Anorexia Nervosa (AN) is an eating disorder where the child or youth restricts the intake of food. They lose a significant amount of weight for their age and stage of development. They may stop growing. It may also mean that they don’t lose any weight but don’t gain weight as expected for their age and development. 

Your child may also begin to exercise too much. Some children develop an intense fear of gaining weight or wanting to control their weight or shape. For example, some youth may become very concerned about how their muscles look. Their thinking and behaviour may also seem compulsive. Anorexia Nervosa can co-occur with obsessive-compulsive disorder, you can find more information here. Some youth say that the compulsion becomes like a voice in their heads, and it is a battle to deal with the demands. It may be helpful to think of the eating disorder as separate to your child and to notice when the eating disorder seems in control of your child’s thoughts, feelings, and actions. 

Anorexia Nervosa can take over their thoughts. Food, weight, or shape can become their main focus. This can lead them to give up time with friends, school, or hobbies. Youth may say they are ‘too busy’ to eat and stop eating certain food groups. They may not realize how serious their symptoms are even when noticed by family, school professionals and medical professionals.  

An eating disorder isn’t just about food and weight. But the first step to recovery is gaining back lost weight and working towards regular eating. Families can work with their primary care provider to develop a treatment plan.

Anorexia nervosa can lead to many medical problems and can result in death. It is a mental health disorder with one of the highest mortality rates. Youth with anorexia nervosa are ten times more likely to die than others their age. There are treatments that are work well for youth with anorexia nervosa and getting help early can make recovery more likely.

There are sub-types of Anorexia Nervosa so it is important to talk to a medical professional to understand what your youth may be experiencing. 

Bulimia nervosa (BN) affects how you feel about your body and how you eat. Those with BN usually restrict intake and try to control what they eat. But there are also times when they eat a very large amount of food in a short time and feel out of control with their eating. This is called a binge eating episode. Afterwards, they may feel ashamed of how much they ate. Sometimes they try to ‘balance it out’ by over-exercising, fasting or purging (vomiting, taking laxatives or diuretics). Those with BN have these cycles occur at least once a week for at least three months.

Eating disorders like Bulimia Nervosa may not be visible to others. Those with BN do not always lose weight. They may binge and purge without others noticing this pattern. BN can cause very serious health problems, and these problems may be hard to reverse if left untreated for too long. Like anorexia nervosa, medical complications with BN can also cause death, however there are treatments that are work well for youth with bulimia nervosa and getting help early can make recovery more likely.

Those with BED eat a large amount of food in a short time. They feel “out of control” during a binge. They also may eat alone, eat very quickly or when they are not hungry. BED is different from bulimia nervosa because those who binge do not try to ‘balance out’ the food they have just eaten through over-exercising, fasting or purging. Individuals with BED binge at least once per week and experience distress about their binge eating.

Youth with BED may binge eat when they are feeling bad about themselves. They may eat when they feel lonely, bored, anxious, or depressed. They may eat when they are having personal problems or problems with others. During a binge, the youth feel out of control when they are eating. After eating, they often feel upset, guilty, ashamed or unattractive. You can find more information on BED here. 

OSFED was previously known as Eating Disorder Not Otherwise Specified (EDNOS). They are just as serious as other eating disorders. Youth may have symptoms like those of other eating disorders, which look different in some ways. They may vary in how much their weight has changed, or how long the behaviour has been happening. 

Types of OSFED diagnoses include:

• Atypical anorexia nervosa: Those who have the symptoms of anorexia nervosa and have lost significant weight. However, they are not underweight for their age and height.
• Bulimia nervosa (low frequency and duration): Those who regularly binge eat, and then do something to try to ‘balance out’ what they have eaten during a binge — like purging by vomiting, exercising, or fasting. But they do this less often than once per week (or have been doing it for less than 3 months).
• Binge-eating disorder (low frequency and duration): Those who regularly binge eat and have other symptoms of binge-eating disorder. But they binge less than once a week (or have been doing it for less than 3 months).
• Purging disorder: Those who purge (vomit or use laxatives or diuretics) to try to control body weight, but they are not underweight and do not regularly binge.

• Night-eating syndrome (NES): Those who eat a lot of food before going to bed or in the middle of the night. Those with NES often don’t feel hungry in the morning and usually don’t eat breakfast. They don’t eat large amounts of food at a time (binge), but they often eat many small snacks all through the night. They are not sleep-walking when they eat at night, they are awake and aware of what they are doing.

   

Visit this website to learn more about OSFED.

Children with ARFID restrict their eating or avoid certain foods and may only like a small variety of foods. There are different reasons why children with ARFID avoid food. Some don’t like eating foods of certain colors or textures. Others might fear choking, vomiting, or feeling pain after eating. Some children feel full quickly or don’t feel hungry at all. This can lead to poor nutrition and slower growth. 

Your child may be living with ARFID if they are not eating enough, and they:

• Experience nutritional deficiency 
• Lose significant weight
• Do not grow as expected
• Need tube feeds 
• Only drink oral supplements or meal replacements
• Have a hard time socially because of their eating

It is not considered ARFID if youth avoid certain foods because of:

• Cultural or religious practices
• Limited options due to food insecurity.

Early detection and intervention play a crucial role in recovery. ARFID can overlap with mental health challenges such as:

• anxiety
• autism spectrum disorder (ASD)
• attention deficit/hyperactivity disorder (ADHD). 
• obsessive-compulsive disorder (OCD)

You can find more information about ARFID and autism here. 

Support for ARFID may be needed if the eating problem becomes a concern beyond what is normally seen with those other conditions. ARFID is not the same as anorexia nervosa. Those with ARFID don't restrict food to try to control their weight. They may want to gain weight but have a hard time doing so. The consequences of being underweight and lacking necessary nutrients can be just as serious. You can use this screening tool for ARFID with your child.

You can watch this Kelty webinar for more information on ARFID.

Pica is when you eat or want to eat something that is not food. It is a strong desire and craving to eat something that is not food. Pica is a “feeding disorder” that can occur at any age. It isn’t clear why someone craves or eats non-food items. Some cravings may have to do with a nutrient that is missing in their diet. Pica can also be related to stress.

It’s normal for children between 18 months and 2 years old to put non-food items in their mouths as part of learning and growing. However, if this happens with older children it’s important to find supports that help your child.

Those with pica may crave and eat a variety of items, such as:

• clay
• dirt
• sand
• stones and pebbles
• hair
• plastic
• paper
• chalk

When a child eats non-foods, it can lead to problems with digestion. It can damage the stomach and intestine. It can also be very dangerous if someone eats something that is toxic, like paint or metal, and can be deadly.

Rumination is where someone regurgitates their food (food comes back into the mouth after they swallow it). It is not done deliberately or due to nausea or vomiting. Youth may be diagnosed with rumination disorder if they regurgitate their food often for a month or more. Babies sometimes regurgitate their food but usually grow out of this behaviour. If a child doesn’t outgrow this, it is important to seek help.

Youth may regurgitate food if they have certain medical conditions or eating disorders like anorexia nervosa, ARFID or bulimia nervosa. In these cases, they would not also be diagnosed with rumination disorder. Those who regurgitate food can develop serious problems like malnutrition.

Muscle Dysmorphia means that the youth is preoccupied with the idea that their body is not muscular enough. Individuals at risk for developing this condition include those who take part in sports that focus on body size (for example, bodybuilding, football and wrestling). Muscle dysmorphia is a kind of body dysmorphic disorder. Youth with these disorders are obsessed with a part of their body that they feel is flawed. Others may not see this flaw. These disorders are classified as obsessive-compulsive and related disorders.

Youth with muscle dysmorphia may be obsessed with how they look. They often have a distorted body image and believe their muscles are much smaller than they actually are.

Some signs of this disorder are:

• Exercising too much
• Measuring weight and calories of food, rigid eating schedules and other extreme dieting
• Eating certain types of foods to try to gain muscle mass
• Using steroids or other dietary supplements 

These habits are dangerous. They can cause liver failure, high blood pressure, and heart attack. Youth may become so obsessed with getting a bigger and stronger body, that it affects other parts of life as well. For example, they may spend hours at the gym every day or turn down invitations because they are ashamed of how they look.

Those with body dysmorphia are concerned about specific aspects of their appearance, like their muscles. This type of condition is different than an eating disorder, but someone who has body or muscle dysmorphia may have disordered eating as well.

Orthorexia is a type of disordered eating but is not currently considered to be an official eating disorder. It is a condition where a child or youth will only eat foods that they consider to be “pure” or “healthy”. They worry about what is in the food they eat and how it was prepared. Often this condition starts when someone just wants to get healthier or lose weight. But, as time passes, their diet becomes the most important part of their lives.

Orthorexia is more than just wanting to eat healthy. It can stop youth from getting important nutrients because those with orthorexia may only eat a very small number of foods. They may also lose weight and spend a great deal of time thinking about food. This obsession can make it difficult to have a social life. It can be hard to enjoy activities with friends and family, such as going out for a meal. 

• Spending a lot of time thinking about and researching weight, food, or calories
• Being very interested in food, like cooking or baking for others, but not eating it
• Refusing to eat certain types of food, like carbs or fats, or having other rules about food or eating
• Feeling uncomfortable eating around other people
• Having unusual food habits (like chewing too much, taking a very long time to eat, or eating foods in a certain order)
• Trying new diets, skipping meals, or eating only small amounts
• Checking their body often or focusing a lot on what they see as flaws
• Wearing baggy or layered clothing to hide weight changes
• Going to the bathroom right after meals
• Having a change in their patterns of exercise or activity

•    Thinking a lot about their body shape or size
•    More intense mood swings or emotions 
•    Pulling away from family, friends, activities, or hobbies
•    Comparing themselves with others (either online or in reality)
•    Having trouble focusing or concentrating
•    Problems with sleep, like sleeping too much or too little 

•    Changes in weight that are obvious (weight gain or weight loss)
•    Stomach aches or other physical issues like constipation or heartburn
•    Feeling dizzy, fainting, or often feeling light-headed
•    Always feeling cold, even when it’s warm
•    Growing fine hair on the body or face (called lanugo)
•    Dry skin, hair loss, or brittle nails
•    Swelling or puffiness in the face
•    Cuts or scrapes on fingers or knuckles from making themselves vomit
•    Problems with teeth, like cavities or discoloration, caused by vomiting
•    Bad breath

•    Unexplained changes in hormones
•    Unusual blood test results (like low iron, potassium, or red/white blood cells)
•    Possible changes in thyroid levels 
•    A weaker immune system that gets sick more easily