Spotting the Signs: A Parent’s Guide to Identifying Disordered Eating in Teens
If you’ve logged onto social media anytime recently, you’ve probably noticed the reprisal of early-2000s body ideals. Diet culture is having yet another “moment,” and teens are especially vulnerable to adopting dangerous lifestyle behaviors in the service of changing their bodies.
Indeed, research indicates that about 22% (over 1 in 5) of children and adolescents worldwide are engaging in disordered eating, which includes dieting behaviors that people often assume are benign.¹ Further, we know that body dissatisfaction and dieting in youth are significant risk factors for the development of a clinical eating disorder.² The good news is that timely intervention is associated with a shorter duration of illness,³ and when warning signs are recognized early, parents have an opportunity to intervene before the illness grows roots. Parents can play a vital role in helping their kids get back on track.⁴
This article aims to equip you (namely, parents) with the information needed to spot the signs of disordered eating in your kids. I’ve broken up the warning signs into three categories, according to the most common types of behaviors characteristic of eating disorders. Additionally, rather than merely reciting diagnostic criteria, which include psychological symptoms only known to the individual struggling, I’ve prioritized warning signs observable to others.
Most warning signs listed in this article could apply to anyone, not just teens, and any loved ones could similarly intervene. While a companion article with next steps will be forthcoming, in the meantime I’ve concluded this article with resources that may be helpful if warning signs are identified.
Restriction
For the purposes of this article, restriction refers to intentionally limiting one’s caloric intake to an amount below what is required for optimal functioning, growth, and development. It also includes restricting the variety of foods or beverages consumed to an unnecessary degree (i.e., independent of medically established food allergies or sensitivities).
While restriction often occurs for the purpose of changing one’s body, people also restrict for other reasons. Examples include seeking a sense of control, fearing certain foods or the feeling of fullness, sensory concerns (such as aversion to food textures), self-punishment, and seeking the physical sensation of emptiness.
Regardless of the reasons, chronically restricting the amount or variety of food consumed can increase risk of medical complications, interfere with normal development, and decrease one’s ability to engage flexibly and spontaneously in social activities involving food (an important part of teens’ social lives).⁵ Even when restriction doesn’t appear severe, it can increase teens’ risk of developing a clinical eating disorder.
Below is a list of observable signs that your teen may be restricting their intake. Note that with each of these lists, we are looking for patterns rather than singular incidents. Further, the more signs you observe within and across categories, the more likely you have reason to be concerned. No list is exhaustive. If your instincts are telling you something is wrong, believe them!
Warning Signs of Restriction
Behavioral
Eating less at meals than is typical for them, repeatedly.
Ritualistic eating behaviors, such as rearranging or pushing food around their plate or excessively cutting their food.
Frequently declining to eat at mealtimes. They may give reasons such as not being hungry, feeling sick, planning to eat later (without you), or having already eaten at a time you didn’t observe.
Declining to eat previously enjoyed or accepted foods, especially if those foods happen to be higher in fat, carbohydrates, or sugar (commonly demonized nutrients).
Showing sudden interest in “healthy” eating with a corresponding reduction or omission of many foods (e.g., cutting out sugar, opting for low-calorie foods such as salads).
Suddenly opting for diet or low-calorie versions of foods and drinks (e.g., Diet Coke [when regular Coke was previously their go-to], sugar-free latte syrups, cauliflower rice or crust).
Significantly increasing their water or zero-calorie beverage consumption between or during meals (“water loading”).
If they typically bring lunch to school:
Appearing to bring less food for lunch, not bringing lunch at all, or their lunch bag returning home with most food still untouched.
If they typically use a school lunch account:
Account balance is not decreasing or needing to be reloaded at a normal rate despite you knowing they’re not bringing lunches from home.
Expressing worry about foods being unhealthy or having eaten too much.
Cooking for others but not eating what they made.
Physical (reported or observed)
Dizziness or lightheadedness.
Fainting spells (“passing out”).
Blacking out upon standing.
Appearing paler than usual.
Hair thinning.
Reporting or seeming to be unusually cold (e.g., wearing multiple layers even when it’s hot outside; undernourishment affects temperature regulation regardless of body weight).
Claiming to feel full sooner than would be expected given your knowledge of their intake (can be a sign of delayed gastric emptying, which is a common side effect of chronic under-eating).
Increased stomach upset after eating (particularly if accompanied by other signs listed).
Note that most of the physical signs relate to malnutrition, which can be caused by purging behaviors as well as restriction. For a more comprehensive list of medical complications associated with eating disorders, see here.
Purging
Purging denotes any behavior used to compensate for (or “undo”) eating, although most of the signs listed relate to self-induced vomiting (i.e., triggering one’s gag reflex to cause vomiting). Teens may “purge” food when they believe they have overeaten (or after any eating occasion) to prevent weight gain, alleviate feelings of fullness, or aid in weight-loss goals. Other reasons for purging can include emotional release, punishment, and seeking physical sensations that follow purging (especially true for self-induced vomiting).
Importantly, there is no safe amount of self-induced vomiting. Vomiting can trigger dehydration, sudden electrolyte imbalances, and life-threatening cardiac emergencies. Repeated vomiting can also lead to esophageal tears and ruptures that can be fatal. It is crucial to intervene as soon as you believe self-induced vomiting is occurring. Other forms of purging, such as the misuse of laxatives, diuretics, or compulsive exercise, can be similarly dangerous and should be addressed with equal urgency.
Below are behavioral and physical signs to watch out for that may indicate your teen is making themselves vomit, as well as some indicators of other forms of purging.
Warning Signs of Purging
Behaviors That May Indicate Self-Induced Vomiting
During or after meals:
Frequently going to the restroom.
When in the restroom, running the water (sink or shower faucet) immediately upon entering.
Frequently showering immediately after meals, particularly if doing so was not previously part of their routine.
Cleaning the toilet more often (or at all, if they never do).
Briefly going into another part of the home after eating without a discernible purpose (especially if a pattern).
Physical Signs of Self-Induced Vomiting
Red or watery eyes when returning from the restroom.
Vocal distortion (e.g., “scratchiness”) or clearing their throat when talking after returning from restroom.
Puffy appearance in their face or cheeks (due to swollen salivary glands from vomiting, called parotid hypertrophy or sialadenosis; see here for a photo of how it may appear).⁶
Abrasions or calluses on the back of hand(s) that do not go away, from contact with the teeth when reaching to trigger gag reflex (“Russell’s sign”).⁷
Vomit-like odor in the bathroom, child’s room, or their person.
Signs of Other Compensatory Behaviors
Evidence of your child acquiring and using laxatives, diuretics, or water pills, such as:
Finding receipts or packaging from the pills in the trash or in the child’s belongings (especially if seemingly hidden).
Finding the actual medications in their possession, especially when you didn’t buy them.
Your teen making a point to exercise after eating occasions, even when inconvenient (e.g., requiring disruption of plans) or unusual (e.g., late at night, when sick or injured, when they’ve never enjoyed the form of exercise).
Binge Eating
While the term binge has entered modern vernacular and is often used to refer to any increased consumption (e.g., “I binge watched Downton Abbey last weekend”), the clinical definition of binge eating is distinct and important to understand for the purposes of identifying when to intervene.
Binge eating is characterized by two co-occurring phenomena as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR):⁸
“Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.”
“A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).”
These criteria help differentiate binge eating from, for example, going back for thirds at Thanksgiving dinner or eating another cookie when you think you shouldn’t. Rather, a binge eating episode often feels frantic or compulsive, like a train that can’t be stopped once it’s left the station. And the amount of food consumed is not consistent with social or cultural norms. Teens are growing and need more food than oftentimes assumed, so it’s not uncommon to find them raiding the pantry after school. That does not mean they’re binge eating. However, when true binge eating occurs regularly, it can wreak havoc on the body, causing painful gastrointestinal symptoms (e.g., nausea, bloating, acid reflux), metabolic stress, and (more rarely) a ruptured stomach, which can be fatal.
Often, you won’t see your teen binge eating, just like we usually don’t see people engage in self-induced vomiting, because it’s done in secret. Diet culture and moral or religious ideas about “gluttony” mean that binge eating is usually accompanied by profound guilt and shame. That’s why the signs below center around evidence that binge eating occurred while you were not around. It’s also one reason why the subject needs to be addressed with empathy and sensitivity so as not to exacerbate existing shame.
Warning Signs of Binge Eating
Food is repeatedly going missing from the pantry or refrigerator (e.g., you could have sworn you bought two boxes of crackers but you’re only seeing one).
Food supplies are deplenishing quicker than usual.
You’re finding large quantities of food wrappers or containers in your child’s room or in the trash can.
You’re finding food in your child’s room with apparent effort to hide it (e.g., the food was under their bed or in their closet).
Your child often eats less or refuses food at mealtimes, stating that they’re not hungry or they feel sick (they may have binge eaten beforehand).
This sign can also indicate restriction.
If your child has a credit or debit card:
You’re noticing increased charges from restaurants, grocery stores, and/or gas stations (beyond what you would expect from their usual activities).
Weight gain
Caveats:
Weight gain should not be assumed to be due to binge eating in the absence of other signs. People generally reach maximum height before they have finished maturing, and additional weight gain (including past 18—maturation continues into people’s 20’s) can be normal and appropriate.
People do not always experience significant weight changes from binge eating, and not everyone who binge eats is in a larger body. Your child’s weight is not sufficient to either diagnose or rule out binge eating. The same applies for restriction and purging.
Next Steps
Perhaps you’ve read through these lists and noticed several warning signs in your own child. As scary as it is to think your child could be at risk, there is so much hope of things turning around, especially now that you know intervention is needed.
I’ll be writing a Part Two for this article soon, but in the meantime, a great place to start is with the excellent guides already published for concerned family members. I’ve linked a couple below so you can go ahead and take action.
“Parent Toolkit” from the National Eating Disorders Association (NEDA)
“Parents Survive to Thrive Guide” from BC Children’s Kelty Mental Health Resource Centre
You can also check out the non-profit F.E.A.S.T. (Families Empowered and Supporting the Treatment of Eating Disorders). Their website is all about "parents helping parents” as they support their children through recovery.⁹
You’re already doing great by being here and reading about ways to help your teen. Take it one day at a time, and know there are countless people and organizations happy to help.
Sources
“Global proportion of disordered eating in children and adolescents: A systematic review and meta-analysis.” JAMA Pediatrics, 177(4), 363-372 (2023). https://doi.org/10.1001/jamapediatrics.2022.5848
“Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study.” Behaviour Research and Therapy, 49(10), 622-627 (2011). https://doi.org/10.1016/j.brat.2011.06.009
“Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature.” European Eating Disorders Review, 29(3), 329-345 (2021). https://doi.org/10.1002/erv.2745
“Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.” JAMA Psychiatry, 67(10), 1025-1032 (2010). https://doi.org/10.1001/archgenpsychiatry.2010.128
“Unique considerations for the medical care of restrictive eating disorders in children and young adolescents.” Journal of Eating Disorders, 11(33) (2023). https://doi.org/10.1186/s40337-023-00759-2
“Sick enough: A guide to the medical complications of eating disorders and undernutrition” (2nd ed.). Routledge (2026). https://www.sickenough.com
“Effects of bulimia on the hands & knuckles.” The Bulimia Project (2026). https://bulimia.com/bulimia-health-risks/hands-knuckles-russells-sign
“Diagnostic and statistical manual of mental disorders (DSM-5-TR).” American Psychiatric Association Publishing (2022). https://doi.org/10.1176/appi.books.9780890425787
“Our mission.” FEAST. https://feast-ed.org/our-mission