“She’s just looking for attention.”

“He can’t have an eating disorder—he’s not underweight!”  “ If they actually wanted to, they’d eat something.”

It’s National Eating Disorder Awareness Week. Like other mental illnesses, there’s a lot of misinformation out there about eating disorders. As an adolescent health specialist at Mount Sinai Adolescent Health Center, I work with many young people who struggle with eating disorders. I spend a lot of time answering parents’ questions, and listening to how scared and frustrated they are. There’s no doubt that dealing with an eating disorder is a confusing and daunting task—both for the young person struggling, and for their parent or guardian.

30 million people in the United States will have an eating disorder at some point in their lives, and everyone experiences them differently. What’s true for the young person in your life may not be true for someone else’s. However, there are still some big misunderstandings about eating disorders out there. If you think that a young person you’re responsible for may have an eating disorder, here are 5 things you need to understand.

1. Eating disorders are real, serious illnesses.

I hear parents ask their children questions similar to these a lot: “Why don’t you just stop?”  “Why don’t you just stop throwing up?” “If you want to lose weight, why don’t you just stop bingeing?” “Why can’t you just eat something?” “Why do you want this much attention?”

These questions all assume that people have control over their eating disorders. Because eating is so basic to most people, many of them think that eating disorders have to be a choice. But nothing could be further from the truth. Eating disorders are a legitimate and very serious psychiatric illness. They have the highest mortality rate of any mental illness.

No one wants an eating disorder. People with eating disorders don’t crave attention. They’re not making it up. They are doing their best to handle a real, serious illness.

2. Eating disorders have a range of symptoms.

You don’t have to be losing weight to have an eating disorder.  Symptoms can include:

  • Skipping meals
  • Avoiding eating with the family
  • Going to the bathroom immediately after eating
  • Exercising right after eating
  • A sudden or intense preoccupation with whether foods are healthy
  • Fixating on body size or body shape
  • Not wanting to gain weight, especially if they’re at an age where they need to gain weight to be healthy
  • Trying to lose weight
  • Personality changes, such as becoming angrier, more anxious, withdrawn, or sad
  • Getting angry if other family members don’t want to eat as healthy as they do
  • Getting angry if someone cooks them their favorite meal
  • Avoiding eating in front of others
  • Covering mirrors in the home
  • Refusing to go shopping for new clothes

Of course, the symptoms depend on what kind of eating disorder they have. The four main eating disorders are anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder, though many also have eating disorders that don’t fit into these categories.

3. Personality changes are not your child, but the eating disorder.

Eating disorders are closely linked with a variety of other mood disorders, like depression, anxiety and obsessive compulsive disorder. In addition, the disorder itself physically changes brain structure. You may have experienced a less intense, temporary version of this if you’ve ever gotten “hangry,” or been irritable or sad because you’re hungry. But that change is temporary. In the brain of a person with an eating disorder, the changes are physical, the brain is actually remodeled in such a way that makes their perception inaccurate.

For example: Last week, I argued with an Ivy League student about whether a handful of pistachios and a cup of tea counted as breakfast. Another time, a younger patient accused her parents of trying to make her fat so that they could sell her away. These are otherwise intelligent, high-achieving individuals. Their irritability and distorted thinking isn’t them—it’s their disorder.

4. Eating disorders can affect anyone.

There’s this stereotype that only rich white girls get eating disorders. That’s ridiculous. Eating disorders don’t discriminate based on background or income or race or nationality. And while they are more prevalent in girls than in boys, people of ANY gender can develop an eating disorder. According to one study, transgender college students are five times more likely to have an ED than their cis peers. As I already mentioned, many people with eating disorders are smart and ambitious. My colleague talks more about the effects of this single narrative surrounding eating disorders here.

In addition, eating disorders aren’t new. The first eating disorder was recorded in the 12th century. While mass media can have a powerful effect on people’s body image, eating disorders existed long before MTV or Instagram. And while body image often does have a lot to do with eating disorders, that’s not always the case. Often, eating disorders are about control and creating order in an otherwise chaotic life.

5. You can help, but don’t do it alone.

If you think that a young person you’re responsible for has an eating disorder, take them to a medical provider. A doctor can help you put a plan in place for how to move forward. Treatment will involve a physician, a nutritionist, and a mental health provider. In the beginning, they’ll probably need to see their doctor once a week.

Your young person’s team will put together a meal plan. This can help ease tension around meal times, and take a lot of pressure off of you. Instead of saying, “You have to eat more because I want you to,” you can say, “You’re not eating as much as the doctor said you should.”

If you live in NYC, Mount Sinai Adolescent Health Center provides free, comprehensive health care to young people. This means that you can see an adolescent health specialist, nutritionist, and mental health provider in one place. If you’re unsure if your young person has an eating disorder, we can help answer any questions.

Lonna Gordon, MD, PharmD is a pediatrician at Mount Sinai Adolescent Health Center who is fellowship trained in adolescent medicine. In addition to general adolescent care, Dr. Gordon sees obese adolescents who are interested in comprehensive medical and reproductive health care through a structured, multidisciplinary approach to weight loss.

The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.