What Does Eating Disorder Recovery Actually Look Like for Teens?

Written by Cristina Luibil MS, RD, LDN with support from Sabrina Stadelman

If your teen has recently been diagnosed with an eating disorder, you may be wondering what recovery will actually look like. You may be wondering what your role will be, feeling overwhelmed by the challenges ahead, or unsure what to watch for. The most important thing to remember is that recovery is a process, not a quick fix. Recovery will look slightly different for each individual, but for every teen will need your consistent support. 

Why Is Eating Disorder Recovery So Hard?

For many people struggling with an eating disorder, letting go of rigid food rules and other eating disorder behaviors is extremely difficult. Eating disorder thoughts are all-consuming, and to your teen, rigid food rules and disordered behaviors may bring them a sense of security. Even though these behaviors are harmful, letting go can feel like spiraling out of control. 

Another difficulty in recovery is that, in our society, eating disorders are often reinforced or even encouraged. Diets aimed at weight loss are constantly emerging trends and are often marketed as “healthy” eating behaviors. Teens experiencing an eating disorder may be encouraged by the media, their family, or their peers, and oftentimes are complimented for these behaviors. This can make recovery very difficult, as your teen must learn to let go of the rigid rules that have consumed their thoughts for so long. Part of recovery for your teen will be learning to recognize that their body or food choices do not define them.

Why Are Eating Disorders Difficult to Recognize?

Eating disorders can develop at any time, and they don’t look obvious right away. Especially at the early stages, eating disorders can easily go unnoticed. Early signs of eating disorders usually look like exercising more, increased focus on “healthy” eating, avoiding “unhealthy” foods, or following a strict diet. To loved ones, these behaviors may all seem positive. In the early stages of eating disorders, teens are often praised for their “healthy” habits and discipline. 

Signs of Disordered Eating / A Potential Eating Disorder 

• Skipping meals or snacks

• Cutting out foods or food groups they used to enjoy

• Making strict rules around eating

• Avoiding social events, especially when they involve food

• Spending a lot of time counting calories or planning meals

• Excessive exercise

• Cutting out calorie-dense foods or entire food groups (such as fat, carbs, etc.)

• Weighing themselves every day or many times per day

• Secretive eating or not wanting to eat in front of others

• Significant or rapid weight loss

• Irritability or intense mood swings

• Sluggishness or tiredness

• Decreased ability to concentrate

• Feeling cold, even in warm surroundings

• Dizziness or fainting

• Becoming sick after eating

• Lack of or disruption in menstrual cycles in teen girls (though this doesn’t always happen)

The problem with these behaviors is that they can quickly spiral into an extremely dangerous and serious eating disorder. Eating disorders usually begin with a desire to be “healthier” and/or to lose weight. Many people who struggle with eating disorders don’t realize these thoughts and behaviors have become controlling and obsessive until their eating disorder becomes serious. 

Many people, even close family members, may struggle to recognize the early signs of eating disorders because working out more and an intense focus on “healthy” eating have been sold to us as discipline and increased “willpower”. Many loved ones may have engaged in intense dieting or exercise themselves at some point. Our culture and society often tell us that these behaviors are “normal” or something to encourage, but that’s far from the truth. Unfortunately, the way that society encourages dieting and disordered behaviors only makes eating disorder recovery more difficult. 

Can My Teen Fully Recover from an Eating Disorder?

Long-lasting recovery from an eating disorder is possible with proper treatment and early diagnosis. Early diagnosis and intervention are very important, as it significantly increases the likelihood of making a full recovery. Proper treatment is also essential and should include nutritional support from a specialized registered dietitian, medical monitoring, and psychological support from qualified mental health professionals. 

What Factors Can Affect Eating Disorder Recovery?

The most important factors in eating disorder recovery are early diagnosis and proper treatment. Early diagnosis and intervention are important because the longer an eating disorder persists, the more it can negatively impact your teen. Not only will disordered thoughts and restrictive eating patterns become harder to break the longer they continue, but eating disorders can also result in long-term physical health complications. 

Disordered eating can lead to many nutrient deficiencies, and they increase the risk of other illnesses. Nutrient deficiencies that result from eating disorders can also increase the risk of osteoporosis later in life and can lead to loss of a menstrual cycle in girls and women. 

Oftentimes, eating disorders don’t look obvious in the early stages. As a parent or caregiver, it is important to pay attention to early warning signs, such as:

• Restricting food intake

• Cutting out certain food groups or foods they used to enjoy

• Unexplained or rapid weight loss

• Excessive exercise 

• Refusing to eat around others 

• Worries or rules around food or eating 

• Intense focus on “healthy” eating 

• Eating in secret 

• Going to the bathroom immediately after meals

If you notice any of these signs, it is important not to ignore them. Talk to your teen’s primary care provider about your concerns and any of the signs you notice.

If your teen is diagnosed with an eating disorder, the treatment they receive will be essential to helping them make a long-lasting recovery. It should include nutrition support and counseling from a specialized registered dietitian, medical monitoring, and psychological support from qualified mental health professionals. A social support network is also important, and it includes you as a parent or caregiver. Your teen will need your support and encouragement, and modeling a healthy relationship with food is an important example for your teen to see. 

What Should I Expect in My Teen’s Eating Disorder Treatment and Recovery?

Before beginning treatment, it’s important for the doctor, therapist, and RD to have all of the information they need about your teen’s eating habits, exercise habits, thoughts and feelings surrounding eating and body image, any purging mechanisms used (laxatives, vomiting, over-exercising, etc.), and physical signs or symptoms of malnutrition. This will allow providers to determine the type and severity of eating disorder that your teen has, which will be important in determining their treatment plan. 

As a parent or caregiver, it’s important that you pay attention to these signs and symptoms as well. Teens suffering from an eating disorder often will try to hide it, and this only delays treatment, which can make recovery harder. It’s important to have open and honest conversations with your teen and their treatment team during recovery to address any challenges – not just in the beginning of treatment, but throughout the whole process – and achieve the best recovery outcomes possible. 

What is the Relapse Rate for Eating Disorders and What Can Help?

According to the NIH, 35-41% of individuals partially or fully relapse within 18 months from anorexia nervosa. These numbers may differ depending on the eating disorder, but relapse can happen with all eating disorders. At Aterra Nutrition, we always validate that eating disorder recovery is hard work. We do not expect perfect recovery, and neither should you. Actions to help prevent relapse include awareness of triggers, building a strong social support network, managing stress and anxiety, and creating a plan when ED challenges occur. 

It is also important to be aware that a “relapse” is usually not a complete reversal into peak eating disorder behaviors. Most often, it involves some minor setbacks like falling back into some eating disorder behaviors. It’s important not to panic in these moments, but instead meet them with patience and understanding, and make sure your teen’s dietitian and therapist are aware. Eating disorder recovery is not a linear process that moves straight from diagnosis to recovery. Instead, it is more of a spectrum, and the process includes ebbs and flows over time. While ebbs may feel discouraging, they are actually a completely normal part of the recovery process. 

As a parent or caregiver caring for a teen recovering from an eating disorder, the idea that they could relapse is likely terrifying. While relapse is definitely something to be aware of and watch for, it does not mean that the person failed in their recovery, and it’s also important not to panic. There are many ways that you, as a parent, can help to support your teen to help prevent relapse. 

What Causes an Eating Disorder Relapse?

There is no one thing that causes relapse, as what bothers one person may be different from what bothers another. The most important thing is to maintain open communication with your teen and talk to them about how they’re feeling, as feelings of stress, anxiety, or lack of control in other areas of life may trigger eating disorder behaviors as a coping mechanism. Major changes and life events can cause these emotions and may lead to relapse of ED behaviors. Some of these possible causes include:

• Starting or ending school or college

• Starting or ending a new job

• Starting or ending a relationship

• Moving to a new house/state/residence

• Experiencing trauma or loss of a loved one

• Weight changes

• Physical injury or lessened mobility

• Having other co-occurring mental health conditions such as depression, anxiety, or obsessive-compulsive disorder

Whether your teen has experienced anything listed above or not, it’s important to keep an open dialogue with them about how they’re feeling. Oftentimes, eating disorder behaviors are used as coping mechanisms, so talking with your teen will be important to understand how they’re feeling and address potential triggers that may lead to relapse. 

How To Create a Plan to Prevent Relapse?

Although relapse is painful and can feel discouraging and scary, it doesn’t determine your teen’s long-term recovery or what their level of success in recovery will be. Relapse is a common experience, and it’s definitely not the end of the story. That being said, you and your teen can work together with their treatment team to create a relapse prevention plan. Your teen’s plan should be unique to them, but focusing on some of these items may be a good place to start:

• Making note of triggers that may lead to relapse

• Having your teen make note of how they’re feeling or what’s going on in their life when/if they do relapse or feel close to a relapse

• Reaching out for support if relapse does occur or is close to occurring

• Finding other ways to cope with emotions, such as therapy, journaling, or talking to someone

• Emphasize the importance of caring for your body through nutrition and adequate rest

• Building a strong social network

• Remain positive and encouraging, even if relapse does occur, to avoid feelings of shame over relapse

Relapse may feel scary or even disappointing, but your teen needs to know that relapse during eating disorder recovery is nothing to be ashamed of. Recovering from an eating disorder is a process, not a quick fix, and there are likely going to be some challenges and bumps in the road along the way. Even if your teen’s recovery does ebb and flow, it's important that you remain supportive and encouraging. Your teen may feel ashamed or even that you’re disappointed in them if they do experience challenges in recovery. It’s important that you let them know that this isn’t the case, and that you will always be there to support them at all stages of recovery.

Eating disorder recovery can be challenging for many reasons. Societal pressures, diet culture, and the psychological aspects of eating disorders can make them difficult to recognize and even more difficult to overcome. As a parent or caregiver, you can expect to play an important role in maintaining open and honest communication throughout recovery. Your support will be vital in all stages of recovery, as well as for helping and modeling for your teen to continue nourishing and caring for their body and themselves (physically and mentally) in the future. 

If you’re looking for support for a teen struggling with an eating disorder, Aterra Nutrition offers virtual nutrition counseling and support for eating disorder recovery with a registered dietitian. We offer one-on-one nutrition counseling for those in DC, Maryland, Virginia, New Jersey, and Michigan. Learn more about the eating disorder services Aterra Nutrition offers on our website at aterranutrition.com.

About the Author

Cristina Luibil, MS, RD, LDN specializes in eating disorder recovery and Intuitive Eating for teens and adults. Aterra Nutrition provides virtual nutrition counseling for those in DC, Maryland, Virginia, New Jersey, and Michigan. This post was researched and written in conjunction with Sabrina Stadelman, dietetics student and nutrition assistant at Aterra Nutrition. Learn more about the whole team at aterranutrition.com/team.

Disclaimer: The information shared in this blog is for general educational and informational purposes only. It may not be tailored to your specific health needs as it is written here. This content is not intended to replace personalized medical advice, nutrition counseling, or medical nutrition therapy. Any recipes or suggestions provided are meant to inspire and should be used at your discretion. Always consult with your own registered dietitian, physician, or healthcare provider before making changes to your nutrition, lifestyle, or treatment plan. If you choose, Aterra Nutrition would be happy to help you in your own, individual nutrition and intuitive eating journey.