My daughter Elena developed anorexia nervosa while she was an adolescent. This isn’t unusual: anorexia is the third most common chronic illness among teens. Unfortunately, anorexia nervosa is also deadly. Its complications prematurely end the lives of 20% of its victims. The sooner a teen gets help for it, the better.
I was blindsided by my daughter’s disorder. Elena never once mentioned dieting or counted calories out loud. She wore baggy clothes that hid her weight loss. She even lied her way through a psychiatric interview and panel of tests and came out with a diagnosis of “completely normal.” It was years before her family saw what was going on, and discovered the truth.
Here are the signs that could have helped me realize sooner that my daughter was anorexic:
1. Elena took her food with her.
“I’m running late. I’ll take a bagel to eat on the way.” Like many students, Elena was very busy, so it made sense to me that she often ate on the run.
But this was an important clue. Anorexia isn’t a diet to its victims, it’s more like claustrophobia — an irrational fear of eating food. Consequently, anorexics are meticulous in planning their escapes from meals. Elena never ate that bagel or sandwich she packed to take with her. As soon she could, she threw it away.
2. Elena hated to eat in public.
My daughter stopped wanting to go to restaurants. I remember attending a pizza night with her at school, and she didn’t eat a single piece. “I don’t want something to get stuck in my teeth,” she said. “Everybody’s watching.”
Anorexia nervosa is all about feeling in control, and it's hard to exercise that kind of control in social settings. Plus, restaurants and eating out generally threaten that control. Menus offer unpredictable choices that might lead to temptation. Observers are everywhere, and that makes it hard for anorexics to hide how much they eat. Add to these worries the prospect of smiling and making conversation while deflecting suggestions to share appetizers or desserts, and you can see why this hatred of public eating was another sign of Elena’s anorexia.
3. Elena was a vegetarian … who hated vegetables.
“Did you know that pigs actually cry?” Elena told me. “I’m a vegetarian now. I don’t want animals dying just so I can stuff my face.”
Vegetarianism can be a meaningful lifestyle choice that brings health benefits and new culinary experiences while upholding a reverence for other forms of life. But that wasn’t how my daughter practiced it. She didn’t hunt up interesting new recipes. In fact, she hated vegetables! Her “vegetarianism” was a convenient way of couching her restrictive eating; it simply allowed her to block out a large category of easy-to-obtain foods.
In fact, Elena wasn't alone in this kind of behavior. According to one study, women with an eating disorder are four times more likely to identify themselves as vegetarians than women without an eating disorder.
4. Elena lost the ability to talk naturally about food.
One day when we were at an ice cream store, Elena couldn’t even pick a flavor. “You choose,” she told me. “Just buy me a flavor I like.”
My daughter had always been a picky eater, but she had had a wide variety of favorite foods. Over time, though, I noticed that she couldn’t seem to say anything good about any food, even foods that had been lifelong favorites. All she could do was criticize everything on her plate. If I asked her what she wanted to eat, she couldn’t tell me.
5. Elena’s stories held us spellbound during meals.
My daughter is a gifted storyteller, and it’s thanks to that gift that we were able to write her memoir of adolescent anorexia, Elena Vanishing. But during her high school years, her dinnertime stories were particularly spectacular. From the time she sat down at the table to the meal’s end, Elena regaled us with one funny story after another.
Sadly enough, this delightful habit was another sign of anorexia. It was a distraction technique. As long as Elena was cheerful and bubbly, we didn’t notice how little she ate. And talking nonstop gave her a reason not to take a bite.
If your child seems underweight, don’t expect him or her to announce that anorexia nervosa is behind it. This is a disorder of shame and closely held secrets. Instead, ask yourself questions like “How much do I see her eat?” or “What is his favorite food these days?” It will be the subtle signs that lead you to the truth of your child’s eating disorder — clues like these ones I missed.