How bulimia, the bingeing-and-purging disorder, affects adolescents, and how it is best treated

Writer: Caroline Miller

Clinical Expert: Daniel Le Grange, PhD

What You'll Learn

- How is bulimia different from anorexia?

- Why do fewer kids with bulimia get treatment than those with anorexia?

- What is the best treatment for bulimia?

- Quick Read

- Full Article

- Symptoms of bulimia nervosa

- Warning signs of bulimia

- Bulimia and shame

- Health consequences of bulimia

- Treatment for bulimia

- Challenges in treating bulimia

- Positive factors in treating bulimia

Bulimia nervosa is a serious eating disorder that usually starts in adolescence. It is characterized by frequent episodes of binge eating followed by purging to avoid weight gain. Unlike anorexia, kids with bulimia often maintain a healthy weight, making it harder to detect. Binge eating involves consuming large amounts of food in a short time, accompanied by a loss of control, followed by purging through vomiting, laxatives, or excessive exercise.

Bulimia can have severe health consequences, including electrolyte imbalances, irregular heartbeats, heart failure, esophageal tears, dental problems, bone weakness, digestive issues, and more. Despite these risks, while it’s twice as common as anorexia, it’s treated much less frequently, in part because of the shame associated with it.

Parents and caregivers play a crucial role in helping their child recover from bulimia. Family-based treatment (FBT) is the most effective approach, focusing on eliminating bingeing and purging behaviors and promoting healthy eating habits. Parents closely supervise their child, monitor bathroom trips, and even flush the toilet to prevent purging. They externalize the disorder, recognizing it as separate from their child, and offering support without criticism.

One challenge in treating bulimia is that tracking progress is more difficult than with anorexia. Rather than monitoring weight gain, it relies on self-reports from the patient and their parents. Sometimes kids with bulimia don’t disclose the full extent of their behaviors due to embarrassment. Therapists work with parents to communicate truthfully about their kids behavior without criticism.

A positive aspect of treating bulimia is that individuals with the disorder are often more willing to seek help compared to those with anorexia. While kids with anorexia often don’t think there’s anything wrong with them, and resist treatment, kids with bulimia may welcome help in overcoming distressing behaviors.

Bulimia nervosa is an eating disorder that involves a pattern of frequent binge eating and then purging to avoid gaining weight. Binge eating is when a person consumes an unusually large amount of food in a short period of time, often feeling out of control or unable to stop while doing so. They will then purge, which is usually done by throwing up, but can also include misuse of laxatives, diuretics, or extreme exercise.  

Bulimia nervosa generally starts in adolescence, and in this age group it’s actually thought to be more common — by one estimate more than twice as common — than anorexia nervosa. And like anorexia, it’s treated most effectively with family-based treatment (FBT).

But bulimia is harder to spot than anorexia. Kids with bulimia usually are not underweight and they may appear to eat a healthy amount at family meals. Bingeing and purging are most often done in secret. When kids go into treatment, many parents are shocked to find out how often they’ve been vomiting after meals, notes Daniel Le Grange, PhD, director of the Eating Disorders Program at the University of California, San Francisco.

Despite its prevalence, far fewer teenagers get treatment for bulimia than anorexia. That may be because bulimia is easier to hide from parents, Dr. Le Grange explains, and because kids are often embarrassed to admit that they have it.

But bulimia is just as life-threatening as anorexia, though the causes of death are perhaps different in the two disorders.

Symptoms of bulimia nervosa

The key symptoms of bulimia are recurring episodes of binge eating, followed by purging, at least once a week for no less than three months at a time. As is the case in anorexia, young people with bulimia also have an intense focus on body weight as the basis for self-esteem.

Binge eating is defined as eating an amount of food that’s larger than what most individuals would eat in a similar period of time under similar circumstances. Dr. Le Grange notes that what’s considered an unusually large amount is relative to the person’s culture. The eating episode is accompanied by a feeling of loss of control over eating. It’s common for teens with bulimia to binge on calorie-rich foods they would otherwise avoid and consume only low-calorie foods between episodes.

Purging involves the use of compensatory behaviors to prevent weight gain, such as self-induced vomiting, fasting, excessive exercise, or the misuse of laxatives or diuretics.

Accompanying the bingeing and purging is an intense focus on weight and body shape as the basis for the teenager’s self-esteem. Like those with anorexia, kids with bulimia are obsessed with their appearance and very worried about gaining weight. Bulimia is 10 times more prevalent in girls than it is in boys.

Warning signs of bulimia

While kids often hide symptoms of this disorder, there are behaviors that can be signs of bulimia that parents might notice, especially if they occur frequently. These behaviors include:

- Worrying or complaining about being fat

- Having a distorted, negative body image

- Eating large quantities of food in one sitting, including foods they usually avoid

- Strict dieting or fasting

- Being secretive about eating

- Going to the bathroom right after eating

- Disappearance of large amounts of food

- Drinking excessive amounts of water or beverages  

- Using excessive amounts of mouthwash, mints, and gum  

- Exercising too much

- Having sores, scars, or calluses on their knuckles or hands

- Having damaged teeth and gums

Bulimia and shame

One important difference between anorexia and bulimia is how kids feel about what they are doing to avoid weight. Anorexia is what Dr. Le Grange calls “ego syntonic,” meaning that it is aligned with the person’s values and self-image. As a result, kids with anorexia don’t think there’s anything wrong with them, and they often resist treatment.

Bulimia, by contrast, is by and large “ego dystonic,” meaning that behaviors such as bingeing and purging conflict with the person’s values and sense of self. “Most young people with bulimia nervosa, ” Dr. Le Grange notes, “do not like the fact that they have bingeing episodes and then compensatory behaviors like self-induced vomiting that are unpleasant ways of getting rid of excess calories. Such episodes are often followed by guilt, disgust, and/or self-loathing.”

While kids with anorexia may be proud of their ability to resist eating and even be admired by other kids, those who binge and purge often see it as a sign of weakness and feel ashamed of these behaviors. It’s common for kids in treatment for bulimia to say they started out meeting criteria for anorexia and then resorted to binge eating because they found restricting calories too difficult. Some of these young people, Dr. Le Grange adds, even describe themselves as “having failed at anorexia.”

Health consequences of bulimia

Due to the many dangerous health risks associated with this disorder, bulimia is associated with an increased likelihood of an early death. Unfortunately, these medical risks are often underestimated because they’re not visible, and at least half of the young people with the disorder are at a healthy-looking weight.

But frequent purging, whether by vomiting, laxatives, or enemas, can damage multiple organs in the body and cause electrolyte imbalances and other health risks. This can lead to irregular heartbeats and possibly heart failure, which is one of the main causes of death in people with bulimia. Repeated vomiting can cause a sore throat and chest pain from esophagus burns, and in some instances even esophageal tears. It can also lead to tooth decay, gum disease, and damage to the salivary glands. A weakened gut lining can make it hard for the body to absorb nutrients, causing one’s bones to become brittle and weak, resulting in higher risk for osteoporosis. Digestive disruption can cause stomach pressure and nausea. Abuse of laxatives can irritate the bowels and lead to constipation and diarrhea. Additionally, dehydration from purging can result in kidney stones and infections.

To prevent or reduce long-term damage from this disorder, it’s important to seek treatment as soon as possible.

Treatment for bulimia

Family-based treatment (FBT) has been shown in studies to be the most effective treatment for adolescents with bulimia, and is recommended by the American Psychiatric Association. In the case of bulimia, the main goal is usually not gaining weight but helping the patient eliminate the bingeing and purging episodes and maintain healthy eating habits.

The parents’ role is to supervise the child carefully enough to inhibit bingeing and purging behaviors. That might mean, for instance, sitting with the child after meals to prevent purging, monitoring trips to the bathroom, and being the one to flush the toilet.

“These are all very intrusive steps,” Dr. Le Grange admits. “But without that level of vigilance, there’s no way you’re going to get a handle on the behaviors. So, we say to the parents, ‘This is what would happen if Amanda was in an inpatient unit. Do you think that you could adopt some of those levels of supervision? This may be what’s necessary to help her overcome these urges and these behaviors that are not just unpleasant, but life-threatening.’ And so parents will usually agree.”

Parents also support their child by what experts call “externalizing the disorder”— identifying the bulimia as separate from the child. “Young people do not choose to develop these illnesses, and illness-related behaviors are not willfully engaged in, even if it seems so at times,” notes Dr. Le Grange.

To avoid being critical or angry, parents are encouraged to keep in mind that the child is in the grip of a powerful disorder that is influencing their thoughts, feelings, and behaviors. They are coached on how best to support their child through this ordeal. “The parents’ task is to battle the bulimia,“ notes Dr. Le Grange, “not their healthy child, who is still there but may be overshadowed by the disorder.”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Challenges in treating bulimia

One challenge in FBT for bulimia is that progress is more difficult to track than with anorexia, because it depends on reports from the patient regarding binge eating and purging episodes, corroborated by their parents, rather than a scale that reports weight gain. The therapist depends on the patient accurately reporting the weekly count of bingeing and purging.

Sometimes the young person feels so embarrassed that they won’t acknowledge the true extent of their bingeing and purging. “When that happens, the clinician needs to help parents share the real frequency of these behaviors without being critical,” notes Dr. Le Grange. “They need language that they can use to express sympathy that the illness has gotten the hold of the young person in this way, rather than saying, ‘Oh, no, that is just blatantly untrue. She vomited at least six times,’ and you can just hear the criticism rolling from the parents’ tongue.”

Positive factors in treating bulimia

What works in the favor of FBT for bulimia is that kids with the disorder tend to be less resistant to participation in treatment than those with anorexia. In part, Dr. Le Grange says, that’s because kids may actually want help to stop these behaviors that they find embarrassing and distressing. This can give parents some leverage in the treatment process, and the child can help articulate how they think parents can best support their changing these behaviors.

But Dr. Le Grange also notes that, for the most part, kids with bulimia tend not to be as emotionally impacted as those with anorexia. For instance, “You don’t typically see someone with bulimia nervosa declining time with their friends or not wanting to go out anymore, isolating themselves. They would still find a way to really be out there in the world with their friends.”

“At least eighty plus percent of young people with bulimia can and should be treated as outpatients,” notes Dr. Le Grange. “If they really have to be admitted to a hospital, then it’s because the degree of engagement in bingeing and purging is such that parental effort has not made any impact on these behaviors.”

Frequently Asked Questions

What is bulimia?

Bulimia nervosa is a serious eating disorder that usually starts in adolescence. It is characterized by frequent episodes of binge eating followed by purging to avoid weight gain.

Why is bulimia harder to detect than anorexia?

How is bulimia treated? https://standingabovethecrowd.com/?p=16618

Photo by Matthias Zomer on Pexels.com

Caring for a loved one with dementia is an act of love that can be overwhelming at times. As dementia progresses, your loved one becomes increasingly dependent on you for their daily needs. 

Our dementia caregiver tips include practical advice on how to help someone with dementia daily, such as keeping your loved one safe, managing behavior, minimizing agitation, reducing sundowning, caring for hygiene needs, managing meals, and more. We also provide tips for caring for yourself and finding resources so you do not have to do it alone.

Keeping Your Loved One Safe

Dementia can cause disorientation, unusual behaviors, and physical limitations that increase your loved one’s risk of injury. An effective safety plan should include the following actions:

- Provide 24-hour supervision. Never leave your loved one alone in the home or the car, and do not allow them to leave the house alone.

- Block access to hazards within the home. Remove stove knobs and add child-proof plastic covers to doorknobs. Install alarms on exterior doors and windows to signal when they are opened.

- Prepare for emergencies. Provide an ID bracelet or necklace for your loved one to wear at all times in case your loved one wanders. Create a fire plan and plan for natural disasters common to your area.

- Remove fall hazards. Avoid using throw rugs, keep clutter to a minimum, and provide nightlights throughout the home.

- Do not let your loved one drive. Disable the car, hide the keys, or sell the vehicle and say it is in the shop. Keep your keys hidden or out of your loved one’s reach. 

Although it may feel dishonest, therapeutic lying is not dishonesty. It is a method of participating in your loved one’s reality and minimizing unnecessary distress.

Managing Dementia-Related Behaviors

People with dementia respond to caregivers and their environment in ways that may be hard to understand. Their bathroom habits may change. They may resist your help and make statements that do not make sense to you. The following tips can help you cope with common dementia-related behaviors:

- Maintain a structured, predictable routine. Establish regular times for sleep, wake-up, meals, and activities.

- Develop a toilet schedule. Once every two hours is common. As dementia progresses, the gastrocolic reflex, which signals the need for a bowel movement, may be reduced. The bladder may also fail to signal the brain with an urge to urinate. A regular toilet schedule can help your loved one maintain continence.

- Accommodate rather than control. If your loved one becomes restless, provide meaningful tasks or activities, and use redirection and distraction rather than force.

- Participate in your loved one’s reality. Avoid arguing or correcting your loved one if they insist something happened or do not remember a conversation. Find natural ways to redirect the conversation or initiate an activity as a distraction.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Minimizing Agitation and Anxiety

Agitation, anxiety, and aggression in a loved one with dementia may stem from pain, hunger, thirst, infections, medications, and difficulty expressing themselves. Confusion and loss of control can contribute to these responses. You may be able to minimize negative emotions and aggression by doing the following:

- Avoid overstimulation. Keep noise, clutter, and visitors to a minimum.

- Maintain a routine. Do everything at the same time of day and avoid rearranging furniture or other items.

- Avoid substances that increase agitation. Do not give alcohol or stimulants to someone with dementia, and avoid using them yourself when you are or will be with them.

- Maintain a soothing environment. Use aromatherapy, such as lavender or lemon essential oils. Play relaxing music at a low volume, such as wholetones, classical music, or your loved one’s preferred music.

- Provide gentle massages. Massage your loved one’s hands or feet.

- Provide exercise opportunities. Go for a daily walk with your loved one or provide other physical activities.

- Avoid forceful solutions. Do not physically restrain your loved one unless necessary for their safety.

- Avoid arguing. Acknowledge your loved one’s thoughts and feelings. Distract, redirect, and perhaps offer a snack to overcome difficult moments.

Handling Duplicate Conversations and Questions

Your loved one may forget conversations within moments and either bring up something they just told you or ask a question you had already answered. It is important to note that there is usually nothing you can say to jog their memory, and it could create embarrassment, agitation, and anxiety in your loved one. The following dementia caregiver tips describe the best ways to handle duplicate conversations and questions:

- Answer questions simply without elaborating.

- Redirect your loved one to an activity or start singing a familiar song.

- Wait to discuss plans until just before the event.

- Create signs that answer frequently asked questions and hang them in relevant areas throughout the house.

Identify behaviors that indicate needs, such as pulling on clothing when they need to use the restroom.

Coping with Delusions, Suspicion, and Paranoia

Brain changes and memory loss alter your loved one’s information-processing abilities and perceptions of others. If your loved one becomes suspicious of you, the following tips can help you cope and may ease your loved one’s concerns:

- Do not take it personally. Your loved one’s suspicions are a reflection of cognitive decline, not failure on your part.

- Avoid giving them money. Your loved one may forget when they bought something and accuse you of stealing the money. Instead, give them play money or an expired credit card.

- Be aware of their hiding places. Your loved one may hide important items out of fear of theft, but they may not remember hiding them. Being able to find the items for them can reassure your loved one and de-escalate the situation.

- Avoid arguing. Trying to prove your innocence will not change your loved one’s perception. Arguing escalates the suspicions, leading to agitation and increasing mistrust.

- Warn other caregivers and loved ones. Let other family members and caregivers know if your loved one tends to accuse people of stealing. Educate them on appropriate responses.

Use verbal and non-verbal reassurances. Use gentle touch and kind words to reinforce your love and affection.

Minimizing Sundowning

Sundowning occurs when someone with dementia experiences an increase in confusion and agitation late in the day. They may become aggressive, ignore directions, or attempt to wander away. The following tips may minimize sundowning:

- Increase daytime activities. Provide activities that involve exercise and physical exertion.

- Expose your loved one to sunlight frequently. Take your loved one outside during the day when they can see the sun.

- Minimize daytime napping. Restrict your loved one from taking naps lasting longer than 15 minutes.

- Provide proper late-day nutrition. Prepare a light meal high in protein and fat and low in sugar in the evening.

- Establish a calming bedtime routine. Provide quiet, structured activities in the late afternoon and evening. Be consistent.

- Prevent shadows. Strange shadows can frighten sundowners and trigger hallucinations. Turn on the lights before the sun goes down and close blinds at night.

Managing Meals

As dementia progresses, eating can become increasingly challenging for your loved one. The following tips will help you make the most of every opportunity:

- Establish a routine. Prepare meals at the same times every day, with breakfast or lunch being the biggest meal. Most people with dementia eat less at night.

- Feed your loved one when they are hungry. If they are constantly hungry, they may be confusing hunger with thirst. Try providing half a meal so they can still eat at their regular time.

- Provide peaceful, quiet meals. Reduce distractions at mealtimes.

- Encourage independence. Allow your loved one to do as much for themselves as possible during mealtimes. Providing a sippy cup and finger foods can make it easier for them to feed themselves without assistance.

- Supervise. Eat with your loved one or at least sit at the table and supervise. Cognitive decline can lead to difficulty swallowing and increase the risk of choking.

- Note decreased food consumption. Track how much your loved one eats and notify their physician if you notice reduced consumption.

- Serve nutritious foods. Avoid empty-calorie foods and foods high in sugar.

Caring for Your Loved One’s Hygiene Needs

Your loved one may lose the ability to perceive when they need to use the restroom and may not remember how to wash their hair or body. The following tips can help you keep your loved one clean and protect their dignity:

- Maintain a routine. Have your loved one use the restroom on a regular schedule, such as every two hours. Establish set days and times for bathing, which may only be necessary twice a week. Try to match their preferred routines from before dementia started.

- Provide towels and clothing for bathing. Your loved one may be uncomfortable naked. Provide clothing or a towel they can wear while bathing.

- Provide safety features. These include proper lighting, a non-slip mat in the bathtub or shower, grab bars near the toilet and bathtub, a shower seat, and a hand-held shower head.

- Provide supervision. Never leave your loved one unattended while bathing or showering.

- Wash hair separately. If your loved one cannot wash their hair, wash it at a separate time in a sink or with dry shampoo.

- Consider a sponge bath. If conventional bathing or showering is difficult or the risk of falling is too high, provide sponge baths instead.

Choosing the Best Clothing for Your Loved One

The wrong clothing could cause your loved one to feel trapped or constricted, and some clothing may be too difficult for them to put on. You can ensure your loved one’s clothing is safe, appropriate, and comfortable by doing the following:

- Provide accommodating clothing. Choose loose-fitting clothing free of zippers or snaps. If they must have clothing with zippers or snaps, ensure they are large and easy to use.

- Establish a clothing selection routine. Set out a change of clothes for your loved one to wear and promptly remove the dirty clothing.

- Reduce conflicts about the same outfit. If your loved one wants to wear the same outfit every day, buy several of that outfit.

- Make it hard to undress if necessary. If your loved one tends to undress themselves at inappropriate times, choose clothing that closes in the back.

Taking Care of Yourself While Caring for Your Loved One

Caring for a loved one with dementia is a 24-hour job. Without appropriate self-care, you can become burned out or malnourished. You cannot provide the quality of care you desire if your mental and physical health suffers. You can take care of yourself and your loved one by doing the following:

- Put your needs first. The most important way to be there for your loved one is to stay strong yourself.

- Get help. Ask friends and family members to help. If they are uncomfortable staying with your loved one, they can help buy groceries or run other errands. Many agencies provide respite care to give caregivers a break.

- Join support groups. Nearly every community offers in-person support groups where you can share experiences and ideas for elderly dementia care. Your loved one’s doctor or your Area Agency on Aging should be able to direct you to local support groups.

- Take time to care for your physical needs. Eat healthy meals, get enough sleep, and exercise regularly.

- Get some alone time. Alone time provides an opportunity to recharge.

- Maintain a sense of humor. Laughter is an important way to relieve stress and feel less overwhelmed.

Managing Your Loved One’s Legal Affairs

If your loved one is newly diagnosed with dementia, take care of legal matters while they can still understand legal documents. Once their dementia progresses and they lose that capacity, your loved one cannot legally sign documents. You will need to do the following:

- Prepare and Execute a Durable Power of Attorney and Advance Directives. The Durable Power of Attorney will allow the person your loved one designates to sign on their behalf in medical, financial, or other matters requiring their signature. Advance Directives inform the family of your loved one’s wishes regarding end-of-life care. An estate planning attorney or elder law attorney can help with these documents.

- Designate a spokesperson. The family spokesperson is often the power of attorney. The spokesperson communicates about your loved one’s condition with health care providers, family members, and friends. If there are disputes within the family, the spokesperson can serve as a buffer.

- Copy documents. Make multiple copies of the Advance Directives and Durable Power of Attorney. Keep a few copies in a safe place and be prepared to provide copies to hospitals and other health care providers. 

Additional Resources for Caregivers of People with Dementia

You do not have to go through this alone. Most communities offer multiple resources for caregivers of people with dementia. We recommend the following:

- The 36-Hour Day by Mace & Rabins

- Area Agency on Aging for your area

- The local chapter of the Alzheimer’s Association

- California Caregiver Resource Center

- Family Care Navigator

- Lanzone Morgan, LLP

Placing Your Loved One in a Nursing Home

Many families must make the difficult decision of entrusting their loved one’s care to a nursing home. Nursing homes must provide quality care in safe, home-like environments. However, if you notice unexplained injuries, rapid cognitive decline, weight loss, wandering incidents, or a gut feeling that something is wrong, your loved one may be experiencing abuse or neglect. 

Negligent nursing homes sometimes impose chemical restraints, such as antipsychotic medications, on high-need residents, particularly those with dementia. These medications can be fatal for dementia patients. Some nursing homes provide inadequate supervision, allowing residents with dementia to wander away unnoticed. Nursing home residents with dementia are also vulnerable to verbal, physical, and sexual abuse.

The following tips can help you choose a safe nursing home for your loved one:

- Visit each facility you are considering. Show up at unannounced times during the day and night. Observe the smells and the care the residents receive. Interview staff and try to determine whether staff like working there.

- Check each nursing home’s ratings. Read Google reviews and look up each nursing home on Medicare.gov. You will be able to view inspection reports and ratings. You can also determine whether a nursing home is understaffed.

Photo by Matthias Zomer on Pexels.com https://standingabovethecrowd.com/?p=16613

The parents’ role in helping children recover

Writer: Hannah Sheldon-Dean

Clinical Expert: Daniel Le Grange, PhD

What You'll Learn

- What is family-based treatment for eating disorders?

- What do parents do in family-based treatment?

- Why does family-based treatment work?

- Quick Read

- Full Article

- What is family-based treatment?

- How does family-based treatment work?

- Time commitment for parents

- Why is family-based treatment effective?

- How is family-based treatment structured?

- How do you know if family-based treatment is right for your child?

For most young people with anorexia or bulimia, the treatment that experts recommend lets kids get better at home with their families. Research shows that family-based treatment helps kids gain weight faster than any other eating disorder treatment.

In family-based treatment, parents take the lead in helping kids recover. A mental health clinician guides parents in showing their child empathy while also enforcing strict rules about eating. Parents choose, prepare and serve all of the child’s foods. They require the child to eat and offer lots of support. The child and their parents meet with a clinician every week for coaching on this process.

Family-based treatment is a big commitment. It’s helpful to think of the treatment like any other emergency medical treatment. It changes everyone’s routines, but the changes are necessary to save the child’s life. In later phases of treatment, the child slowly takes charge of their own eating again.

The idea behind family-based treatment is that getting the child nourished is the most important thing. That’s because it’s hard for kids to think clearly when they are starving. Once they start eating more, they can get perspective on their eating disorder and start to behave in a healthier way.

As long as your child does not need emergency medical or psychiatric treatment, recovering from an eating disorder at home is usually the best option. A clinician can help you manage the changes in routine and find ways to balance your other responsibilities.

Traditional approaches to treating eating disorders in children and young adults often involve removing kids from their homes — and their parents — for in-patient psychiatric treatment.

In cases where a young person with an eating disorder needs immediate medical or psychiatric care, in-patient treatment is still recommended. But the treatment experts prefer for most kids with anorexia or bulimia lets kids remain at home, with parents taking the lead in helping them recover. Family-based treatment (or FBT) gives parents the job of strictly supervising the patient’s eating, and evidence shows that it is the quickest way for an underweight child to return to a healthy weight. And in the case of bulimia, parents also learn to monitor the child’s opportunities for binging and purging.

What is family-based treatment?

The core of family-based treatment is the assumption that parents are capable of helping a child recover from an eating disorder. “FBT relies on that core parental capacity to feed your child,” says Daniel Le Grange, PhD, one of the founders of FBT and director of the Eating Disorders Program at the University of California, San Francisco. “In practice, it coaches parents to do the same job that nurses in an in-patient program would do.”

Because eating disorders are complex and confusing illnesses that severely disrupt family life, parents of a child with anorexia have often come to doubt themselves, and they may have given up asserting parental authority over the child’s eating. In FBT they take back that role. “Clinicians in FBT reinforce the idea that parents can do this,” Dr. Le Grange says. “We slowly but surely coach them to begin to trust their gut once more.”

How does family-based treatment work?

In FBT, a clinician guides parents or caregivers in replicating the two major components of in-patient eating disorder treatment: empathy for the child and, in Dr. Le Grange’s words, “an environment in which not eating is not an option.” Just as a parent would insist on treatment for an illness like cancer, even if it is unpleasant, the parent insists that the child comply with FBT guidance. A child with an eating disorder will almost certainly fight eating food that will enable them to gain weight. “But parents need to understand that the disorder is like a malignant tumor,” Dr. Le Grange explains. “They’re not fighting their kid, they’re not trying to make their child’s life miserable. They’re fighting the illness.”

Right at the start of FBT, parents manage their child’s eating, from choosing foods to preparing and serving them. “Essentially, you say to the child: ‘I know this is tough for you, but I’m going to sit here with you until you eat this,’” Dr. Le Grange says. Repeating that process without any exceptions is the core of the initial phase of FBT.

“It can take time,” says Melissa Gerson, LCSW, the founder and clinical director of Columbus Park, a New York City eating disorder treatment clinic. “We may have a parent sitting at the table with the child for an extended period of time, and just waiting for the child to finish.” The idea, she says, is that there’s no room for negotiation. By calmly and confidently directing their child’s eating under a clinician’s guidance, parents are empowered to enforce the boundaries that kids need in order to recover.

Time commitment for parents

Participating in FBT usually means big changes in the family’s routine. For instance, in a two-parent family, the parents might take turns staying home from work to supervise the child’s eating. In single-parent families, it may be necessary to enlist help from extended family or trusted friends. “The first phase of FBT really requires parents to put their lives on hold,” says Dr. Le Grange. Because the treatment can be so disruptive, he emphasizes to parents that eating disorders are an urgent medical threat. “It’s like having a child who’s in renal failure and needs dialysis three times a week,” he says. The change in routine can be hard to manage, but it’s medically necessary.

Ideally, siblings are involved in FBT as well. “Parents are responsible for weight restoration, and siblings are supposed to be supportive of their ill sibling outside of mealtimes,” Dr. Le Grange says. Because the treatment can be stressful and upsetting for the child with the eating disorder, siblings can give the child space to relax and be a kid, away from the structures that the parents impose at mealtimes. Depending on the family circumstances, it may not be plausible to involve siblings without creating more stress, but when possible, they can be an important support system.

In later phases of FBT, the goal is to return decision-making over food intake back to the child or adolescent, once they’ve regained sufficient nutrition and stabilized their weight and behaviors.

Why is family-based treatment effective?

FBT has been shown to be efficacious for underweight kids (with anorexia nervosa) and kids with binge eating and purging behavior (bulimia nervosa). FBT has also been used for kids with other eating disorders such as a typical anorexia or ARFID, but the evidence is not quite as robust as it is for anorexia and bulimia.

The thinking behind FBT is that focusing on improving nutrition is more helpful than analyzing the underlying causes of the disorder. That’s because, Gerson explains, “with anorexia in particular, much of the distress around food — and the low mood, and the isolation, and the compulsivity — is caused by starvation. The child is behaving this way mainly because the brain is starved.” Once the child is no longer starving, they’re better able to think through what’s happening and maintain healthier behaviors going forward.

Dr. Le Grange notes that it’s crucial for families to avoid getting trapped in what clinicians call “anorexic debate.” When your child is trying to convince you that it’s fine to eat only salad, he says, “you’re not reasoning with your rational, smart adolescent. You’re having a discussion with a psychiatric illness.” FBT gives parents a structure in which they can avoid those dead-end debates and focus instead on getting their kids nourished.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

How is family-based treatment structured?

FBT generally involves roughly 20 weekly sessions, divided into three phases. Throughout all three phases, the clinician works primarily with the parents or caregivers, while being supportive of the adolescent who is in distress. At the start of each session, the child has a short check-in with the FBT clinician to check their weight and get basic mental health support. Then, parents or caregivers, along with the child and sometimes their siblings, meet with the clinician for coaching and support around their work to nourish their child.

The first phase usually lasts for 10 to 12 sessions, and it’s where the bulk of the work takes place. “Phase one is all about re-nourishing the adolescent,” Dr. Le Grange says. During phase one, parents focus on all aspects of the child’s eating.

The child usually does not attend school for the first week or two, in part because they need to conserve energy while they gain weight. Then, if the treatment is going well, the parents might supervise the child a bit less as phase one goes on. “For instance,” says Dr. Le Grange, “by week three the child might go back to school after lunch. And if they keep gaining weight, then maybe by week five the child eats lunch at school, but with a parent or school counselor there to supervise.”

In phase two, which lasts for five or six sessions, the child begins to make some limited decisions about their eating again, and to participate in age-appropriate activities outside of the home. It’s important to move slowly and look out for backsliding in phase two. “These are all very tentative moves, because just a month or two earlier they were still pretty unwell,” Dr. Le Grange notes. “We had a case where the adolescent was doing really well, and they were a very good athlete, but the parents reintroduced physical activity too quickly, and too vigorously, and everything came tumbling down.” If problems do arise in phase two, then the family has to largely return to phase one.

Phase three, the final three or four sessions of FBT, focuses on launching the child back into their normal daily life. It also helps parents learn how to interact with their child again now that their relationship is much less focused on the eating disorder.

How do you know if family-based treatment is right for your child?

If a child or young adult is in a life-threatening medical or psychiatric situation, then hospitalization is necessary. In most other cases of anorexia and bulimia — including those where the young person is very underweight but otherwise medically stable — experts recommend FBT.

Dr. Le Grange emphasizes while FBT might sound daunting, most parents do have the capacity to manage it. “All parents come to us with strengths and weaknesses,” he says. FBT involves coping with each family’s unique challenges and building on their strengths. “And the major strength is that families love their kids,” Dr. Le Grange adds. There are other eating disorder treatments (including enhanced cognitive behavioral therapy, called CBT-E, and adolescent-focused therapy, called AFT) available if FBT doesn’t work or isn’t feasible, but they generally don’t help kids regain weight as fast as FBT does.

Accordingly, Dr. Le Grange urges parents not to rule out FBT, even if their circumstances are challenging. “We have to be creative as clinicians,” he says. That might mean helping parents juggle work responsibilities or financial difficulties, bringing in extended family for support, or helping parents navigate disagreements with each other. “Some situations are much tougher than others, without a doubt,” says Dr. Le Grange. “But that just means that we as clinicians have to work harder and be more supportive.”

Frequently Asked Questions

What is family-based-treatment (FBT) for eating disorders?

In family-based treatment (FBT) for eating disorders, a mental health clinician guides parents in showing their child empathy while also enforcing strict rules about eating. Parents choose, prepare, and serve all the child’s foods. The child and their parents meet with a clinician every week for coaching. https://standingabovethecrowd.com/?p=16607

Clinical Expert: Jennifer Louie, PhD

- 1. What is anorexia nervosa?

- 2. What are the symptoms of anorexia nervosa?

- 3. How is anorexia diagnosed?

- 4. What are the risk factors for anorexia?

- 5. How is anorexia nervosa treated?

- 6. Risks for other disorders

What is anorexia nervosa?

Anorexia nervosa is an eating disorder that can cause kids to starve themselves. Children and teenagers with anorexia believe they are too fat, even though everyone else sees them as way too thin. To maintain a very low weight, they eat very little and often throw up on purpose or exercise intensely. They may not understand that that their opinion of their body isn’t normal and that their choices are not healthy.  

Anorexia usually begins during the teenage years. Because children with anorexia often do well in school and are popular, it can be hard for parents and other adults to see there’s a problem. Girls are diagnosed much more often than boys, but that could be partly because anorexia is harder to spot in boys. 

Anorexia is extremely serious. The earlier it is treated, the better. If it’s not treated, it can lead to fatal medical problems or suicide. 

What are the symptoms of anorexia nervosa?

The key indication that a child or teenager has anorexia is if they look in the mirror and see themselves as too fat when everyone else sees them as way too thin. Specific symptoms include: 

- Extreme weight loss  

- Weighing much less than is normal for their age  

- Being very afraid of getting fat 

- Refusing to eat a normal amount of food or going on extreme diets 

- Seeing weight as a very important part of their identity 

- Making themselves vomit or using laxatives (this is called purging) 

- Exercising too much 

- Weak nails or hair loss  

- Constipation  

- Not having regular periods  

How is anorexia diagnosed?

Anorexia is diagnosed by a doctor. They look at the child’s weight and compare it to what is average for their age. If the child’s weight is 15% or more below average, the doctor will look for further signs of anorexia. The doctor will try to learn if the child: 

- Is very worried about gaining weight 

- Is scared of being fat, even though they’re so thin 

- Thinks their body looks different than it does  

- Doesn’t believe they have a serious problem  

- Doesn’t have regular periods  

There are two different kinds of anorexia diagnosis. One is the restrictive type, where kids eat very little. The other is the binging/purging type, where kids limit food and also keep weight down by vomiting or using laxatives. 

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

What are the risk factors for anorexia?

Girls are ten times more likely to be diagnosed with anorexia. Other risk factors include: 

- A parent or sibling with anorexia 

- Doing activities that focus on being thin, such as modeling and sports 

- Having an anxiety disorder 

- Tending to obsess over things 

How is anorexia nervosa treated?

The first goal of anorexia is to get the child to a healthy weight. This could require hospitalization or a residential program if the child’s health is in danger. Treatment works best when the disorder is caught early.  

The most successful therapy for children and teenagers with anorexia is?family-based therapy. When the whole family participates in therapy, they learn how to support the child in developing healthier eating habits at home. The longer a child stays at a healthy weight, the less likely it is that they will experience anorexia again. 

There are no medications specifically for anorexia. However, a child may be prescribed an SSRI (selective seretonan reuptake inhibitor) to treat related depression, anxiety?or?obsessive-compulsive disorder (OCD) symptoms. Treating these disorders can make the therapy for anorexia more successful. 

Risks for other disorders

Children can have serious medical problems if they don’t receive the nutrition they need. Even if they don’t look extremely thin, they can have: 

- Anemia, a blood condition that can make them feel tired or weak 

- Kidney trouble  

- Thin bones that break easily 

- Problems with hormones and electrolytes 

At worst, anorexia can make the heart stop suddenly, causing death. 

Anorexia also usually affects a child’s social life and their relationship with their family. As a result, suicide is a serious risk.  https://standingabovethecrowd.com/?p=16602

Ayrton Ostly

This article discusses suicide and suicidal ideation. If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.

Minnesota Vikings wide receiver Rondale Moore died yesterday at 25 years old. The NFL world continues to react to his death as the investigation continues in Floyd County, Indiana.

Current and former NFL players have paid tribute to the former Purdue Boilermakers and Arizona Cardinals wideout. Maxx Crosby, Hollywood Brown, J.J. Watt and Raheem Mostert were among the many to post to social media in Moore's honor.

One former player shared his insight criticizing the league for its handling of mental health issues in players.

"Imma keep it a stack.. I don’t care, I’m retired I’ll say what I want," former defensive lineman Breiden Fehoko wrote on X. "These NFL teams come out here and post these mental health awareness posts talking about they care about players 'don’t be afraid to reach out' etc. All they care about is what you bring to the table when it’s game day. Most players don’t wanna get help inside the building of an NFL organization because they know you’ll get looked at differently. You go to a staff member tell em you struggling watch how different they start treating and looking at you. I seen it first hand."Expert NFL Playoffs picks: Exclusive betting insights only at USA TODAY.

Fehoko went undrafted in 2020 out of LSU but played for five years in the NFL. He spent the 2020 through 2022 seasons with the Los Angeles Chargers before a two-year stint with the Pittsburgh Steelers.

"I’ll start believing they care about player health when the Owner, GM, & head coach treat everyone on that roster the same from the franchise QB to the janitor," he wrote. "Until then don’t tell me they care cause they posted some hotline number when (expletive) like this happens."

Fehoko finished his statement by encouraging players to reach out to him if they're struggling.

"I’m here for any of my brothers that just wanna talk and shoot the (expletive). I love y’all. I care about y’all. I’m here for y’all."

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Fehoko similarly spoke out after the death of Dallas Cowboys defensive lineman Marshawn Kneeland.

Kneeland, 24, died by suicide in Frisco, Texas last November.

"Sometimes as a man especially in the football world we're afraid of being judged or looked at weak," Fehoko wrote in response on X. "Make it mandatory to have a sit down with guys cause most of em won't take the initiative."

Moore's cause of death remains under investigation at time of publishing. https://standingabovethecrowd.com/?p=16598

What to look for if you are concerned about your child, or a friend

Eating Disorder

Writer: Rae Jacobson, MS

Clinical Expert: Allison Baker, MD

https://www.youtube.com/watch?v=WLuWTZbLcMQ

What You'll Learn

- What are the signs that a college student may have an eating disorder?

- What are common eating disorders?

- Quick Read

- Full Article

- Hating her body

- Weighty worries

- Anorexia 

- Bulimia

- Binge eating disorder

People with eating disorders often try to hide what’s happening from friends and family. If you’re concerned a college student may have an eating disorder, it’s important to know what to look for. Here are some warning signs that a college student may have an eating disorder.

Eating disorders include anorexia, bulimia, and binge eating disorder, and each disorder has a different set of signs. A lot of talk about hating their body or wanting to look like someone who is thinner can be a warning sign for an eating disorder.

Anorexia is a disorder in which someone starves themselves because of an intense fear of being fat. People with anorexia go to extremes, not eating and over-exercising to the point of sickness. Signs that someone might be anorexic include an obsession with getting thinner, avoiding calories, and exercising more than is healthy. Skipping meals or parties, avoiding the dining hall, and wearing baggy clothes to hide weight loss are also signs.

People who have bulimia also have an obsession with body image and desire to lose weight. But they eat large amounts of food in a short period of time — called binging. Then they get rid of the calories by vomiting or exercising too much, which is called purging. People with bulimia aren’t always very thin, which can make it harder to spot.

Signs someone might be bulimic include buying and hiding large amounts of food and making up reasons to go to the bathroom to purge. If someone is always disappearing after a meal, that’s a big tip-off. People with bulimia may also have bad breath from vomiting. And they may skip parties and events that interfere with binging and purging.

People who struggle with binge eating disorder (BED) eat large amounts of food. The disorder is different from anorexia and bulimia because people with BED aren’t obsessed with being thin. A person with binge eating disorder may be feeling overwhelmed or out of control. They may struggle to managing stress and use food as a way to comfort themselves. Signs that someone may have BED include rapid weight gain, wearing baggy clothes to hide weight gain, making excuses to eat alone, and hiding food.

The first warning signs that your college-age child, or your friend in college, may have an eating disorder is often not what she does but what she says.

Try tuning in to how she talks (and how much she talks) about herself.

“I’m so fat. I’m a pig.”

“I wish I looked like her.”

“I’m on a diet.”

Of course not everyone who wishes she was thinner or looked a bit more like a supermodel has an eating disorder, but this kind of self-loathing language can be a warning flag. When someone begins to show constant preoccupation with thinness, diet, or body image it might be time to listen a little more closely.

Hating her body

“I couldn’t stop comparing myself to every girl I saw,” says Jessica, who struggled with anorexia during her late teens and early twenties. ” ‘Am I thinner than her? Am I fatter?’ It was endless, and I was almost always the fat one. It was all I thought about so it was all I wanted to talk about.”

This kind of constant self-criticism is pretty common, and can be a clue to friends, parents, and clinicians that an eating disorder may be developing.

“Eating disorders are not about vanity or just the desire to be thin,” explains Alison Baker, MD, “but it’s important not to dismiss that piece of it because it can be the language of distress. In a lot of cases this is the first clue. People express their anxieties and complaints by wishing they looked more like someone in their community or a movie star.”

College is a place where you can find people to participate in almost anything you’re interested in, and criticizing your body is no exception. Now 25 and in recovery, Jessica says it was easy to get other girls talking about how much they hated their bodies—even if they didn’t have an eating disorder. “We were all worried about our weight. Someone was always willing to go down the rabbit hole with me,” she says.

Weighty worries

While some weight concerns are normal, the mix of anxiety and the constant pressure to be thin can be a very dangerous mix for some. A history of serious anxiety is a strong indicator foreating disorders during college.

Dr. Baker, a child and adolescent psychiatrist, notes that if a student seems very stressed out, or down, and has been obsessing over losing weight, it’s important to intervene.

“If she’s reporting that she’s unhappy or very anxious, and she looks very different than the last time you saw her, then it’s time to ask,” says Dr. Baker. Eating disorders include anorexia, bulimia, and binge eating disorder, and each disorder has a different set of signs.

Anorexia 

Anorexia is characterized by an intense fear of gaining weight. People with anorexia go to extremes, restricting food and over-exercising to prevent weight gain.

Signs that someone might be anorexic include:

Obsession with getting thinner: Constant preoccupation with gaining weight, calories, food intake, or food ingredients that might be “fattening.” A generalobsession with body size and weight.

Excessive exercising: This goes way beyond being a gym rat. If someone spends hours running on the treadmill to “work off” a small snack, or insists on going jogging outside even when she’s sick or the weather’s bad, that may be cause for concern.

Food avoidance, hiding and lying: People with eating disorders often try to hide what’s happening from friends and family, which can make it harder to spot a problem. This might mean:

- Skipping meals, or parties where eating or drinking are the main event.

- Avoiding the dining hall

- Always saying she’s had a big breakfast or is in “too much of a hurry” to eat.

- Wearing baggy clothes to hide weight loss.

A need for control: People at risk for anorexia are perfectionists and often set impossible goals for themselves, whether it’s getting straight A’s, having a super-clean room, or being the president of every club on campus. When the chaos of college makes it hard to control their environment, people with anorexia try to alleviate stress and anxiety by controlling the one thing they feel in charge of—their bodies.

Serious weight loss: Losing a ton of weight, especially in a short period of time, is a sign of real danger. If someone looks painfully thin it’s time to seek help.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Bulimia

Like anorexia, bulimia is a serious eating disorder characterized by an overpowering obsession with body image and desire to lose weight. However, it takes a very different form when it comes tosigns and symptoms.

Bulimia is a cycle of binging—eating large amounts of food in a short period of time—and purging, which could include self-inducing vomiting, abusing laxatives or diuretics, over-exercising, or a combination of all three. People with bulimia aren’t necessarily noticeably thin, which can make it harder to spot.

Signs someone might be bulimic include:

Binging and purging:

- Buying and hiding large amounts of food

- Hiding uneaten food or wrappers from binges

- Inventing reasons to go to the bathroom to purge— if someone is always disappearing after a meal, that’s a big tip-off.

- Bad breath, swelling under the jaw or cheeks, tooth discoloration, acid reflux, or even knuckle calluses from self-induced vomiting.

Obsessing about weight: Talking about weight and size more than is usually considered normal. Constantly comparing her body to the bodies of friends, strangers, and movie stars—and always finding herself wanting.

Withdrawal from social events:

- Skipping parties where eating is important

- No longer engaging in things she used to enjoy.

- Passing on activities that interfere with the routine of binging and purging.

Binge eating disorder

People who struggle with binge eating disorder (BED) will frequently eat large amounts of food, but unlike a person with bulimia, they don’t engage in any of the “purging” behaviors. The disorder is different from anorexia and bulimia because people with BED are not preoccupied with thinness, although they may struggle with poor self-esteem and often feel guilty and ashamed over any weight they’ve gained from their binges.

People with binge eating disorder may be feeling overwhelmed or out of control—they may struggle with managing stress or difficult emotions—and use food as a way to comfort themselves. Binge eating disorder is often associated with depression.

Signs that someone may have BED include:

Rapid weight gain: Binge eating leads to weight gain and can cause serious health problems including heart disease, diabetes, high blood pressure, and others. Kids who are binge eating may be wearing really baggy clothes to hide weight gain.

Hiding out: For people with BED, binging is usually done in private. If someone is making excuses to eat alone, hiding food around her room, or you’ve notice large amounts of food missing from the dorm, it might be a sign of trouble.

Depression and withdrawal: People with BED often struggle with feelings of guilt and shame after a binge, becoming depressed and isolated which perpetuates the binge-eating cycle.

Eating disorders don’t discriminate

Recognizing an eating disorder sometimes means looking beyond the typical stereotype.

Eating disorders are more prevalent in females, but approximately 10% of people with anorexia and 40% of those with binge eating disorder are male. Boys and men with an eating disorder often go overlooked. If the signs are there, don’t discount the possibility of an eating disorder because someone doesn’t fit the stereotype.

Eating Disorder https://standingabovethecrowd.com/?p=16596

James Donaldson on Mental Health - Risk factors driving rising suicide rates among Black youth identified

Author(s) Celeste Krewson, Assistant Editor

Key Takeaways
- Prior self-harm was the strongest predictor of suicide, with an odds ratio of 16.40, underscoring the need for close follow-up and intervention after deliberate self-harm.
- Recent psychiatric care, traumatic brain injury, violence exposure, and educational or occupational problems were significantly associated with increased suicide risk among Black youth enrolled in Medicaid.
- Family and contextual stressors—including abuse or neglect, relational conflict, economic hardship, and high social vulnerability— were more common among suicide decedents, highlighting the importance of multi-level prevention strategies.

A study highlights prior self-harm, traumatic brain injury, family instability, and social vulnerability as major risk factors associated with suicide among Black youth.

Risk factors driving rising suicide rates among Black youth identified

Researchers have identified factors contributing to the significant rise in suicide rates among Black youth, publishing their findings in JAMA Network Open.1

These factors include depression, brain injury, exposure to violence, and more. Prior self-harm was the most common risk factor among Black youth committing suicide, with a prevalence of 56.4% This indicates a critical avenue of follow-up to decrease the odds of suicide in this population.1

“We focused on a Medicaid population because Black youth are disproportionately covered by Medicaid compared to other child populations,” said Cynthia Fontanella, PhD, principal investigator at Nationwide Children’s Hospital.1

Assessing suicide risk factors in Black youth

The population-based matched case-control study was conducted to provide a deeper understanding of intragroup patterns and correlates of suicide among Black youth.2 Participants included non-Hispanic Black patients aged 9 to 24 years with Medicaid enrollment between January 1, 2010, and December 31, 2019.

All participants had a lifetime mental health diagnosis including posttraumatic stress disorder, anxiety, psychotic, mood, disruptive behavior, substance use disorders, and attention-deficit/hyperactivity disorder. Youth with suicide after at least 10 months of Medicaid enrollment were considered cases.2

Each case was matched to 10 controls based on sex, age, and state of residence. These controls included Black youth with a lifetime mental health diagnosis who were alive on the index date, defined as the case’s death date.2

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Relevant data and participant characteristics

Data was obtained from the Medicaid Analytic eXtract, Transformed Medicaid Statistical Information System Analytic File, and National Death Index. Suicide death was reported as the primary outcome based on International Statistical Classification of Diseases and Related Health Problems, Ninth and Tenth Revision cause of death codes.2

Patient covariates included Medicaid eligibility reason, mental health and general medical conditions, prior deliberate self-harm (DSH), social determinants of health, and acute or outpatient mental health care within 1 month before the index date. Child abuse or neglect, family relational problems, and economic problems were reported as family covariates.2

There were 9625 participants included in the final analysis, 875 of whom were cases and 8750 were controls. Of patients, 72.2% were male, with a mean age of 18.9 years reported at the index date. Hanging or suffocation was the most common suicide method, reported in 43.5%. This was followed by firearms in 31.8% and poisoning in 8.2%.2

Strongest individual- and family-level risk factors

Individual, family, and contextual factors significantly differed between groups. These included increased odds of Medicaid enrollment through disability or foster care among cases, with adjusted odds ratios (aORs) of 1.22 and 1.85, respectively.2

Additional aORs highlighting risk factors of suicide included 2.12 for recent acute mental health care, 4.38 for traumatic brain injury or concussion, and 2.71 for violence exposure. DSH and educational or occupational problems had unadjusted odds ratios of 16.40 and 2.36, respectively. There were also multiple health disorders more common in cases vs controls.2

Family-level factors were also more common in suicide decedents. After adjustment, only family relational problems had a significant link, with an aOR of 2.18. Unadjusted odds ratios in this population included:2

- 2.21 for child abuse or neglect history
- 3.45 for family relational problems
- 4.83 for economic or housing problems

Implications

Finally, contextual-level factors such as living in urban areas or a county with moderate to high social vulnerability were more likely in Black youth who committed suicide. Overall, the results highlighted a variety of factors that may be used to inform suicide prevention strategies in this population.2

“Research shows that one of the highest risk periods for suicide in all youth is after hospitalization for psychiatric care,” said Fontanella.1 “We need to target these critical periods.”

References

- Understanding the rising suicide risk among Black youth. Nationwide Children’s Hospital. February 18, 2026. Accessed February 20, 2026. https://www.eurekalert.org/news-releases/1117030
- Fontanella CA, Xia X, Llamocca EN, et al. Suicide risk and protective factors among medicaid-enrolled Black youth with a mental health diagnosis. JAMA Netw Open. 2026;9(2):e2559657. doi:10.1001/jamanetworkopen.2025.59657
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