Normal Teen vs. Troubled Teen Behavior

As teenagers begin to assert their independence and find their own identity, many experience behavioral changes that can seem bizarre and unpredictable to parents. Your sweet, obedient child who once couldn’t bear to be separated from you now won’t be seen within 20 yards of you, and greets everything you say with a roll of the eyes or the slam of a door. These, unfortunately, are the actions of a normal teenager.
As the parent of a troubled teen, you’re faced with even greater challenges. A troubled teen faces behavioral, emotional, or learning problems beyond the normal teenage issues. They may repeatedly practice at-risk behaviors such as violence, skipping school, drinking, drug use, sex, self-harming, shoplifting, or other criminal acts. Or they may exhibit symptoms of mental health problems like depression, anxiety, or eating disorders. While any negative behavior repeated over and over can be a sign of underlying trouble, it’s important for parents to understand which behaviors are normal during adolescent development, and which can point to more serious problems.

When Typical Teen Behavior Becomes Troubled Teen Behavior
Typical Teen Behavior	Warning Signs of a Troubled Teen
Changing appearance. Keeping up with fashion is important to teens. That may mean wearing provocative or attention-seeking clothing or dyeing hair. Unless your teen wants tattoos, avoid criticizing and save your protests for the bigger issues. Fashions change, and so will your teen.	Changing appearance can be a red flag if it’s accompanied by problems at school or other negative changes in behavior, or if there’s evidence of cutting and self-harm or extreme weight loss or weight gain.
Increased arguments and rebellious behavior. As teens begin seeking independence, you will frequently butt heads and argue.	Constant escalation of arguments, violence at home, skipping school, getting in fights, and run-ins with the law are all red flag behaviors that go beyond the norm of teenage rebellion.
Mood swings. Hormones and developmental changes often mean that your teen will experience mood swings, irritable behavior, and struggle to manage his or her emotions.	Rapid changes in personality, falling grades, persistent sadness, anxiety, or sleep problems could indicate depression, bullying, or another emotional health issue. Take any talk about suicide seriously.
Experimenting with alcohol or drugs. Most teens will try alcohol and smoke a cigarette at some point. Many will even try marijuana. Talking to your kids frankly and openly about drugs and alcohol is one way to ensure it doesn’t progress further.	When alcohol or drug use becomes habitual, especially when it’s accompanied by problems at school or home, it may indicate a substance abuse issue or other underlying problems.
More influenced by friends than parents. Friends become extremely important to teens and can have a great influence on their choices. As teens focus more on their peers, that inevitably means they withdraw from you. It may leave you feeling hurt, but it doesn’t mean your teen doesn’t still need your love.	Red flags include a sudden change in peer group (especially if the new friends encourage negative behavior), refusing to comply with reasonable rules and boundaries, or avoiding the consequences of bad behavior by lying. Your teen spending too much time alone can also indicate problems.

Seeking professional help for a troubled teen

If you identify red flag behaviors in your teen, consult a doctor, counselor, therapist, or other mental health professional for help finding appropriate treatment.
Even when you seek professional help for your teen, though, that doesn’t mean that your job is done. As detailed below, there are many things you can do at home to help your teen and improve the relationship between you. And you don’t need to wait for a diagnosis to start putting them into practice.

Understanding Teen Development

No, your teen is not an alien being from a distant planet, but he or she is wired differently. A teenager’s brain is still actively developing, processing information differently than a mature adult’s brain. The frontal cortex—the part of the brain used to manage emotions, make decisions, reason, and control inhibitions—is restructured during the teenage years, forming new synapses at an incredible rate, while the whole brain does not reach full maturity until about the mid-20’s.
Your teen may be taller than you and seem mature in some respects, but often he or she is simply unable to think things through at an adult level. Hormones produced during the physical changes of adolescence can further complicate things. Now, these biological differences don’t excuse teens’ poor behavior or absolve them from accountability for their actions, but they may help explain why teens behave so impulsively or frustrate parents and teachers with their poor decisions, social anxiety, and rebelliousness. Understanding adolescent development can help you find ways to stay connected to your teen and overcome problems together.

Anger and Violence in Teenagers

If you’re a parent of a teenage boy who is angry, aggressive, or violent, you may live in constant fear. Every phone call or knock on the door could bring news that your son has either been harmed, or has seriously harmed others.
Teenage girls get angry as well, of course, but that anger is usually expressed verbally rather than physically. Teen boys are more likely to throw objects, kick doors, or punch the walls when they’re angry. Some will even direct their rage towards you. For any parent, especially single mothers, this can be a profoundly upsetting and unsettling experience. But you don’t have to live under the threat of violence.

Dealing with angry teens

Anger can be a challenging emotion for many teens as it often masks other underlying emotions such as frustration, embarrassment, sadness, hurt, fear, shame, or vulnerability. When teens can’t cope with these feelings, they may lash out, putting themselves and others at risk. In their teens, many boys have difficulty recognizing their feelings, let alone being able to express them or ask for help.
The challenge for parents is to help your teen cope with emotions and deal with anger in a more constructive way:

• Establish rules and consequences. At a time when both you and your teen are calm, explain that there’s nothing wrong with feeling anger, but there are unacceptable ways of expressing it. If your teen lashes out, for example, he or she will have to face the consequences—loss of privileges or even police involvement. Teens need rules, now more than ever.
• Uncover what’s behind the anger. Is your child sad or depressed? For example, does your teen have feelings of inadequacy because his or her peers have things that your child doesn’t? Does your teen just need someone to listen to him or her without judgment?
• Be aware of anger warning signs and triggers. Does your teen get headaches or start to pace before exploding with rage? Or does a certain class at school always trigger anger? When teens can identify the warning signs that their temper is starting to boil, it allows them to take steps to defuse the anger before it gets out of control.
• Help your teen find healthy ways to relieve anger. Exercise, team sports, even simply hitting a punch bag or a pillow can help relieve tension and anger. Many teens also use art or writing to creatively express their anger. Dancing or playing along to loud, angry music can also provide relief.
• Give your teen space to retreat. When your teen is angry, allow him or her to retreat to a place where it’s safe to cool off. Don’t follow your teen and demand apologies or explanations while he or she is still raging; this will only prolong or escalate the  anger, or even provoke a physical response.
• Manage your own anger. You can’t help your teen if you lose your temper as well. As difficult as it sounds, you have to remain calm and balanced no matter how much your child provokes you. If you or other members of your family scream, hit each other, or throw things, your teen will naturally assume that these are appropriate ways to express his or her anger as well.

Red flags for violent behavior in teens

It only takes a glance at the news headlines to know that teen violence is a growing problem. Movies and TV shows glamorize all manner of violence, many web sites promote extremist views that call for violent action, and hour after hour of playing violent video games can desensitize teens to the real world consequences of aggression and violence. Of course, not every teen exposed to violent content will become violent, but for a troubled teen who is emotionally damaged or suffering from mental health problems, the consequences can be tragic. 
Warning signs that a teen may become violent include:

• Playing with weapons of any kind
• Obsessively playing violent video games, watching violent movies, or visiting websites that promote or glorify violence
• Threatening or bullying others
• Fantasizing about acts of violence he’d like to commit
• Being violent or cruel to pets or other animals

Helping Troubled Teens Tip #1: Connect With Your Teen

Whatever problems your teen is experiencing, it is not a sign that you’ve somehow failed as a parent. Instead of trying to assign blame for the situation, focus on your teen’s current needs. The first step to doing this is to find a way to connect with him or her.
It may seem hard to believe—given your child’s anger or indifference towards you—but teens still crave love, approval, and acceptance from their parents. That means you probably have a lot more influence over your teen than you think. To open the lines of communication:

• Be aware of your own stress levels. If you’re angry or upset, now is not the time to try to communicate with your teen. Wait until you’re calm and energized before starting a conversation. You’re likely to need all the patience and positive energy you can muster.
• Be there for your teen. An offer to chat with your teen over coffee will probably be greeted with a sarcastic put-down or dismissive gesture, but it’s important to show you’re available. Insist on sitting down for mealtimes together with no TV or other distractions, and attempt to talk to your teen then. Don’t get frustrated if your efforts are greeted by nothing more than monosyllabic grunts or shrugs; you may have to eat a lot of dinners in silence, but when your teen does want to open up, he or she will have the opportunity to do so.
• Find common ground. Trying to discuss your teen’s appearance or clothes may be a sure-fire way to trigger a heated argument, but you can still find some areas of common ground. Fathers and sons often connect over sports, mothers and daughters over gossip or movies. The objective is not to be your teen’s best friend, but to find common interests that you can discuss peacefully. Once you’re talking, your teen may feel more comfortable opening up to you about other things.
• Listen without judging or giving advice. When your teen does talk to you, it’s important that you listen without judging, mocking, interrupting, criticizing, or offering advice. Your teen wants to feel understood and valued by you, so maintain eye contact and keep your focus on your child, even when he or she is not looking at you. If you’re checking your email or reading the newspaper, your teen will feel that he or she is not important to you.  
• Expect rejection. Your attempts to connect with your teen may often be met with anger, irritation, or other negative reactions. Stay relaxed and allow your teen space to cool off. Try again later when you’re both calm. Successfully connecting to your teen will take time and effort. Don’t be put off; persevere and the breakthrough will come.

Helping Troubled Teens Tip #2: Make Healthy Lifestyle Changes

The tips below can help put balance back in your troubled teen’s life, no matter the exact diagnosis of his or her problems:

• Create structure. Teens may scream and argue with you about rules and discipline, or rebel against daily structure, but that doesn’t mean they need them any less. Structure, such as regular mealtimes and bedtimes, make a teen feel safe and secure. Sitting down to breakfast and dinner together every day can also provide a great opportunity to check in with your teen at the beginning and end of each day.
• Reduce screen time. There is a direct relationship between violent TV shows, movies, Internet content, and video games, and the violent behavior in teenagers. Even if your teen isn’t drawn to violent material, too much screen time can still impact brain development. Limit the time your teen has access to electronic devices—and restrict phone usage after a certain time at night to ensure your child gets enough sleep.
• Encourage exercise. Even a little regular exercise can help ease depression, boost energy and mood, relieve stress, regulate sleep patterns, and improve your teen’s self-esteem. If you struggle getting your teen to do anything but play video games, encourage him or her to play activity-based video games or “exergames” that are played standing up and moving around—simulating dancing, skateboarding, soccer, or tennis, for example. Once exercise becomes a habit, encourage your teen to try the real sport or to join a club or team.
• Eat right. Healthy eating can help to stabilize a teenager’s energy, sharpen his or her mind, and even out his or her mood. Act as a role model for your teen. Cook more meals at home, eat more fruit and vegetables and cut back on junk food and soda.

• Ensure your teen gets enough sleep. Sleep deprivation can make a teen stressed, moody, irritable, and lethargic, and cause problems with weight, memory, concentration, decision-making, and immunity from illness. You might be able to get by on six hours a night and still function at work, but your teen needs 8.5 to 10 hours of sleep a night to be mentally sharp and emotionally balanced. Encourage better sleep by setting consistent bedtimes, and removing TVs, computers, and other electronic gadgets from your teen’s room—the light from these suppresses melatonin production and stimulates the mind, rather than relaxing it. Suggest your teen tries listening to music or audio books at bedtime instead.

Helping Troubled Teens Tip #3: Take Care of Yourself

The stress of dealing with any teenager, especially one who’s experiencing behavioral problems, can take a toll on your own health, so it’s important to take care of yourself. That means looking after your emotional and physical needs and learning to manage stress.

• Take time to relax daily and learn how to regulate yourself and de-stress when you start to feel overwhelmed.
• Don’t go it alone, especially if you’re a single parent. Seek help from friends, relatives, a school counselor, sports coach, religious leader, or someone else who has a relationship with your teen. Organizations such as Boys and Girls Clubs, YMCA, and other youth groups can also help provide structure and guidance.
• Watch out for signs of depression and anxiety, and get professional help if needed.

This won’t last forever

It’s worth reminding your teen that no matter how much pain or turmoil he or she is experiencing right now, with your love and support, things can and will get better—for both of you. Your teen can overcome the problems of adolescence and mature into a happy, successful young adult.

What is Cyberbullying?

Cyberbullying occurs when a child or teen uses the Internet, emails, text messages, instant messaging, social media websites, online forums, chat rooms, or other digital technology to harass, threaten, or humiliate another child or teen. Unlike traditional bullying, cyberbullying doesn't require physical strength or face-to-face contact and isn't limited to just a handful of witnesses at a time. Cyberbullies come in all shapes and sizes—almost anyone with an Internet connection or mobile phone can cyberbully someone else, often without having to reveal their true identity. cyberbullies can torment their victims 24 hours a day and the bullying can follow the victim anywhere so that no place, not even home, ever feels safe, and with a few clicks the humiliation can be witnessed by hundreds or even thousands of people online.
If you or a loved one is currently the victim of cyberbullying, it's important to remember that you're not alone. As many of one third of teenagers have suffered from cyberbullying at some time in their lives.

How cyberbullying harms

The methods kids and teens use to cyberbully can be as varied and imaginative as the technology they have access to. It ranges from sending threatening or taunting messages via email, text, or IM to breaking into your email account or stealing your online identity to hurt and humiliate you. Some cyberbullies may even create a website or social media page to target you.
As with traditional bullying, both boys and girls cyberbully, but tend to do so in different ways. Boys tend to bully by "sexting" (sending messages of a sexual nature) or with messages that threaten physical harm. Girls, on the other hand, more commonly cyberbully by spreading lies and rumors, exposing your secrets, or by excluding you from emails, buddy lists, or other electronic communication. Because cyberbullying is so easy to perpetrate, a child or teen can easily change roles, going from cyberbullying victim at one point to cyberbully the next, and then back again.

The Effects of Cyberbullying

Any type of bullying can make you feel hurt, angry, helpless, isolated, even suicidal, or lead to problems such as depression, anxiety, and low self-esteem. In many cases, cyberbullying can be even more painful than face-to-face bullying because:

• Cyberbullying can happen anywhere at any time, even in places where you normally feel safe, such as your home, and at times you'd least expect, such as at the weekend in the company of your family. It can seem like there's no escape from the taunting and humiliation.
• A lot of cyberbullying can be done anonymously, so you may not be sure who is targeting you. This can make you feel even more threatened and can embolden bullies, as they believe online anonymity means they're less likely to get caught. Since cyberbullies can't see your reaction, they will often go much further in their harassment or ridicule than they would do face-to-face with you.
• Cyberbullying can be witnessed by potentially thousands of people. Emails can be forwarded to hundreds of people while social media posts or website comments can often be seen by anyone. The more far-reaching the bullying, the more humiliating it can become.

Tips for Kids or Teens Dealing with Cyberbullying

If you are targeted by cyberbullies, it's important not to respond to any messages or posts written about you, no matter how hurtful or untrue. Responding will only make the situation worse and provoking a reaction from you is exactly what the cyberbullies want, so don't give them the satisfaction.
It's also very important that you don't seek revenge on a cyberbully by becoming a cyberbully yourself. Again, it will only make the problem worse and could result in serious legal consequences for you. If you wouldn't say it in person, don't say it online.
Instead, respond to cyberbullying by:

• Saving the evidence of the cyberbullying, keep abusive text messages or a screenshot of a webpage, for example, and then report them to a trusted adult, such as a family member, teacher, or school counselor. If you don't report incidents, the cyberbully will often become more aggressive.
• Reporting threats of harm and inappropriate sexual messages to the police. In many cases, the cyberbully's actions can be prosecuted by law.
• Being relentless. Cyberbullying is rarely limited to one or two incidents. It's far more likely to be a sustained attack on you over a period of time. So, like the cyberbully, you may have to be relentless and keep reporting each and every bullying incident until it stops. There is no reason for you to ever put up with cyberbullying.
• Preventing communication from the cyberbully, by blocking their email address, cell phone number, and deleting them from social media contacts. Report their activities to their internet service provider (ISP) or to any web sites they use to target you.

If you are being cyberbullied, remember:

• Don't blame yourself. It is not your fault. No matter what a cyberbully says or does, you should not be ashamed of who you are or what you feel. The cyberbully is the person with the problem, not you.
• Try to view cyberbullying from a different perspective. The cyberbully is an unhappy, frustrated person who wants to have control over your feelings so that you feel as badly as they do. Don't give them the satisfaction.
• Don't beat yourself up. Don't make a cyberbullying incident worse by dwelling on it or reading the message over and over. Instead, delete any cyberbullying messages and focus on positive experiences. There are many wonderful things about you so be proud of who you are.
• Get help. Talk to a parent, teacher, counselor, or other trusted adult. Seeing a counselor does not mean there is something wrong with you.
• Learn to deal with stress. Finding ways to relieve stress can make you more resilient so you won't feel overwhelmed by cyberbullying. Exercise, meditation, positive self-talk, muscle relaxation, and breathing exercises are all good ways to manage the stress from cyberbullying.
• Spend time doing things you enjoy. The more time you spend with activities that bring you pleasure—sports, hobbies, hanging out with friends who don't participate in cyberbullying, for example—the less significance cyberbullying will have on your life.

Tips for Parents and Teachers to Stop Cyberbullying

No matter how much pain it causes, kids are often reluctant to tell parents or teachers about cyberbullying because they fear that doing so may result in losing their computer or cell phone privileges. While parents should always monitor a child's use of technology, it's important not to threaten to withdraw access or otherwise punish a child who's been the victim of cyberbullying.

Spot the warning signs of cyberbullying

Your child may be the victim of cyberbullying if he or she:

• Becomes sad, angry, or distressed during or after using the Internet or cell phone.
• Appears anxious when receiving a text, IM, or email.
• Avoids discussions or is secretive about computer or cell phone activities.
• Withdraws from family, friends, and activities they previously enjoyed.
• Suffers an unexplained drop in grades.
• Refuses to go to school or to specific classes, or avoids group activities.
• Shows changes in mood, behavior, sleep, appetite, or shows signs of depression or anxiety.

Monitor your child's technology use

Regardless of how much your child resents it, you can only protect him or her by monitoring what they do online.

• Keep the computer in a busy area of your house so you can easily monitor its use, rather than allowing your child use a laptop or tablet in his or her bedroom, for example.
• Limit data access to your child's smart phone if he or she uses it to surf the web. Some wireless providers allow you to turn off text messaging services during certain hours.
• Set up filters on your child's computer. Tracking software can block inappropriate web content and help you check up on your child's online activities.
• Insist on knowing your child's passwords and learn the common acronyms kids use online and in text messages.
• Know who your child communicates with online. Go over your child's address book and instant messenger "buddy list" with them. Ask who each person is and how your child knows them.
• Encourage your child to tell you or another trusted adult if they receive threatening messages or are otherwise targeted by cyberbullies, while reassuring them that doing so will not result in their loss of computer or cell phone privileges.

Deal with incidents of cyberbullying

• Don't reply to any incidents of cyberbullying but do save and document the threats (harassing messages, sexually explicit pictures, or threatening texts, for example) and report them to the police. Seek appropriate legal advice.
• Report incidents of cyberbullying to the ISP, the cell phone company, and to any web site used in the cyberbullying.
• Block the cyberbully's email address or cell phone number, or change your child's email address or phone number.
• If you are able to identify the cyberbully, you could contact his or her parents or notify your child's school if the cyberbully is also a student there. Many schools have established protocols for handling cyberbullying but check with your child first as he or she may prefer to resolve the problem privately.

If Your Child is a Cyberbully

It can be difficult for any parent to learn that their child is bullying others but it's important to take steps to end the negative behavior before it has serious and long-term consequences for your child.
If your child has responded to being cyberbullied by employing their own cyberbullying tactics, you can help your child find better ways to deal with the problem. If your child has trouble managing strong emotions such as anger, hurt, or frustration, talk to a therapist about helping your child learn to cope with these feelings in a healthy way.

Bullying is often a learned behavior

Some cyberbullies can learn aggressive behavior from their experiences at home, so it’s important to set a good example with your own Internet and messaging habits. As a parent, you may be setting a bad example for your kids by spanking or otherwise striking them, verbally or physically abusing your spouse, or by displaying bullying behavior such as:

• Sending or forwarding abusive emails or text messages that target coworkers or acquaintances.
• Communicating with people online in ways that you wouldn’t do face-to-face.
• Abusing your child’s sports coach, umpires and referees, or members of the opposing team.
• Swearing at other drivers on the road.
• Humiliating a waitress, shop assistant, or cab driver who makes a mistake.
• Talking negatively or writing abuse messages about other students, parents, or teachers so that your child thinks it’s acceptable to use verbal abuse or cyberbullying to intimidate others.

Tips for parents dealing with a cyberbullying child

• Educate your child about cyberbullying. Your child may not understand how hurtful and damaging their behavior can be. Foster empathy and awareness by encouraging your child to look at their actions from the victim’s perspective. Remind your child that cyberbullying can have very serious legal consequences.
• Manage stress. Teach your child positive ways to manage stress. Your child’s cyberbullying may be an attempt at relieving stress. Or your own stress, anxiety, or worry may be creating an unstable home environment. Exercise, spending time in nature, or playing with a pet are great ways for both kids and adults to let off steam and relieve stress.
• Set limits with technology. Let your child know you’ll be monitoring his or her use of computers, tablets, smartphones, email, and text messaging. If necessary, remove access to technology until behavior improves.
• Establish consistent rules of behavior. Make sure your child understands your rules and the punishment for breaking them. Children may not think they need discipline, but a lack of boundaries sends a signal that the child is unworthy of the parents’ time, care, and attention.

What is anorexia nervosa?

Anorexia nervosa is a complex eating disorder with three key features:

• refusal to maintain a healthy body weight
• an intense fear of gaining weight
• a distorted body image

Because of your dread of becoming fat or disgusted with how your body looks, eating and mealtimes may be very stressful. And yet, what you can and can’t eat is practically all you can think about.
Thoughts about dieting, food, and your body may take up most of your day—leaving little time for friends, family, and other activities you used to enjoy. Life becomes a relentless pursuit of thinness and going to extremes to lose weight.
But no matter how skinny you become, it’s never enough.
While people with anorexia often deny having a problem, the truth is that anorexia is a serious and potentially deadly eating disorder. Fortunately, recovery is possible. With proper treatment and support, you or someone you care about can break anorexia’s self-destructive pattern and regain health and self-confidence.

Types of anorexia nervosa

There are two types of anorexia. In the restricting type of anorexia, weight loss is achieved by restricting calories (following drastic diets, fasting, and exercising to excess). In the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and diuretics.

Anorexia is not about weight or food

Believe it or not, anorexia isn’t really about food and weight—at least not at its core. Eating disorders are much more complicated than that. The food and weight-related issues are symptoms of something deeper: things like depression, loneliness, insecurity, pressure to be perfect, or feeling out of control. Things that no amount of dieting or weight loss can cure.

What need does anorexia meet in your life?

It’s important to understand that anorexia meets a need in your life. For example, you may feel powerless in many parts of your life, but you can control what you eat. Saying “no” to food, getting the best of hunger, and controlling the number on the scale may make you feel strong and successful—at least for a short while. You may even come to enjoy your hunger pangs as reminders of a “special talent” that most people can’t achieve.
Anorexia may also be a way of distracting yourself from difficult emotions. When you spend most of your time thinking about food, dieting, and weight loss, you don’t have to face other problems in your life or deal with complicated emotions.
Unfortunately, any boost you get from starving yourself or shedding pounds is extremely short-lived. Dieting and weight loss can’t repair the negative self-image at the heart of anorexia. The only way to do that is to identify the emotional need that self-starvation fulfills and find other ways to meet it.

The difference between dieting and anorexia
Healthy Dieting	Anorexia
Healthy dieting is an attempt to control weight.	Anorexia is an attempt to control your life and emotions.
Your self-esteem is based on more than just weight and body image.	Your self-esteem is based entirely on how much you weigh and how thin you are.
You view weight loss as a way to improve your health and appearance.	You view weight loss as a way to achieve happiness.
Your goal is to lose weight in a healthy way.	Becoming thin is all that matters; health is not a concern.

Signs and symptoms of anorexia

Living with anorexia means you’re constantly hiding your habits. This makes it hard at first for friends and family to spot the warning signs. When confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you wont be able to deny their instincts that something is wrong—and neither should you.
As anorexia develops, you become increasingly preoccupied with the number on the scale, how you look in the mirror, and what you can and can’t eat.

Anorexic food behavior signs and symptoms

• Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
• Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
• Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of meals (“I had a huge lunch” or “My stomach isn’t feeling good.”).
• Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.
• Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it out, using a specific plate).

Anorexic appearance and body image signs and symptoms

• Dramatic weight loss – Rapid, drastic weight loss with no medical cause.
• Feeling fat, despite being underweight – You may feel overweight in general or just “too fat” in certain places such as the stomach, hips, or thighs.
• Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
• Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws. There’s always something to criticize. You’re never thin enough.
• Denial that you’re too thin – You may deny that your low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

Purging signs and symptoms

• Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
• Throwing up after eating – Frequently disappearing after meals or going to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
• Compulsive exercising – Following a punishing exercise regimen aimed at burning calories. Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or eating something “bad.”

Anorexia nervosa causes and risk factors

There are no simple answers to the causes of anorexia and other eating disorders. Anorexia is a complex condition that arises from a combination of many social, emotional, and biological factors. Although our culture’s idealization of thinness plays a powerful role, there are many other contributing factors, including your family environment, emotional difficulties, low self-esteem, and traumatic experiences you may have gone through in the past.

Psychological causes and risk factors for anorexia

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless. Through their harshly critical lens, if they’re not perfect, they’re a total failure.

Family and social pressures

In addition to the cultural pressure to be thin, there are other family and social pressures that can contribute to anorexia. This includes participation in an activity that demands slenderness, such as ballet, gymnastics, or modeling. It also includes having parents who are overly controlling, put a lot of emphasis on looks, diet themselves, or criticize their children’s bodies and appearance. Stressful life events—such as the onset of puberty, a breakup, or going away to school—can also trigger anorexia.

Biological causes of anorexia

Research suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry also plays a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well-being.

Effects of anorexia

One thing is certain about anorexia. Severe calorie restriction has dire physical effects. When your body doesn’t get the fuel it needs to function normally, it goes into starvation mode and slows down to conserve energy. Essentially, your body begins to consume itself. If self-starvation continues and more body fat is lost, medical complications pile up and your body and mind pay the price.

Some of the physical effects of anorexia include:

Severe mood swings; depression Lack of energy and weakness Slowed thinking; poor memory Dry, yellowish skin and brittle nails

Constipation and bloating Tooth decay and gum damage Dizziness, fainting, and headaches Growth of fine hair all over the body and face

Source: National Women's Health Information Center

Getting help for anorexia

Deciding to get help for anorexia is not an easy choice to make. It’s not uncommon to feel like anorexia is part of your identity—or even your “friend.”
You may think that anorexia has such a powerful hold over you that you’ll never be able to overcome it. But while change is hard, it is possible.

Steps to anorexia recovery

• Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight. The first step in anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowledging the physical and emotional damage that you’ve suffered because of it.
• Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your anorexia a secret for a long time. You may be ashamed, ambivalent, or afraid. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
• Stay away from people, places, and activities that trigger your obsession with being thin. You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-ana” sites that promote anorexia.
• Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

Anorexia treatment and therapy

Since anorexia involves both mind and body, a team approach to treatment is often best. Those who may be involved in anorexia treatment include medical doctors, psychologists, counselors, and dieticians. The participation and support of family members also makes a big difference in treatment success. Having a team around you that you can trust and rely on will make recovery easier.
Treating anorexia involves three steps:

• Getting back to a healthy weight
• Starting to eat more food
• Changing how you think about yourself and food

Medical treatment for anorexia

The first priority in anorexia treatment is addressing and stabilizing any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalized until you reach a less critical weight. Outpatient treatment is an option when you’re not in immediate medical danger.

Nutritional treatment for anorexia

A second component of anorexia treatment is nutritional counseling. A nutritionist or dietician will teach you about healthy eating and proper nutrition. The nutritionist will also help you develop and follow meal plans that include enough calories to reach or maintain a normal, healthy weight.

Counseling and therapy for anorexia

Counseling is crucial to anorexia treatment. Its goal is to identify the negative thoughts and feelings that fuel your eating disorder and replace them with healthier, less distorted beliefs. Another important goal of counseling is to teach you how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive, way.

Helping an anorexic person

Encouraging an anorexic friend or family member to get treatment is the most caring and supportive thing you can do. But because of the defensiveness and denial involved in anorexia, you’ll need to tread lightly. Waving around articles about the dire effects of anorexia or declaring “You’ll die if you don’t eat!” probably won’t work. A better approach is to gently express your concerns and let the person know that you’re available to listen. If your loved one is willing to talk, listen without judgment, no matter how out of touch the person sounds.
It’s deeply distressing to know that your child or someone you love may be struggling with anorexia. There’s no way to solve the problem yourself, but here are a few ideas for what you can do now to help make a difference for someone you love.

Tips for helping a person with anorexia

• Think of yourself as an “outsider.” In other words, someone not suffering from anorexia. In this position, there isn’t a lot you can do to “solve” your loved one’s anorexia. It is ultimately the individual’s choice to decide when they are ready.
• Be a role model for healthy eating, exercising, and body image. Don’t make negative comments about your own body or anyone else’s.
• Take care of yourself. Seek advice from a health professional, even if your friend or family member won’t. And you can bring others—from peers to parents—into the circle of support.
• Don’t act like the food police. A person with anorexia needs compassion and support, not an authority figure standing over the table with a calorie counter.
• Avoid threats, scare tactics, angry outbursts, and put-downs. Bear in mind that anorexia is often a symptom of extreme emotional distress and develops out of an attempt to manage emotional pain, stress, and/or self-hate. Negative communication will only make it worse.

What is bulimia?

Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, followed by frantic efforts to avoid gaining weight. It affects women and men of all ages.
When you’re struggling with bulimia, life is a constant battle between the desire to lose weight or stay thin and the overwhelming compulsion to binge eat.
You don’t want to binge—you know you’ll feel guilty and ashamed afterwards—but time and again you give in. During an average binge, you may consume from 3,000 to 5,000 calories in one short hour.
After it ends, panic sets in and you turn to drastic measures to “undo” the binge, such as taking ex-lax, inducing vomiting, or going for a ten-mile run. And all the while, you feel increasingly out of control.
It’s important to note that bulimia doesn’t necessarily involve purging—physically eliminating the food from your body by throwing up or using laxatives, enemas, or diuretics. If you make up for your binges by fasting, exercising to excess, or going on crash diets, this also qualifies as bulimia.

The binge and purge cycle

Dieting triggers bulimia’s destructive cycle of binging and purging. The irony is that the more strict and rigid the diet, the more likely it is that you’ll become preoccupied, even obsessed, with food. When you starve yourself, your body responds with powerful cravings—its way of asking for needed nutrition.
As the tension, hunger, and feelings of deprivation build, the compulsion to eat becomes too powerful to resist: a “forbidden” food is eaten; a dietary rule is broken. With an all-or-nothing mindset, you feel any diet slip-up is a total failure. After having a bite of ice cream, you might think, “I’ve already blown It, so I might as well go all out.”
Unfortunately, the relief that binging brings is extremely short-lived. Soon after, guilt and self-loathing set in. And so you purge to make up for binging and regain control.
Unfortunately, purging only reinforces binge eating. Though you may tell yourself, as you launch into a new diet, that this is the last time, in the back of your mind there’s a voice telling you that you can always throw up or use laxatives if you lose control again. What you may not realize is that purging doesn’t come close to wiping the slate clean after a binge.

Signs and symptoms of bulimia

If you’ve been living with bulimia for a while, you’ve probably “done it all” to conceal your binging and purging habits. It’s only human to feel ashamed about having a hard time controlling yourself with food, so you most likely binge alone. If you eat a box of doughnuts, then you’ll replace them so your friends or family won’t notice. When buying food for a binge, you might shop at four separate markets so the checker won’t guess. But despite your secret life, those closest to you probably have a sense that something is not right.

Binge eating signs and symptoms

• Lack of control over eating – Inability to stop eating. Eating until the point of physical discomfort and pain.
• Secrecy surrounding eating – Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy.
• Eating unusually large amounts of food with no obvious change in weight.
• Disappearance of food, numerous empty wrappers or food containers in the garbage, or hidden stashes of junk food.
• Alternating between overeating and fasting – Rarely eats normal meals. It’s all-or-nothing when it comes to food.

Purging signs and symptoms

• Going to the bathroom after meals – Frequently disappears after meals or takes a trip to the bathroom to throw up. May run the water to disguise sounds of vomiting.
• Using laxatives, diuretics, or enemas after eating. May also take diet pills to curb appetite or use the sauna to “sweat out” water weight.
• Smell of vomit – The bathroom or the person may smell like vomit. They may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
• Excessive exercising – Works out strenuously, especially after eating. Typical activities include high-intensity calorie burners such as running or aerobics.

Physical signs and symptoms of bulimia

• Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting.
• Puffy “chipmunk” cheeks caused by repeated vomiting.
• Discolored teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.
• Not underweight – Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia.
• Frequent fluctuations in weight – Weight may fluctuate by 10 pounds or more due to alternating episodes of bingeing and purging.

Effects of bulimia

When you are living with bulimia, you are putting your body—and even your life—at risk. The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure.
Other common medical complications and adverse effects of bulimia include:

Weight gain Abdominal pain, bloating Swelling of the hands and feet Chronic sore throat, hoarseness Broken blood vessels in the eyes Swollen cheeks and salivary glands

Weakness and dizziness Tooth decay and mouth sores Acid reflux or ulcers Ruptured stomach or esophagus Loss of menstrual periods Chronic constipation from laxative abuse

The dangers of ipecac syrup

If you use ipecac syrup, a medicine used to induce vomiting, after a binge, take caution. Regular use of ipecac syrup can be deadly. Ipecac builds up in the body over time. Eventually it can lead to heart damage and sudden cardiac arrest, as it did in the case of singer Karen Carpenter.
Source: National Women's Health Information Center

Bulimia causes and risk factors

There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play major roles, there are many other contributing causes. In most cases, people suffering with bulimia—and eating disorders in general—have trouble managing emotions in a healthy way. Eating can be an emotional release so it’s not surprising that people binge and purge when feeling angry, depressed, stressed, or anxious.
One thing is certain. Bulimia is a complex emotional issue. Major causes and risk factors for bulimia include:

• Poor body image: Our culture’s emphasis on thinness and beauty can lead to body dissatisfaction, particularly in young women bombarded with media images of an unrealistic physical ideal.
• Low self-esteem: Women or men who think of themselves as useless, worthless, and unattractive are at risk for bulimia. Things that can contribute to low self-esteem include depression, perfectionism, childhood abuse, and a critical home environment.
• History of trauma or abuse: Women with bulimia appear to have a higher incidence of sexual abuse. People with bulimia are also more likely than average to have parents with a substance abuse problem or psychological disorder.
• Major life changes: Bulimia is often triggered by stressful changes or transitions, such as the physical changes of puberty, going away to college, or the breakup of a relationship. Binging and purging may be a negative way to cope with the stress.
• Appearance-oriented professions or activities: People who face tremendous image pressure are vulnerable to developing bulimia. Those at risk include ballet dancers, models, gymnasts, wrestlers, runners, and actors.

Getting help for bulimia

If you are living with bulimia, you know how scary it feels to be so out of control. Knowing that you are harming your body just adds to the fear. But take heart: change is possible. Regardless of how long you’ve struggled with bulimia, you can learn to break the binge and purge cycle and develop a healthier attitude toward food and your body.
Taking steps toward recovery is tough. It’s common to feel ambivalent about giving up your binging and purging, even though it’s harmful. If you are even thinking of getting help for bulimia, you are taking a big step forward.

Steps to bulimia recovery

• Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight and control what you eat. The first step in bulimia recovery is admitting that your relationship to food is distorted and out of control.
• Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your bulimia a secret for a long time. You may be ashamed, ambivalent, or afraid of what others will think. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
• Stay away from people, places, and activities that trigger the temptation to binge or purge. You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-mia” sites that promote bulimia. You may also need to be careful when it comes to meal planning and cooking magazines and shows.
• Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

The importance of deciding not to diet

Treatment for bulimia is much more likely to succeed when you stop dieting. Once you stop trying to restrict calories and follow strict dietary rules, you will no longer be overwhelmed with cravings and thoughts of foods. By eating normally, you can break the binge-and-purge cycle and still reach a healthy, attractive weight.

Bulimia treatment and therapy

To stop the cycle of bingeing and purging, it’s important to seek professional help early, follow through with treatment, and resolve the underlying emotional issues that caused the bulimia in the first place.

Therapy for bulimia

Because poor body image and low self-esteem lie at the heart of bulimia, therapy is an important part of recovery. It’s common to feel isolated and shamed by your bingeing and purging, and therapists can help with these feelings.
The treatment of choice for bulimia is cognitive-behavioral therapy. Cognitive-behavioral therapy targets the unhealthy eating behaviors of bulimia and the unrealistic, negative thoughts that fuel them. Here’s what to expect in bulimia therapy:

• Breaking the binge-and-purge cycle – The first phase of bulimia treatment focuses on stopping the vicious cycle of bingeing and purging and restoring normal eating patterns. You learn to monitor your eating habits, avoid situations that trigger binges, cope with stress in ways that don’t involve food, eat regularly to reduce food cravings, and fight the urge to purge.
• Changing unhealthy thoughts and patterns – The second phase of bulimia treatment focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. You explore attitudes about eating, and rethink the idea that self-worth is based on weight.
• Solving emotional issues – The final phase of bulimia treatment involves targeting emotional issues that caused the eating disorder in the first place. Therapy may focus on relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness.

Helping a person with bulimia

If you suspect that your friend or family member has bulimia, talk to the person about your concerns. Your loved one may deny bingeing and purging, but there’s a chance that he or she will welcome the opportunity to open up about the struggle. Either way, bulimia should never be ignored. The person’s physical and emotional health is at stake.
It’s painful to know your child or someone you love may be binging and purging. You can’t force a person with an eating disorder to change and you can’t do the work of recovery for your loved one. But you can help by offering your compassion, encouragement, and support throughout the treatment process.

If your loved one has bulimia

• Offer compassion and support. Keep in mind that the person may get defensive or angry. But if he or she does open up, listen without judgment and make sure the person knows you care.
• Avoid insults, scare tactics, guilt trips, and patronizing comments. Since bulimia is often caused and exacerbated by stress, low self-esteem, and shame, negativity will only make it worse.
• Set a good example for healthy eating, exercising, and body image. Don’t make negative comments about your own body or anyone else’s.
• Accept your limits. As a parent or friend, there isn’t a lot you can do to “fix” your loved one’s bulimia. The person with bulimia must make the decision to move forward.
• Take care of yourself. Know when to seek advice for yourself from a counselor or health professional. Dealing with an eating disorder is stressful, and it will help if you have your own support system in place. 

Eating disorder recovery

The road to eating disorder recovery starts with admitting you have a problem. This admission can be tough, especially if you’re still clinging to the belief—even in the back of your mind—that weight loss is the key to happiness, confidence, and success. Even when you finally understand this isn’t true, old habits are still hard to break.
The good news is that the eating disorder behaviors you’ve learned can be unlearned if you’re motivated to change and willing to ask for help. However, overcoming an eating disorder is about more than giving up unhealthy eating behaviors. It is also about rediscovering who you are beyond your eating habits, weight, and body image.
True recovery from anorexia and bulimia involves learning to:

• Listen to your body.
• Listen to your feelings.
• Trust yourself.
• Accept yourself.
• Love yourself.
• Enjoy life again.

Eating disorder treatment: Help for anorexia and bulimia

The exact treatment needs of someone struggling with an eating disorder will vary according to the individual. It is, therefore, important that a health professional coordinate any treatment plan.

Eating disorder treatment step #1: Ask for help

It can be scary and embarrassing to seek help for an eating disorder but gaining support from a trusted friend, family member, religious leader, school counselor, or work colleague is for many people the first step on the road to recovery. Alternately, some people find it less threatening to confide in a treatment specialist, such as an eating disorder counselor or nutritionist.
Whoever you select as a confidant, set aside a specific time to discuss your situation with them, ideally in a quiet, comfortable place away from other people and distractions. Remember, your friend or family member may be shocked when you disclose details of your eating disorder. They may even be angry or confused, unsure of how to respond or the best way to help you. It’s important to remain patient. Take time to educate them about your specific eating disorder and the ways you’d like them to support you during the recovery process.

Eating disorder treatment step #2: Find a specialist

Eating disorder recovery is much easier when you have experienced, caring health professionals in your corner. It’s important to find a professional counselor or nutritionist who specializes in anorexia or bulimia. As you search, focus on finding the right fit, someone who makes you feel comfortable, accepted, and safe. To find an eating disorder treatment specialist in your area:

• Ask your primary care doctor for a referral.
• Check with local hospitals or medical centers.
• Ask your school counselor or nurse.
• Call the National Eating Disorders Association’s toll-free hotline at 1-800-931-2237 (Mon–Fri, 8:30 a.m. to 4:30 p.m. PST).

Eating disorder treatment step #3: Address health problems

Anorexia and bulimia can be deadly—and not just if you’re drastically underweight. Your health may be in danger, even if you only occasionally fast, binge, or purge, so it’s important to get a full medical evaluation. If the evaluation reveals health problems, they should take top treatment priority. Nothing is more important than your physical well-being. If you’re suffering from any life-threatening problem, you may need to be hospitalized in order to keep you safe.

Eating disorder treatment step #4: Make a long-term treatment plan

Once your health problems are under control, you and your doctor or therapist can work on a long-term recovery plan. First, you’ll need to assemble a complete eating disorder treatment team. Your team might include a family doctor, a psychologist, a nutritionist, a social worker, and a psychiatrist. Then you and your team will develop a treatment plan that’s individualized to meet your needs.
Your eating disorder treatment plan may include:

Inpatient treatment Individual or group therapy Family therapy

Eating disorder education Nutritional counseling Medical monitoring

An effective treatment program for eating disorders should address more than just your symptoms and destructive eating habits. It should also address the root causes of the problem—the emotional triggers that lead to disordered eating and your difficulty coping with stress, anxiety, fear, sadness, and other uncomfortable emotions.

Treatment options for anorexia and bulimia

While there are a variety of different treatment options available for those struggling with eating disorders, it is important to find the treatment, or combination of treatments, that works best for you.

Therapy for eating disorders

Therapy is crucial to treating anorexia and bulimia. There are many ways a therapist can work with you, including addressing any feelings of shame and isolation caused by your eating disorder. Different therapists have different methods, so it is important to discuss with a therapist your goals in working towards recovery.
The most common therapy for eating disorders is cognitive-behavioral therapy. This targets the unhealthy eating behaviors of anorexia and bulimia and the unrealistic, negative thoughts that fuel them. One of the main goals is for you to become more self-aware of how you use food to deal with emotions. The therapist will help you recognize your emotional triggers and learn how to avoid or combat them. Cognitive-behavioral therapy for eating disorders also involves education about nutrition, healthy weight management, and relaxation techniques.

Nutritional counseling for eating disorders

The goal of a nutritionist or dietician is to help you incorporate healthy eating behaviors into your everyday life. A nutritionist can’t change your habits overnight, but over a period of time you can learn to develop a healthier relationship with the food you consume.

Eating disorder support groups

While family and friends can be a huge help in providing support, you may also want to join an eating disorder support group. They provide a safe environment where you can talk freely about your eating disorder and get advice and support from people who know what you’re going through.
There are many types of eating disorder support groups. Some are led by professional therapists, while others are moderated by trained volunteers or people who have recovered from an eating disorder.
To find an eating disorder support group in your area:

• Ask your doctor or therapist for a referral
• Call local hospitals and universities
• Call local eating disorder centers and clinics
• Visit your school’s counseling center
• Search the National Eating Disorders Association’s. See the Resources & References section below.

Self-help for eating disorders: Learning new coping skills

Anorexia and bulimia aren’t about food. They’re about using food to cope with painful emotions such as anger, self-loathing, vulnerability, and fear. Disordered eating is a coping mechanism—whether you refuse food to feel in control, binge for comfort, or purge to punish yourself. But you can learn healthier ways to cope with negative emotions.
The first step is figuring out what’s really eating you up inside. Remember, “fat” is not a feeling, so if you feel overweight and unattractive, stop and ask yourself what’s really going on. Are you upset about something? Depressed? Stressed out? Lonely? Once you identify the emotion you’re experiencing, you can choose a positive alternative to starving or stuffing yourself.
Here are a few suggestions to get you started:

Call a friend Listen to music Play with a pet Read a good book Take a walk

Write in a journal Go to the movies Get out into nature Play a favorite game Do something nice for someone else

Self-help for eating disorders: Improving your self-image

When you base your self-worth on physical appearance alone, you’re ignoring all the other qualities, accomplishments, and abilities that make you beautiful. Think about your friends and family members. Do they love you for the way you look or who you are? Chances are, your appearance ranks low on the list of what they love about you—and you probably feel the same about them. So why does it top your own list?
Placing too much importance on how you look leads to low self-esteem and insecurity. But you can learn to see yourself in a positive, balanced way:

• Make a list of your positive qualities. Think of all the things you like about yourself. Are you smart? Kind? Creative? Loyal? Funny? What would others say are your good qualities? Include your talents, skills, and achievements. Also think about bad qualities you DON’T have.
• Focus on what you like about your body. Instead of searching for flaws when you look in the mirror, appreciate the things you like about your appearance. If you’re distracted by “imperfections,” remind yourself that nobody’s perfect. Even supermodels get airbrushed.
• Challenge negative self-talk. When you catch yourself being self-critical or pessimistic, stop and challenge the negative thought. Ask yourself what evidence you have to support the idea. What is the evidence against it? Just because you believe something, doesn’t mean it’s true.

Tips to Improve your Body Image
Wear clothes you feel comfortable in	Dress to express yourself, not to impress others. You should feel good in what you wear.
Stay away from the scale	If your weight needs to be monitored, leave that up to the doctors. How much you weigh should never affect your self-esteem.
Stay away from fashion magazines	Unless you can look through these magazines knowing they are purely fantasy, it's just better to stay away from them.
Do nice things for your body	Get a massage, a manicure, or a facial. Pamper yourself with a candlelight bath, scented lotion, or a new perfume.
Stay active	Movement therapy helps improve your sense of wellbeing. Take up Yoga or Tai' Chi, play volleyball with the kids, or bike ride with friends. Make angels in the snow or sandcastles at the beach. Be active and enjoy life!
Adapted from: The Something Fishy Website on Eating Disorders

Tips to Improve your Body Image
Wear clothes you feel comfortable in - Dress to express yourself, not to impress others. You should feel good in what you wear.
Stay away from the scale - If your weight needs to be monitored, leave that up to the doctors. How much you weigh should never affect your self-esteem.
Stay away from fashion magazines - Unless you can look through these magazines knowing they are purely fantasy, it's just better to stay away from them.
Do nice things for your body - Get a massage, a manicure, or a facial. Pamper yourself with a candlelight bath, scented lotion, or a new perfume.
Stay active - Movement therapy helps improve your sense of wellbeing. Take up Yoga or Tai' Chi, play volleyball with the kids, or bike ride with friends. Make angels in the snow or sandcastles at the beach. Be active and enjoy life!
Adapted from: The Something Fishy Website on Eating Disorders

Self-help for eating disorders: Learning healthy eating habits

Learning and establishing healthy eating habits is an essential step in recovery from anorexia and bulimia.

• Stick to a regular eating schedule. You may be used to skipping meals or fasting for long stretches. But when you starve yourself, food becomes all you think about. To avoid this preoccupation, make sure to eat every three hours. Plan ahead for meals and snacks, and don’t skip!
• Challenge your strict eating rules. Strict rules about food and eating fuel anorexia and bulimia, so it’s important to replace them with healthier ones. For example, if you have a rule forbidding all desserts, change it into a less rigid guideline such as, “I won’t eat dessert every day.” You won’t gain weight by enjoying an occasional ice cream or cookie.
• Don’t diet. Healthy eating—not dieting—is the key to avoiding weight gain. Instead of focusing on what you shouldn’t eat, focus on nutritious foods that will energize you and make your body strong. Think of food as fuel for your body. Your body knows when the tank is low, so listen to it. Eat when you’re truly hungry, then stop when you’re full.

Relapse prevention for anorexia and bulimia

The work of eating disorder recovery doesn’t end once you’ve adopted healthy habits. It’s important to take steps to maintain your progress and prevent relapse.

• Develop a solid support system. Surround yourself with people who support you and want to see you healthy and happy. Avoid people that drain your energy, encourage disordered eating behaviors, or make you feel bad about yourself.
• Stick with your eating disorder treatment plan. Don’t neglect therapy or other components of your treatment, even if you’re doing better. Follow the recommendations of your treatment team.
• Fill your life with positive activities. Make time for activities that bring you joy and fulfillment. Try something you’ve always wanted to do, develop a new skill, pick up a fun hobby, or volunteer in your community. The more rewarding your life, the less desire you’ll have to focus on food and weight.
• Avoid pro-ana and pro-mia websites. Don’t visit websites that promote or glorify anorexia and bulimia. These sites are run by people who want excuses to continue down their destructive path. The “support” they offer is dangerous and will only get in the way of your recovery.
• Identify your “triggers.” Are you more likely to revert to your old, destructive behaviors during the holidays, exam week, or swimsuit season? Know what your triggers are, and have a plan for dealing with them, such as going to therapy more often or asking for extra support from family and friends.