Why is it common for teens to hide eating disorders?

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Secrecy is a common aspect of eating disorders.

The reasons for this can vary from person to person. Some potential explanations include:

• Shame or guilt: People with eating disorders can feel intense shame or guilt about their bodies, eating, changes in weight, or the eating disorder itself.
• Fear of judgment: Teens with eating disorders may fear others’ reactions if they find out about their symptoms. They may worry about the opinions or judgment of peers or that adults will punish them.
• Fear of being a burden: Teens may take it upon themselves to protect others’ feelings by hiding their eating disorder. They may worry that their problems are inconvenient to others or want to avoid causing anxiety or stress.
• Perfectionism: Perfectionism is a risk factor for eating disorders. A person might hide one due to feeling they must seem “perfect” to others.
• Lack of awareness: Not everyone with an eating disorder knows they have one. Some people may not fully understand why they prefer eating alone or why they engage in other behaviors. Alternatively, they may not want to admit it to themselves.
• Avoiding treatment: People with eating disorders may have feelings that make them not want to get well at that time or may have mixed feelings about doing so. They may also fear a loss of control, worry that treatment will be harsh and unpleasant, or fear that it will cause them to gain weight.

Teens may hide an eating disorder in varying ways, depending on the disorder affecting them.

With any eating disorder, people may avoid eating in front of others or lie to explain their symptoms. For example, they might pretend weight changes have a medical cause.

Teens who are restricting their calorie intake or fasting for extended periods may:

• say they ate at school, or at someone else’s house, to avoid meals
• throw food away to make it look as though they have eaten it
• wear baggy clothing to disguise weight loss
• avoid changing clothes in front of others

Teens who engage in bingeing or purging behavior may:

• hoard food in secret locations
• take large quantities of food and then replace it
• make frequent or long trips to the bathroom, especially after meals
• use mouthwash, breath mints, or air freshener to disguise the smell of vomit

Females are more likely to develop eating disorders than males. The one exception to this is binge eating disorder, which is more common in males and older adults.

The reasons for this are complex but include unrealistic beauty standards that emphasize thinness in women and muscularity and strength in men.

However, this does not mean teenage males cannot have eating disorders. Males may develop disordered eating while trying to gain muscle definition without seeming to lose weight.

That said, a 2021 study of young participants, including 27 cisgender males, 28 cisgender females, and six transgender people, found no difference in eating disorder symptoms between cisgender males and females, nor in concerns about muscularity.

Trans teenagers had more severe symptoms, and cisgender males had a faster and more complete recovery.

Learn more about eating disorders in trans people.

Keeping an eating disorder secret can allow a person to continue engaging in the behaviors the disorder leads to. The impact of this will depend on:

• the type of disorder
• how severe the symptoms are
• how long the symptoms continue

Some of the potential effects include:

• extreme weight loss or gain
• nutrient deficiencies
• malnourishment
• weakness and fatigue
• muscle wasting
• loss of bone density
• lack of menstruation or infertility
• damage to the teeth or esophagus due to vomiting
• difficulty participating in daily activities
• worsening body image, anxiety, and depression
• suicidal thoughts
• self-harm
• organ damage
• organ failure

Without treatment, eating disorders can be fatal.

The most important thing to do when trying to help a teen with an eating disorder is to approach the situation with compassion.

Judgment, anger, punishment, or force may only cause them to withdraw further from friends or family. If they feel they can trust someone, a teen may open up.

It is best to avoid trying to take control or casting blame. Instead, a person can lead with curiosity and empathy. This may require adults to manage their own emotions to prevent them from taking over the conversation.

When starting a discussion, it may help to:

• be in a private place
• make sure there is plenty of time to talk
• use “I” statements, such as, “I have noticed you have lost weight.”
• focus on personal observations and facts
• if they cannot see an issue with their weight or food intake, move on to other observations that might be easier for them to spot, such as fatigue
• avoid arguing with the teen’s opinion about their body or diet
• emphasize concern rather than judgment
• ask open-ended questions about how they feel or why they are engaging in certain behaviors

Sometimes, people feel relieved when someone asks about their symptoms, but this is not always the case. If the teen gets angry, defensive, or denies their symptoms, do not retaliate. Instead, express care for their well-being and leave the conversation there.

Once a teen has confided in an adult, it is important to maintain firm, reasonable boundaries around what happens next. This means:

• encouraging them to try professional help
• offering to look into treatments together
• giving them as much control over the help they get as possible while maintaining that this is the path forward
• asking what they need but not agreeing to things that help enable the disorder

Eating disorders require medical treatment. If a caregiver is concerned that a teen seems very unhappy in any way or has physical signs of a disorder, it is best to seek advice and guidance.

This could be from a doctor, therapist, school counselor, or support organization specializing in teen mental health or eating disorders.

Teens may hide eating disorders because doing so allows them to continue fasting, bingeing, purging, or other behaviors. These behaviors seem beneficial to them, as they may feel they help them cope with difficult emotions or reach the body weight they think they need.

Teens and adults may hide their symptoms in various ways, such as hoarding food in secret places, wearing baggy clothes, or lying about the cause of weight gain or loss.

An adult can help a teen with an eating disorder by being a safe person to confide in while also maintaining boundaries around the importance of getting treatment.

Treatment can improve a person’s quality of life. If their symptoms are very severe, it may even be lifesaving.