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Understanding Eating Disorders In Young People · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:01
  SPEAKER_00: Hello and welcome to the Children's Consultancy Podcasts.
• 0:04
  SPEAKER_00: I'm Kim Lee, child and adolescent psychotherapist.
• 0:08
  SPEAKER_00: Now, today I want to talk about eating disorders and disordered eating in children and young people, what they are, how common they are, how they differ, and most importantly, how parents can help.
• 0:22
  SPEAKER_00: Now, this can be a frightening topic for many families because eating disorders can feel deeply personal, highly emotional, and sometimes invisible until they become very serious.
• 0:35
  SPEAKER_00: My aim is to offer clear understanding in a way that I hope you experience as compassionate so that you feel more equipped to notice, respond, and seek support.
• 0:49
  SPEAKER_00: Now the fact that the prevalence in this particular area is increasing, I think is important to state because many parents will feel very alone, may feel that they can't seek guidance and help.
• 1:09
  SPEAKER_00: But the truth is, eating disorders are more common than many families realize.
• 1:14
  SPEAKER_00: And the numbers in the UK have increased over recent years.
• 1:18
  SPEAKER_00: And I want to share a few key figures to help you understand the scale of this.
• 1:23
  SPEAKER_00: And I'll keep the language as parent-friendly as I can.
• 1:27
  SPEAKER_00: Now, large UK national surveys suggest that around one in eight young people aged 17 to 19 reported an eating disorder in 2023 with rates significantly higher in girls and young women.
• 1:45
  SPEAKER_00: Among younger adolescents aged 11 to 16, eating disorders are also more common in girls, with estimates of around 4.3% in girls compared with around 1% in boys.
• 2:24
  SPEAKER_00: Beyond diagnosed eating disorders, disordered eating behaviors are much more widespread.
• 2:51
  SPEAKER_00: So, in simple language, that which starts as disordered eating can become an eating disorder.
• 3:00
  SPEAKER_00: Now, UK charity Beat estimates that at least 1.25 million people in the UK live with an eating disorder, and around one quarter of those affected are male, which reminds us that eating disorders are not only a female issue, or at least predominantly, but they can affect men, boys, young adolescents.
• 3:26
  SPEAKER_00: NICE and NHS guidance emphasize that early identification and intervention in childhood and adolescence significantly improves outcomes and reduces medical risk.
• 3:40
  SPEAKER_00: And this supports long-term recovery.
• 3:44
  SPEAKER_00: So what are eating disorders?
• 3:46
  SPEAKER_00: Well, they're mental health conditions characterized by persistent disturbances in eating behaviors, weight or shape concerns, and significant physical or psychological impairment.
• 4:01
  SPEAKER_00: Some of the main types include anorexia nervosa, and this involves significant restriction of food intake, intense fear of weight gain, and distorted body image.
• 4:14
  SPEAKER_00: Children and adolescents may become preoccupied with calories, exercise excessively or avoid eating in front of others.
• 4:24
  SPEAKER_00: The next category is bulimia nervosa.
• 4:27
  SPEAKER_00: Now, bulimia involves cycles of binge eating followed by compensatory behavior such as vomiting, which we call purging or laxative use, or excessive exercise.
• 4:41
  SPEAKER_00: And there is often intense shame and secrecy in this.
• 4:46
  SPEAKER_00: There is also something we call binge eating disorder, and this involves recurrent episodes of eating large amounts of food with a sense of loss of control without compensatory behaviors, and it's often linked to emotional distress and shame.
• 5:04
  SPEAKER_00: Another condition is known as APID, which is avoidant restrictive food intake disorder.
• 5:11
  SPEAKER_00: And this is common in younger children and involves restrictive eating not driven by body image but by sensory sensitivities, fear of choking, vomiting, or lack of interest in food.
• 5:24
  SPEAKER_00: And this can lead to nutritional deficiencies and growth concerns.
• 5:30
  SPEAKER_00: Now I said earlier about the distinction between disordered eating and eating disorders.
• 5:36
  SPEAKER_00: Now, disordered eating refers to problematic eating behaviors that may not meet clinical criteria for an eating disorder, but still concerning.
• 5:48
  SPEAKER_00: So examples include chronic dieting or skipping meals, body dissatisfaction, emotional eating or loss of control around food, having rigid food rules, sometimes cutting out entire food groups, excessive exercise driven by guilt or fear.
• 6:10
  SPEAKER_00: And this distinction is important.
• 6:13
  SPEAKER_00: Disordered eating is common and often situational, but it can escalate into an eating disorder.
• 6:21
  SPEAKER_00: That's if the underlying emotional and relational needs are not understood and supported.
• 6:28
  SPEAKER_00: So why do eating difficulties develop?
• 6:32
  SPEAKER_00: Well, both eating disorders and disordered eating rarely exist in isolation.
• 6:38
  SPEAKER_00: They often emerge in the context of anxiety, perfectionism, or high self-criticism, trauma, bullying or social pressures, puberty and body changes, a need for control during times of uncertainty, family dynamics and relational stress.
• 6:59
  SPEAKER_00: So food and the body can become a language for emotional experience, a way of expressing distress, asserting autonomy, or managing overwhelming feelings.
• 7:13
  SPEAKER_00: Very often when I work with patients who are suffering with either of the two conditions, I look for where the internal seemingly overwhelming conflict is within the patient.
• 7:30
  SPEAKER_00: Because underneath the behavior is a complex conflict which has not yet found words.
• 7:40
  SPEAKER_00: Many patients have talked to me about the voice that they hear, which we call the eating disorder voice.
• 7:49
  SPEAKER_00: It is always very critical, it is always restrictive, it is punitive, and it is something that the patient hears, and they have a relationship with this voice, which they need.
• 8:06
  SPEAKER_00: Somehow, even though this restrictive voice is harming them, they experience it as a kind of internal regulator.
• 8:19
  SPEAKER_00: From the inside, that may very well feel comforting, but it's a highly dysfunctional mechanism that creates its own sometimes very serious problems.
• 8:32
  SPEAKER_00: So let's have a think about what do we do?
• 8:36
  SPEAKER_00: Well, parents can help, and if you're concerned about your child or young person, see if you can notice patterns, not just episodes.
• 8:49
  SPEAKER_00: Look for changes in mood, withdrawal, rigidity, secrecy, avoidance or anxiety around eating, rather than focusing only on weight or food quantities.
• 9:04
  SPEAKER_00: Stay curious but not confrontational.
• 9:07
  SPEAKER_00: Bear in mind this is a secret disorder, and there's a good deal of shame attached to it.
• 9:15
  SPEAKER_00: But the person is actually exercising a form of dysfunctional control, and they fear exposure.
• 9:23
  SPEAKER_00: They will rationalize their behaviors, and so we have to be careful in terms of how we how we approach this.
• 9:32
  SPEAKER_00: So open conversations with warmth, a good starting point.
• 9:38
  SPEAKER_00: Things like I've noticed that eating feels hard for you lately.
• 9:42
  SPEAKER_00: Can you help me understand what it's like?
• 9:45
  SPEAKER_00: Avoid power struggles around food.
• 9:48
  SPEAKER_00: Eating difficulties often involve control, as I've said.
• 9:53
  SPEAKER_00: So collaborative, supportive approaches which reduce shame and resistance are helpful.
• 10:00
  SPEAKER_00: I think also trying to model a balanced attitude to food and body.
• 10:06
  SPEAKER_00: Children absorb parental beliefs about dieting, weight, and appearance.
• 10:11
  SPEAKER_00: Seek professional support early.
• 10:15
  SPEAKER_00: Remember that early intervention improves outcomes.
• 10:19
  SPEAKER_00: GP, pediatric and specialist services can assess physical and psychological risk.
• 10:27
  SPEAKER_00: Now, in addition to this, and certainly not instead of, relational psychotherapy is a very powerful tool because it focuses on the emotional and relational context in which the eating difficulties develop rather than seeing the eating disorder as the problem alone.
• 10:50
  SPEAKER_00: We understand it as a response to internal and relational experiences.
• 10:55
  SPEAKER_00: So in therapy, young people explore their relationships with their body, food and control, underlying feelings such as shame, anxiety, anger, or sadness, their attachment patterns and how they experience closeness, autonomy, and dependency.
• 11:15
  SPEAKER_00: The other thing that I think is very important is that when we see the prevalence of this in adolescence, certainly as a clinician, I'm curious about what part of this represents the adolescent's urge for independence and autonomy.
• 11:37
  SPEAKER_00: I still have to pay attention to the psychological damage that the young person has sustained alongside understanding the developmental processes, but I think part of my approach has to do with saying this is you trying to be you.
• 11:58
  SPEAKER_00: Have to add to that.
• 12:00
  SPEAKER_00: It doesn't work though, but I can see what might be happening.
• 12:05
  SPEAKER_00: Parents are often involved to help rebuild safe emotional communication and reduce misunderstanding and support healthy autonomy.
• 12:17
  SPEAKER_00: This relational lens helps children feel understood rather than managed, and it supports long-term emotional development alongside symptom reduction.
• 12:29
  SPEAKER_00: Eating disorders and disordered eating can be very frightening, but recovery is possible with compassionate parental support, but informed compassionate parental support because parents don't automatically know what to do.
• 12:46
  SPEAKER_00: When your child is refusing the food that you've given to them, it will touch something very deeply in you.
• 12:54
  SPEAKER_00: I think helping parents to understand, helping them to see that this is not about something they've done wrong can be enormously powerful.
• 13:06
  SPEAKER_00: In my experience of working with such parents and their families, I found that recovery is almost always possible.
• 13:22
  SPEAKER_00: And once the young person, child or young person, has an understanding of and a better capacity to tolerate the feelings underneath their behaviors, we start to see significant change.
• 13:43
  SPEAKER_00: Now, this is something which I'm going to be looking at in one of our parent courses, and we have significant psychoeducational resources to help families understand and respond to eating difficulties whilst they're waiting for specialist services.
• 14:04
  SPEAKER_00: We also are able in many cases, if the condition hasn't been diagnosed, to escalate referrals so that the right people can be involved to help you as a family and your child.
• 14:20
  SPEAKER_00: Thank you for listening.
• 14:22
  SPEAKER_00: And if you think this podcast might be particularly helpful for anyone, then do please pass it on to them.
• 14:31
  SPEAKER_00: And you can also visit our website, thechildren's consultancy.com, where there are other resources.