Stressed asian student thinking about her problems in a classroom

Many of the parents that bring their teen to treatment at Walden often ask, “Why did my child get an eating disorder?” Some parents wonder if the many pressures that teens face on a daily basis contribute to the development of their child’s eating disorder. Unfortunately, there is not one simple answer or cause. Eating disorders are complex and best explained by using a biopsychosocial model when approaching both cause and treatment. The biopsychosocial model captures the impact that the pressures teens face have on the development and maintenance of their eating disorder, while also accounting for other contributing factors. It is helpful to understand and acknowledge these pressures in order to offer effective treatment and support.

Pressures Teens Face

At Walden, the majority of teens that we treat discuss the impact that the expectations and desire to be perfect have on negative thought distortions and the maintenance of their eating disorders. Anything less than achieving self-defined expectations and standards of perfection often lead to negative thoughts and urges to use eating disorder behaviors. This pressure to be perfect permeates throughout a teen’s daily life into their academic and social environments. Below are a list of common pressures discussed by teens:

  • Academic – The academic world that teens are faced with is competitive. The expectation to be high achieving in the classroom is reinforced through positive and negative feedback around grades, assignments, and overall performance. How a teen is taught to define success contributes to the development of particular standards of perfection.
  • Full Schedules – Take a moment to think about your teen’s daily schedule. Teens often have a full schedule (whether it is a combination of school, volunteering, academic clubs, band, chorus, sports teams, dance, babysitting, chores, etc.) that leaves a teen with little down time. The stress to be perfect at each of these activities can be an additional stressor or trigger for negative thoughts and behaviors. The teen’s enjoyment of one activity can get lost within the stress of trying to be perfect at all activities. Similarly, teens may feel as though they must do many activities in order to demonstrate their perfection in multiple areas. This standard can also be positively and negatively reinforced by feedback that they are receiving from teachers, coaches, peers, friends, and family.
  • Social Environment– Teens are constantly connected to their social world. This connection can be positive yet it also contributes to the ongoing pressure created by comparisons to others and the desire to appear perfect to their external world. This desire to present an external appearance of perfection can suppress internal anxieties in an unhealthy way. Additionally, teens often report comparing themselves to peers and friends while at school or on social media (Facebook, instagram, twitter, snapchat). These comparisons can lead not only to negative self-esteem, but also bullying. Bullying not only occurs in school or in person social settings but also occurs via social media and text. Bullying from peers is a strong contributor to the development of negative body image and low self-esteem, both of which impact eating disorder thoughts and behaviors. It is easier for teens to bully others via social media as opposed to face-to-face, but the impact for the victim is just as strong, if not stronger.
  • Media– Access to technology has created a constant stream of positive and negative images for teens. This constant stream of images, access, and connection to social media and media (television, magazines, advertisements, music, movies, celebrities, news) influences body image, standards, and expectations. Teens get messages from their social environments and media outlets constantly. These messages can often times set unrealistic standards about success and beauty. Teens may hold onto these messages and feel pressure to reach and maintain these unrealistic standards of perfection.

Could these pressures cause eating disorders?

So… can the pressures that teens face cause eating disorders?! No, but they can certainly influence there development. There are many factors that play a role in the development and maintenance of eating disorders. The biopsychosocial model accounts for the biological, psychological, and social factors that influence eating disorders. In the section above, the pressures listed all fall under the social realm of this model and may impact psychological influences. Below this model is briefly outlined to better understand the impact that a combination of factors has on the development and maintenance of eating disorders:

  • Biological Factors:
    • Genetics
    • Birth factors – Individuals diagnosed with Anorexia Nervosa are more likely to have been born pre-term, low birth weight, or one of a multiple birth (e.g., twins).
    • Puberty – Early puberty in girls and late puberty in boys increases the risk of developing an eating disorder.
  • Psychological Factors:
    • Thoughts – Negative thoughts and cognitive “distortions.” Distorted thinking is when thoughts are not based on the facts or reality of a situation. Distortions can be based around unrealistic expectations or standards of perfection.
    • Emotions- Teens can often have difficulty with emotion regulation however, individuals with eating disorders may have difficulty decreasing the intensity of their emotional reactions. This can lead to the use of ineffective coping mechanisms (e.g., restricting, purging, cutting) in order to manage emotions.
    • Behaviors- Eating disorder behaviors (e.g., restricting, purging, over-exercise, binging) have an addictive quality which contributes to the maintenance of the eating disorder.
  • Social Factors:
    • Social triggers – Bullying, relationships, low self-esteem, environment, media
    • Body image concerns
    • Family values around eating and exercise

When considering these factors it is important to keep in mind that NO one factor alone causes or maintains an eating disorder. The interaction between multiple factors contributes to the development and maintenance of an eating disorder. Thus, while the pressure to be perfect can impact the development of a teen’s eating disorder it is not a standalone cause. With that being said, effectively addressing a teen’s desire to be perfect can help reduce the risk of developing an eating disorder or positively impact recovery for teens already struggling from an eating disorder.

What Can I Do As A Parent?

While the pressures that contribute to eating disorders might be obvious, many parents struggle with how to help their teen handle them. Often, parents of adolescents in treatment at Walden will ask, “With social media being more popular than ever, academics becoming increasingly competitive and bullying on the rise, it seems impossible to protect my teen from negative influences, what can I do?” And while we (unfortunately) cannot shelter teens from what is portrayed as the “perfect body” in the media, posted online or talked about in the hallways at school we can help them view their world in a more healthful and positive way.

Parents can be the first line of defense against low self-esteem and poor body-image by the example they set at home. Parents can model positive self-esteem and body image to their children and teens through banning negative self-talk (i.e. I look so fat today, I shouldn’t have eaten that, I should be better…etc.) about themselves AND others. Many parents are shocked to hear that their teenager knows about their diet, unhappiness with their own bodies and about the time they spend in front of the mirror scrutinizing themselves. Teenagers are highly observant and learn from watching their parents. Just like a toddler learns to sip from a cup by watching mom and dad, a teenager will learn to speak negatively about them self, diet and self-shame by watching their parents behaviors.

It will take time and hard work to banish negative self-talk and body shaming completely but the payoff will be worth it. Unfortunately, negative self-talk has become commonplace and a way people (especially women) bond. Surely, you can think of a time you and a friend bonded over “feeling fat” or feeling guilty over ice-cream. The good news is that this bad habit can change. Instead of focusing on negative aspects of your body and self, start to focus on what is good about your body outside of your physical form. Instead of muttering, “I’m so fat” (or any other negative adjective) focus on something you’re grateful for or proud of, “I’m so lucky to have a supportive family” or “I really aced that project at work.” Showing your teen through example that confidence and self-love can come from leading a full life and not having the “perfect body” can set a positive and healthy tone and encourage them to have a higher self-esteem.

Modeling high self-esteem and a body positive image isn’t the only thing you can do to support your teen. And while you cannot be with your teenager 24/7 you can keep an eye on what they are exposed to in the home. Monitor internet use, look out for websites dedicated to “fitspo”, “pro-ana” or “thinspiration”. Keep fitness and beauty magazines out of the house. And most importantly, keep an open dialogue with your teen. While they may not appreciate you monitoring their activity, explain to them that many websites, blogs and videos are promoting unhealthy and potentially deadly lifestyles. Let them know that eating disorders are the most deadly mental health disorder. You may need to set limits with your teenager in order to make your home a body -positive place.

And lastly, check in. Ask your teen how their day was, if they seem down, ask them what’s up, clear space in your busy schedule just for them. A 15 minute walk, time spent working on a school project together or five minutes in the car in-between activities can make a huge impact. Even if they don’t want to talk, even if their eyes never leave their smartphones, they are hearing you. Knowing that you are there and willing to talk to them, without judgment, can help your teen feel like they do not have to take on this ever-changing, confusing and challenging world on their own. Being a presence in your teenager’s life will also allow you to get to know them and their world, making it easier to notice subtle changes that may indicate something is wrong. Can you protect your teenager from being heartbroken, frustrated, challenged or angry? No. But you can help them approach the world with confidence, self-knowledge and a dose of healthy skepticism about what, or who, they are being told they “should” be.


About the authors:

Christine McQuade, MA

FullSizeRendersmallChristine McQuade received her MS in Clinical Mental Health Counseling from Southern Connecticut State University and completed her clinical internship at Walden Behavioral Care in the Adolescent PHP and IOP programs at the South Windsor, CT Clinic. Currently, Christine works as a clinician for the Adolescent PHP and IOP programs at the Peabody Clinic. Christine’s previous experience includes working as a Mental Health Counselor for Walden Behavioral Care at various sites, completing her graduate practicum at Sacred Heart University’s Counseling Center and as an Intake Coordinator for Monte Nido at Laurel Hill. In her free time, Christine enjoys exploring Boston, spending time with her cat and practicing yoga.

Ashley Meilleur, MA

meilleur-ashley1Ashley Meilleur received her MA in Counseling and Health Psychology from William James College (formerly Massachusetts School of Professional Psychology) and completed her clinical internship at Walden Behavioral Care. After completing her internship in April 2015, Ashley was hired as an adolescent clinician at Walden Behavioral Care’s Peabody location working in the partial hospitalization and intensive outpatient programs. Ashley’s previous experience includes clinical research at Connecticut Children’s Medical Center and clinical oncology research at Harvard Medical School and Massachusetts General Hospital. In her free time, Ashley enjoys spending time with friends and family, traveling, biking, and hiking.