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Adolescents are at particular risk for many mental health conditions, including eating disorders and these disorders are often co-morbid with others as well. Though roughly 3% of children ages 13-18 will be diagnosed with an eating disorder, the prevalence is more likely higher than that. This is due to factors such as socioeconomic status, location and family views on mental health disorders that can make treatment difficult or impossible.

When adolescents are facing a mental health crisis such as anxiety, depression or an eating disorder, and are not given appropriate treatments, they often turn to substance abuse to self-medicate.  While eating disorders are often an attempt to regain control the client feels they have lost — whether consciously or subconsciously — substance abuse is used to mask or alleviate their suffering. One of the biggest problems in this regard with teens is that substance abuse and eating disorders can arise from direct peer pressure if stress such as a concurrent mental health disorder already exists.

Coupled with anxiety and an eating disorder like anorexia nervosa, a teen abusing alcohol or drugs may spiral out and critically endanger their lives. Identifying risk factors, signs of eating disorders and substance abuse and getting your loved one into counseling are significant steps you can take to help them recover. We will examine the factors that cause both eating disorders and substance abuse in teens, signs to look out for with both, how you can bring the topic up to your loved one and then how treatment can help them recover.

Eating Disorders In Teens

The prevalence of eating disorders in teens is slightly higher in young women than it is in the general population — roughly 5-8%. This can be attributed to social pressures on physical looks and considerations of attractiveness presented in media, but teen girls are more susceptible to peer pressure than many other demographics. Research suggests that teens with a family or personal history of anxiety show an increased risk for substance abuse concurrent with that anxiety, and on into their young adult years than teens who do not.

Ultimately, anorexia nervosa and bulimia nervosa manifest differently in teens than any other demographic. The stress of work and family life for an adult can begin as restrictive eating patterns in what is viewed as “necessity” to keep up with external pressures and then, once internalized, become a pathological eating disorder. In teens the pressure typically begins internally, but not as an instinct to oblige others- rather, peer pressure causes comparisons that create a poor self-image, which then leads to restrictive eating patterns. Additionally, stressors at home, like abuse or neglect can cause a teen to restrict eating as they feel it’s something that’s fully within their control.

Stressful behavior patterns often lead to negative habits as a coping mechanism, and substance abuse typically tops that list. Unfortunately, in many families, it is easier to treat pain with drugs or alcohol as a teen than with proper psychological protocols. Even in families who would be accepting of a mental health issue, however, many teens feel they cannot bring it to light for a myriad of reasons:

  • Fear of failure — that they will be held to scrutiny or disappointment, even in scenarios where that’s not the normal behavior of the family. Being embroiled in anxiety, depression or an eating disorder can negatively influence and skew a client’s ability to think clearly, leading to unfounded fears influencing their behavior.
  • Fear of reprisal — a teen with an eating disorder — particularly one who is using substances to cope — might fear they will be punished.
  • Embarrassment — it isn’t easy to admit you need help, and for many reasons, there is still a stigma about mental health disorders that can impede a client’s ability or desire to seek therapy.

Signs of disordered eating in teens

Emotional and psychological signs of an eating disorder are very similar to more common disorders like anxiety or depression, and truthfully they often appear concurrently in clients:

  • Withdrawal and disinterest in behaviors and activities that are normally greeted enthusiastically.
  • Noticeable and ritualistic behavior with regard to meals — eating alone, guarded and meticulous eating around family or friends, etc. Particularly in binge eating disorder, avoiding meals with others is exceptionally common.
  • Sleeping noticeably more or less than is “average” for the client.
  • Moodiness, anger or frustration at simple inconveniences.

There may be physical symptoms or there may not; fluctuations in weight with external stress are common across all demographics but physical signs of eating disorders are very specific. In anorexia nervosa some physical signs are:

  • Constant coldness or complaints of being cold, along with bluish-hued extremities indicating poor circulation
  • Hair loss
  • Fatigue
  • Weakened immune response (longer to get over cold or for wounds to heal)
  • Confused cognition

In bulimia nervosa, some signs are:

  • Yellowing and eroding of the teeth
  • Weakness, fatigue, immune impairment
  • Calloused or discolored fingertips
  • Hoarseness

These symptoms are not universal and may not manifest at all, but when combined with the emotional signs of disordered eating, they can indicate that you need to seek outside help. There are also conditions like binge eating disorder which may present as bulimia but have different causal factors and treatments. Finally, there are partial eating disorders that may present with symptoms of both anorexia and bulimia but are neither. Still, these disorders can be dangerous and will need professional treatment to resolve totally. 


Signs Of Substance Abuse In Teens

Substance abuse in teens is more common in groups that have been diagnosed with a concurrent mental health disorder. The reasons for use vary but primarily the goal is to self-medicate, but there is an interesting disparity between restrictive and purging disordered eating patterns. Teens who purged were significantly more likely to use substances, usually as a way to relax or escape their stressors, whereas restrictive eaters were less likely to use drugs or alcohol. The most commonly used drug by restrictors, however, is caffeine, due in large part to the fatiguing effects of sub-caloric needs being met.

Teens who are engaged in substance abuse alone may not act much differently than they had previously, particularly if the abuse is occurring socially. Those who are using alcohol or drugs without peer involvement, however, are more likely to be withdrawn, lacking interest in old activities. They may fall asleep during the day, exhibit mood swings, change peer groups or stop socializing in general. They may experience failing grades, difficulty with extracurricular activities or sports, and general disinterest.

Physical symptoms of dependence include:

  • Weight fluctuations
  • Fatigue
  • Vomiting
  • Impaired cognition
  • Sweats and tremors

It’s important to get professional help if you suspect your child is abusing alcohol or drugs, and in particular, if you also fear they might have an eating disorder. Both substance abuse and disordered eating take a heavy toll on the body and when presenting at the same time can be life-threatening.

Other Concerns

Anxiety and depression are highly co-morbid with both substance abuse and eating disorders and can confound treatment. Once your child is in treatment, identifying confounding variables and removing them will be a top priority. This process will include therapy and may include medical treatment as well. 

Similarly, if either condition has progressed to causing physical harm, your child may need in-client treatment or hospitalization to recover from malnourishment, physical dependence and any other bodily damage both conditions can cause. This must be done before proper recovery can be attained.

There is also the consideration that you do not want to come on too strong when you address your concerns with your child. It’s imperative that you do not sound judgmental, accusatory or punitive when you discuss your teen’s potential eating disorder and/or substance abuse. You’ll want to broach the topic quietly, in a calm setting where both of you can be relaxed and without other people around. Ask leading questions such as:

  • Has there been anything in particular that’s been bothering you lately?
  • How have you been feeling?
  • How are you dealing with various stresses in school/life/friends?

Though these questions might feel vague, the goal is to be in a comforting setting that indicates the discussion is more serious than surface-level chit-chat, but not so much that it’s stressful. Your child needs to know they’re not being judged and that they’re safe, and questions like these allow them to open up and talk about what’s going on. This can lead to a frank discussion about getting help.

Eating Disorders And Substance Abuse Recovery

While both pathological eating patterns and substance abuse pose a threat to the health and well-being of clients, recovery is very much possible. Studies indicate that outpatient treatment consisting of multiple facets of treatment is significantly more effective than hospitalization. Programs like Clementine that specialize in treating young women who are facing eating disorders and substance abuse are designed to combine nutrition, therapy, group talk, and aftercare to ensure long-term recovery. 

Hospital stays for treatment of mental health disorders — including eating disorders — create two problems. The first is that clients are far less likely to embrace the help they get when it’s forced on them in the sterile environment of a hospital, as it seems against their will (and in many cases it is). Secondly, a hospital does not recreate a real-life concept that they will be facing day-to-day in recovery. Hospital stays dictate what and when you eat, what you can do and are restrictive and it’s difficult for clients to transfer that treatment into their everyday life. Studies show that when clients can demonstrate self-efficacy in their own health, they are more likely to own their recovery and stick with the program, and hospitalization does not allow for that.

Outpatient clinics like Clementine put your daughter in a home-like setting where they don’t feel trapped. Because their staff is trained on eating disorders and substance abuse, every facet of treatment is tailored to lifelong recovery. You won’t just get a dietitian; you’ll get one that understands the rigors and difficulties of a restrictive pattern of eating. Group talk and one-on-one therapy that involves a cognitive-behavioral approach put more power in the hands of your child over her own health.

Because Clementine only focuses on treating women, their approach is uniquely tailored by years of direct, positive experience in treating young women. These focused protocols have a much higher rate of success than hospitalization or seeing varied specialists at home, which is why clients who have recovered with Clementine are so eager to speak highly of the program.

A comprehensive treatment program that provides physical, mental and social support with a robust aftercare plan is what Clementine offers. This method of treatment makes client recovery much more likely, giving them the confidence to maintain their remission. If you feel that a loved one is suffering from an eating disorder and/or substance abuse problem, talk to them and let them know they’re not alone, that they’re not judged and that they are loved. Enrollment in a treatment program that cares about you and your family is the first step towards a healthy, bright future for you and your child.


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.