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School is, even in the best of cases, a tremendously tumultuous time, particularly for young women. With unreasonable standards being impressed upon children at a young age, and with the advent of social media and constant connection, there is more pressure all the time to fit into a model of beauty and conformity. Some teens navigate these pressures better than others, but most adolescents are not forthcoming with their parents about social issues, leading to a gap of connection between them and their children.

The average age of onset for eating disorders is around 18, but the beginnings of these mental health concerns begin much younger. With over 3.2 million children between 12 and 17 reporting at least one major depressive episode which contributes to the development of other mental health concerns. 

Being attentive and interested in your child’s daily life can help you identify dangers to their mental and emotional health. Negative influences at school and online will, in most cases, manifest in behavioral changes in your daughter. Early detection – like with any disease – is pivotal to successful treatment. Anorexia nervosa and bulimia nervosa, when identified early, have positive treatment outcomes, so it comes down to diligence and effective intervention to help children battle negative influences.

We will examine five signs that your child might be negatively influenced at school, as well as adjacent factors that can amplify this peer pressure. 

 Signs Of Negative Influence At School

Negative peer interactions are widespread in adolescence and can manifest in many ways. For some children, these interactions will result in minor behavioral changes:

  • Challenging authority
  • Moodiness
  • Changes in longstanding friend groups.

While nobody would argue that these changes on their own are anything other than teen development, it is when they cause distress or difficulty functioning that you would want to be concerned. Unwanted side effects of negative peer pressure, real-life altercations or cyberbullying can include clinically significant mental health issues:

  • Anxiety
  • Depression
  • Bulimia nervosa
  • Anorexia nervosa
  • Binge eating disorder
  • Eating disorder otherwise not specified

The common thread in adolescent girls with all of these disorders is that they arise out of conflict, typically with perception and reality. The influence to fit into certain physical models or to stay popular creates a drive to control body image. Moreover, a feeling of loss of control or identity can manifest in an eating disorder, as a way to regain control.

Identifying the disorders after they’re noticeable means your child has been suffering from them for a while, so a more effective approach would be to determine if these negative impressions were occurring before they can cause emotional damage. To that end, what follows are some of the most evident signs that your child is experiencing negative influences at school. This isn’t an exhaustive list, and children manifest psychological and emotional conflict in many ways. Being an active, non-judgmental listener for your child is going to be one of the best ways to stay ahead of the pressures that life will throw at her.

Behavioral Changes

This goes without saying – teenagers are facing a lot and acting out is understandable. The behavior changes you need to look out for are ones that affect their ability to function. Especially in children who were larger than their peers for most of their lives, the potential negative self-image that creates can be amplified by external negative image attacks. This makes them far more likely to succumb to peer pressure and bullying which might manifest as bulimia nervosa, depression or anxiety. Particularly in cases of bulimia nervosa and anorexia nervosa, the behavioral changes might accompany physical manifestations as well. Particular to bulimia, behavior changes to watch out for are:

  • Uncharacteristic negative self-talk, particularly (but not exclusively) about body image
  • Rituals about food, such as only eating very certain amounts or in certain company
  • Preoccupation with food, particularly as it pertains to weight; this might specifically manifest with comparisons to peers, and in these cases, the negative influence from school or other peer-activities is more evident
  • Mood swings
  • Loss of interest in friends or hobbies

Physical manifestations of bulimia nervosa may or may not accompany these behavioral changes:

  • Yellowing teeth and enamel damage
  • Periods of extreme eating followed by purging, but in most cases, these will be done in secret
  • Loss of menstrual cycles
  • Fainting
  • Calloused fingers from inducing vomiting 
  • Reduced immune functioning, resulting in longer illness, reduced wound healing and general malaise

While anorexia nervosa typically focuses more on staying under a specific weight, bulimia nervosa patients might maintain a constant weight, so fluctuations are not a good indicator, unfortunately.

When bulimia nervosa manifests due to peer-caused pressure, you will notice more preoccupation with peer appearances and success. This is because the factor causing the mental health crisis is externally manifested.

Declining Attention and Grades

While many physiological factors affect students’ ability to stay focused – sleep, hormones, comorbid mental health disorders like Attention Deficit Disorder – in young women who are experiencing negative influence at school, these problems will be especially marked. The way negative peer pressure manifests is typically dramatic:

  • Slipping grades, especially if the child was previously a high-marks student
  • Behavioral problems at school
  • Cutting class
  • Self-harm
  • Changes in school-related home behavior, like studying or reading. This can extend to the longstanding practice of an instrument or a learned ability, like karate or dance.

Many times, poor performing students are viewed as rebellious and command a lot of social currency. Since these students are low performers, when their influence affects your child, it will result in behavior that damages their own positive behaviors.

In patients with bulimia, there is also a concern about the physical effects of the eating disorder. Most prominent appears to be cortical thickening-related memory and learning impairment. While it’s possible in some cases this cortical change – which impairs judgment and memory processing – is causal for bulimia, the physiological effects of prolonged bulimic episodes appear to also cause the thickening. A cycle of negative influence, impaired judgment, and bulimia all impact one another, amplifying and prolonging each. 

Oppositional Behavior

While oppositional behavior is more common in boys, it’s still a possibility in girls, particularly in teens. Children are inclined to test boundaries, and because rule-following and intelligence are looked down on in some peer groups, influence from these groups will cause contrarian behaviors. We touched on this with the changes in school, study, and extracurricular activities but a common manifestation of this type of negative influence is breaking curfew and theft.

There appears to be a direct link between disordered eating behaviors and shoplifting. Both behaviors are in many cases a way of regaining lost control, and also a manifestation of a lack of impulse control. This fits in well with the cortical thickening problems we touched on earlier, but in general, many bulimia patients show signs of impaired impulse control. Petty theft in students who otherwise show no external troubles is not at all uncommon, and while many students steal at some point in their youth, it is far more common in eating disorder patients.

Shoplifting, vandalizing and breaking curfew are all non-aggressive ways of challenging authority and will likely happen at some point in many teens’ lives. Spontaneous, repeated and increasingly dramatic episodes of these three “symptoms,” however, point to external influence and can usually be attributed to negative peer input.

Substance Abuse

Smoking, drinking and non-prescribed use of drugs are boundary-pushing behavior that is extremely common in peer pressure. Particularly in media, these things are demonstrated to be socially positive, in spite of or perhaps because of their rebellious nature. Naturally, if your child is participating in any of these behaviors, despite their negative health effects, likely, it’s not their own intuition driving the choice.

Substance abuse commonly appears alongside depression, anxiety and eating disorders in young women. A student who is exhibiting signs of one or more of these disorders is significantly more likely to suffer from one or more of the others. If there is anything positive about substance abuse, it’s that it’s difficult to hide for many reasons and can be addressed. Additionally, by discovering substance abuse, you can determine if any other issues need assistance as well, and solving them can be the root cause of the resolution of the others.

In teens, substance abuse can be more common when a peer group shift occurs and often occurs with the above behavioral changes as well. This is a bid to fit in with the new peer group and is far more obvious than other signs of negative influence.

Preoccupation With Image and “Fitting In”

When a student is in healthy peer relationships, they focus more on themselves, success in given interests and simply living. Everyone worries about judgment from others to an extent, but when it becomes a sole preoccupation, it does not typically come from within. Most often this type of preoccupation occurs when going from junior high to high school when daily routines are changed, and their friend circle can change rapidly.

If students are not with friends they grew up alongside, for instance, they may feel the need to find a new peer group quickly. In these cases, concerns about fitting in will be paramount and potentially negative. Additionally, since many students take a school change as a chance to reinvent themselves, they may find they are not fitting in with their old peer groups who have themselves changed behaviors and hobbies. This can manifest as a disordered concept that having a certain body type or dressing in certain clothes will help them achieve popularity. 

 Successfully Dealing With Negative Peer Influence

If you believe your daughter is being negatively influenced at school and in other peer groups, to the point it’s causing distress and dysfunction, the first step is addressing it with her. You should approach her in a non-judgmental way, being open to listening above all else. Some effective ways to begin this conversation are:

  • Is there anything you want to talk about?
  • You seem to be preoccupied lately; do you want to discuss it?
  • How is/are school/your hobbies going, and can I help them be better?

You don’t want to confront your daughter in an accusing, attacking or negative manner. It’s also best to broach these subjects when you two are comfortable and alone. 

If you can determine there is a negative influence going on that is causing bulimia or any other mental health difficulties, the treatment is your next step. Cognitive-behavioral therapy is the gold standard for treating eating disorders, and intensive outpatient and inclusive programs like Clementine are shown to be dramatically more effective than hospitalization. 

Intensive inclusion programs have medical staff, trained psychologists, nutritionists and group therapy in a home setting that does the main thing a hospital cannot; it creates a comfortable setting that relaxes the patient. Rigid opposition to treatment because of sterility in hospitals or defiance of treatment are sure to not be productive. Clementine focuses exclusively on adolescent girls and young women and approaches eating disorders primarily while also working on concurrently occurring troubles, like substance abuse, negative peer influence, and other mental health disorders.

Client experience is overwhelmingly positive, and this is largely due to the non-judgmental, residential setting. Studies have shown that patients who perceive highly clinical settings are less likely to succeed in treatment, largely due to opposition or a belief that only a clinical setting can “cure” them.  Clementine uses the highest level of medical and psychiatric care outside of a hospital, in a non-clinical, homelike setting. 

Perception of self-efficacy in their own health is critical for success and remission, and Clementine’s programs instill that in their patients. Being aware of how to determine if your daughter is being negatively influenced is the first step in helping her; a quality treatment protocol is the logical conclusion.


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.