Both anorexics and bulimics may have a relentless preoccupation with exercise and weight loss. And both groups tend to have distorted body images, seeing themselves as heavy and unattractive. At the same time they may excel in school and other areas of their life. They frequently don't see themselves as having a problem, even when it is obvious to everyone around them that they do.
Take Action: "Unfortunately prevention isn't always possible, but parents who are worried about an eating disorder should seek treatment as soon as possible," Kaye urged. Eating disorders have the highest death rate of any mental illness. The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of all causes of death combined for females under the age of 25.
Kaye advised that family-based treatment tends to be the most successful, with up to 70 percent of patients responding well. "We work in alliance with the family rather than blaming them. There is no evidence that family causes the disorder. The important thing is to work with the anxiety and other symptoms, and put them in charge of eating and maintaining weight," Kaye said. Still, many struggle with symptoms for years, even decades.
At Risk: Although teens cutting themselves with scissors and knifes gets the media attention, adolescents tend to engage in all types of self-injurious behavior. They might stab, choke or burn themselves. Boys, for example aren't as prone to self-injury behaviors as girls but are often more violent. They might jump off a building not in an attempt to kill themselves but as a response to their emotions.
"We don't have great data on who is specifically at risk, but many have other emotional issues and have difficulty at school and with interpersonal relationships," said Wendy Lader, co-author of the book Bodily Harm. An estimated 13 percent of 15- and 16-year-olds have carried out an act of deliberate self-harm.
Red Flags: According to Lader, it can be challenging to identify the extreme emotional distress that precipitates acts of self-harm. "Parents can look for blood and bloody clothes," she said. "Kids may also wear long sleeves, even in warm weather to cover up marks." Previous emotional problems, drug and alcohol use, impulsivity and low self-esteem are also common warning signs.
Take Action: "The best thing to do is acknowledge the underlying emotions. Don't focus on behavior," said Lader. She recommended a professional evaluation to get to the root of the problem. "Kids will not always be honest with you but may be with a professional."
Lader adds, "I hope that parents are concerned about this type of behavior. I get so many e-mails from kids who've tried to talk to their parents about it but they weren't taken seriously as if they've done something bad or did it for the attention. Many parents become dismissive, overwhelmed or overprotective, none of which is very helpful."