The new Netflix film To the Bone is raising awareness around a teen mental health issue that doesn’t get enough attention: eating disorders. While eating disorders are the most deadly of all mental illnesses, only 10 percent of people suffering from anorexia, bulimia, binge-eating disorder, or other eating disorders receive treatment. Therefore, kudos to Netflix for raising awareness of this topic and creating a platform for discussion around a mental illness that disproportionately affects teenagers. According to the Johns Hopkins Eating Disorders program, the most common age of onset is between 12 and 25. And, although they are much more common in females, 10 percent of those suffering from eating disorders are males.
Newport Academy Expert Featured on ABC 7 Los Angeles Discussing To the Bone
Chelsea Reeves, Director of Alumni Services at Newport Academy, spoke on the new film in a live segment on ABC 7 Los Angeles. She explained that To the Bone does a great job in creating conversation and awareness about eating disorders, as well as the underlying issues that can cause them.
“When someone struggles with eating disorders, it’s not about the weight, it’s about the underlying trauma,” Chelsea says. Furthermore, she adds that the film did well in showing the importance of peer connection and community for those suffering from eating disorders. —Chelsea Reeves, Director of Alumni Services for Newport Academy
Watch the Full Interview with ABC 7 LA
The Deadliest Mental Illness
One of the most frightening aspects of eating disorders is the fact that they have the highest death rate of any mental illness. This is due in part to the higher-than-average rate of suicide among those with eating disorders, and partly to the medical complications associated with eating disorders.
In fact, studies show that those with anorexia are over five times more likely to die than the rest of the population, according to a recent Newsweek article. Moreover, 15- to 34-year-old women with anorexia nervosa are 18 times more likely to die by suicide, compared to the general population of females that age, the article says.
“Eating disorders carry the highest death rate of all mental health disorders, through suicide or medical complications. As a result, they are far deadlier than any of the others.”
—Rachel Fortune, MD, National Medical Director for Newport Academy
Teen Eating Disorder Statistics
- 30 million people in the US currently suffer from an eating disorder, according to the National Association of Anorexia and Associated Disorders.
- In addition, half of these people also meet the criteria for depression.
- Among high school students, 44 percent of girls and 15 percent of boys are trying to lose weight at any given time.
- 35 percent of normal dieters progress to obsessive, pathological dieting. And, 20 to 25 percent of pathological dieters progress to an eating disorder.
- Every 62 minutes, a person dies because of an eating disorder.
- Fortunately, half of teens with anorexia or bulimia have a full recovery.
Signs and Symptoms of Teen Eating Disorders
There are both behavioral and physical warning signs of adolescent eating disorders. Here’s what parents should watch for.
Behavioral Signs of Teenage Eating Disorders
- Making excuses to avoid eating
- Always on a diet, even when not needed
- Over-exercising; obsessed with exercise to lose weight
- Secretly storing food or eating alone, particularly at night
- A distorted body image; body dysmorphia (an obsessive focus on a perceived flaw in one’s appearance)
- Compulsive use of laxatives, diet pills, and weight-loss aids
- An intense, obsessive focus on calories and caloric intake
- An unwillingness to discuss weight gains or weight losses
- Resistance to joining social situations where eating is expected
- Extended bathroom use during or right after meals
Physical Symptoms of Teenage Eating Disorders
- Unhealthy loss or gain of weight
- Repeated weight cycling, going up and down
- Constipation or vomiting
- Skin rash or dry skin
- Erosion of tooth enamel; dental cavities
- Loss of hair. And, loss of nail quality
- Obvious signs of exhaustion, insomnia
- Irregular menstruation or absence of menstruation
- Easily bruised; more prone to physical injury
- Cold sensitivity; unable to tolerate cold
Read about specific signs and symptoms of the most common eating disorders: anorexia, bulimia, and binge-eating disorder.
Eating Disorders, Depression, and Suicide
Because eating disorders are symptoms of underlying causes, they are frequently linked with other teen mental health challenges. Here are some findings of a National Institute of Mental Health study of 10,000 teenagers (ages 13 to 18) with eating disorders.
- The study showed significant impairment in day-to-day functioning, as well as suicidal ideation and suicide attempts.
- About a third of those with bulimia, 15 percent of those with binge eating, and eight percent of those with anorexia had attempted suicide.
- In addition, 55 to 88 percent reported such problems as anxiety, depression, or a behavioral disorder.
- Teens with eating disorders are also at greater risk for substance abuse and self-harming behavior.
- Researchers found that the majority of teens with eating disorders did have contact with mental health care, school services, or general medical services. But, less than a third had talked with a professional about their eating or weight problems.
The Link Between Eating Disorders and Drug Abuse
Furthermore, many studies have showed that teen eating disorders and drug abuse—both maladaptive, destructive behaviors—are intimately linked with one another. In fact, according to a report from the National Center on Addiction and Substance Abuse at Columbia University, as many as 50 percent of those with an eating disorder also abuse drugs. In addition, just over one-third of individuals with substance abuse disorder also have an eating disorder. However, this is in contrast to the general population, in which only 3 percent of people overall struggle with disordered eating habits.
“This lethal link between substance abuse and eating disorders sends a signal to parents, teachers, and health professionals–where you see the smoke of eating disorders, look for the fire of substance abuse and vice versa.”
—Joseph A. Califano Jr., former US Secretary of Health, Education, and Welfare
Social Media and Eating Disorders
In the film To the Bone, the main character, Ellen is an artist who made artwork about her eating disorder and shared it online. Subsequently, another teen is inspired and obsessed by Ellen’s drawings, which appear to have contributed to the decline in her mental health. The film points here to the prevalence of social media sites and conversations around eating disorders.
Online “pro-ana” (anorexia) or “pro-mia” (bulimia) sites encourage and even give instructions for disordered eating. In fact, in a study by Professor Nicole Martins and PhD candidate Daphna Yeshua-Katz at Indiana University, interviews with regular pro-ana bloggers revealed that many felt the websites granted permission for them to continue with their eating disorder. In addition, another study showed that such sites are visited by 13 percent of young female teens. And, that number triples among female teens who exhibit problematic eating behaviors.
Healing from Eating Disorders
The biggest obstacles in effectively treating eating disorders are the roadblocks to mental health treatment that are thrown up by the medical component of the disease. Moreover, kids with anorexia or bulimia can require frequent medical intervention for conditions caused by malnutrition, such as low heart rate, potassium deficiency, and dehydration.
“When kids are medically unstable, we’re unable to treat the underlying depression and/or anxiety, because the medical treatment always trumps the mental health work.”
—Rachel Fortune, MD, National Medical Director for Newport Academy
However, once teens with eating disorders are stabilized, there are many treatment options. For example, in To the Bone, the approach that ultimately catalyzes Ellen’s turnaround involves an intimate residential setting with half a dozen other young people. The film depicts residential treatment that includes moments of bonding, mutual support, and friendship among peers—all supportive elements of recovery.
Furthermore, Residential care has been shown to be very effective in treating teen eating disorders. However, whatever type of care families decide on, the most important thing, according to Dr. Fortune, is to have a team of treatment experts available to address this deadly issue. Thus, the team should include a physician who can keep the patient medically stable, a nutritionist, a therapist, and a family therapist.
Most importantly, what’s vital for teens and families to remember is that healing is possible. Consequently, those with anorexia, bulimia, and other teen eating disorders can recover and live happy and healthy lives.
Arch Gen Psychiatry. 2011 Jul;68(7):724-31.
Arch Gen Psychiatry. 2011 Jul;68(7):714-23.
Health Commun. 2013;28(5):499-508.
Addict Behav. 2010 May;35(5):392-8.