binge Eating Disorder (BED)
- Recurrent binges with no compensation
- Often with obesity
- Shame, loss of control, depression
ARFID (Avoidant/Restrictive Food Intake Disorder)
- Selective eating, insufficient weight gain
- Body image is normal
- More common in younger children (6-12), prevalent in autism spectrum
Atypical Anorexia
- All psychological features of AN, but body weight in normal/high range
- Rising diagnosis — especially in children with prior obesity now rapid loss
Early warning signs in children
Behavioral red flags
- Obsessive talk about calories
- Avoiding family meals ("ate at school")
- Secret post-bathroom vomiting
- Excessive exercise (2+ hr/day)
- Baggy clothing (body hiding)
- Cessation of menses
- Social withdrawal, mood changes
- Food prep obsession (cooks for others but doesn't eat)
Physical signs
- Weight loss >4 kg/year (growth phase)
- Fatigue, feeling cold
- Hair loss, dry skin
- Lanugo (fine hair on face, back)
- Bradycardia, low blood pressure
- Calluses on knuckles (from vomiting → tooth marks)
- Enamel erosion (frequent vomiting)
Growth impact
Short-term (months)
- Height velocity slows (<3 cm/year)
- Percentile drop
- Menstrual cessation (girls) → estrogen drop → bone mineralization halts
- Thyroid function suppressed
- IGF-1 falls
Long-term (years)
- Adult height shortens (typical 5-8 cm loss, up to 10+ cm)
- Osteoporosis: bone mineral density permanently low
- Infertility: delayed menarche, anovulation in girls
- Tooth loss: frequent vomiting → enamel erosion
- Brain structure changes: persistent cognitive effects even post-treatment
Diagnostic process
1. Pediatric screening
- BMI percentile (Neyzi 2008)
- Vitals: heart rate, BP, temperature
- Growth curve deviation
- Screening questionnaires: SCOFF, EAT-26
2. Child psychiatry consult
- DSM-5 diagnosis
- Comorbidity (depression, OCD, anxiety)
- Family dynamics
3. Endocrine workup
- TSH, T3/T4 — sick euthyroid syndrome
- LH, FSH, estrogen/testosterone — gonadal axis
- IGF-1, GH stimulation — growth axis
- Electrolytes — critical for purge type
- Bone mineral density (DEXA) — 1+ yr AN
4. Nutritionist
- Refeed plan
- Refeeding syndrome management
- Family education
Treatment
Family-Based Treatment (FBT / Maudsley)
Gold standard for adolescent AN. The family restores the child's eating. 3 phases:
- Phase 1: Weight restoration (family control)
- Phase 2: Control returned to child
- Phase 3: Adolescent identity + development
Cognitive Behavioral Therapy (CBT-E)
Common for BN and atypical. 20 sessions, manualized program.
Nutritional rehabilitation
- Target weight: BMI percentile p25-50
- Refeeding syndrome alert: first 5-7 days require caution (phosphate monitoring)
- Calorie increase: 200-300 kcal/week
- Some cases need NG tube
Medication (limited indication)
- AN: SSRIs are ineffective for AN itself, but used for comorbid depression/OCD
- BN: high-dose fluoxetine (60 mg) approved
- Olanzapine: low-dose for refractory AN — weight gain side effect therapeutic
Hospitalization criteria
- BMI < 70% median
- Severe electrolyte disturbance
- Bradycardia <40 bpm, hypotension
- Syncope, dehydration
- Suicidal ideation
- Failed outpatient
Sport + eating disorders — special risk
High-risk sports:
- Aesthetic: gymnastics, dance, figure skating, diving
- Weight-class: wrestling, judo, boxing, weightlifting
- Endurance: running, cycling, distance swimming
Coaching technique correlates with eating disorders — Turkish Olympic Committee has run an education program for 5 years. Our bio-banding article offers more context.
FAQ
My child started a diet — should I worry?
A diet by itself isn't harmful, but it's the strongest risk factor for an eating disorder. Signs: excessive weight loss (>5 kg/year), avoiding family meals, calorie obsession. Consult pediatrics + child psychiatry on suspicion.
Do video games / social media cause eating disorders?
No direct causal evidence, but correlation exists. Instagram + TikTok body- image manipulation, "thinspo" content are risk factors. Parents should moderate social-media exposure.
Do boys get eating disorders?
Yes — traditionally under-recognized but prevalence is ~1%. Usually starts as "muscle development" (muscle dysmorphia), protein supplements, excessive exercise. Symptoms otherwise mirror girls: weight obsession, secret eating behaviors, social withdrawal.
How long is treatment?
AN: avg 3-7 yr treatment course. 50-60% full recovery, 30% partial, 10-20% chronic. Early diagnosis (within 3 yrs) dramatically improves outcomes.
Bottom line
Eating disorders are a medical emergency and a family's hardest confrontation. Tracking your child's height + weight + BMI percentile systematically is the most effective early-warning tool. Sign up free, enter measurements monthly, and if percentile drops alert you, consult pediatrician + child psychiatry. Early diagnosis = recovery + long-term height + bone health.