Eating Disorders in Teens & Adolescents: Puberty & Development

Eating disorders often emerge during adolescence, a time of rapid growth and change. Warning signs in teens can be easy to miss, making early screening and careful monitoring of weight, mood and behavior especially important. With timely, evidence-based treatment, teens have a strong chance of recovery.

Why do eating disorders develop in teenagers?

Every year, about 14 million people worldwide experience an eating disorder, 3 million of whom are children and adolescents.¹ 2.7% of teens will experience an eating disorder in their lifetime, and 13% of adolescents will develop an eating disorder by the age of 20.^2,3

This stage of life is stressful and filled with rapid physical, emotional and social changes that can increase the risk of eating disorders. Hormonal shifts, puberty and ongoing brain development make managing emotions and body image more challenging.

Combined with pressures from peers, media, and high expectations, teens may turn to controlling food or weight as a way to cope. For those with genetic or psychological vulnerabilities, these factors can create a perfect storm for developing an eating disorder.

It is crucial for parents, caretakers and providers to recognize the signs of eating disorders in teens and know how to seek help. 

Eating Disorder Diagnoses in Adolescents

Eating disorders in young people present with a variety of symptoms and behaviors as outlined below.

Anorexia nervosa and atypical anorexia nervosa

Anorexia nervosais an eating disorder characterized by an intense fear of gaining weight and behaviors to suppress weight.¹² The fear of weight gain leads to distorted body image and disturbances in eating behaviors.

Atypical anorexia occurs in someone in a BMI >18.5 who has experienced weight suppression.⁴

There are two subtypes:⁴

• Restricting subtype (AN-R)
• Binge-eating and purging subtype (AN-BP)

Anorexia nervosa poses a serious risk to adolescents because restricting nutrients and energy during a key growth period can cause lasting effects on growth.

Bulimia nervosa

Bulimia nervosa is an eating disorder characterized by repeated episodes of binge eating followed by compensatory behaviors, such as vomiting, compulsive exercise or fasting. It is often connected to intense fear of weight gain and a distorted body image, even when weight appears within a typical range.⁴

Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by restriction of food, not due to concerns regarding weight or shape but due to lack of interest in food, avoidance of food based on sensory concerns such as smell, taste or texture or fear of adverse consequences of food.⁴

While ARFID is less common in teenagers, it can persist in adolescence, especially if not diagnosed and treated early. This can cause malnutrition because food avoidance and restriction make it difficult to meet nutrition needs.

Binge eating disorder

Binge eating disorder (BED)is a condition where individuals experience repeated episodes of overeating.⁴ These episodes often occur when a child is not hungry, involve consuming large amounts of food, and frequently extend well beyond the point of feeling full. Children and teens with binge eating disorder often feel a lack of control over their eating habits and struggle to sense when they are full.

How do eating disorders affect puberty and development?

Not only are teens at risk of all the same complications of food restriction and purging behaviors as adults, but some complications of eating disorders in these key development years have a lifelong impact on their growth and development

Puberty delays

Malnutrition can delay or halt puberty. Low body fat and malnutrition interfere with the hypothalamic-pituitary-gonadal (HPG) axis, decreasing levels of hormones like estrogen and testosterone. This can delay or prevent menstruation, growth and sexual development, effectively postponing puberty.

Amenorrhea

Amenorrhea is the absence of menstruation; amenorrhea is divided into two subtypes. Teens may have primary amenorrhea, the absence of menstruation in someone who has not had a period by age 15, or secondary amenorrhea, which occurs in girls who’ve had periods in the past.

Amenorrhea in patients with eating disorders is most often related to loss of body weight and its associated hormonal changes, known as hypothalamic amenorrhea, rather than a primary problem with the ovaries or uterus.

Low bone mineral density

Early onset of an eating disorder can prevent the development of peak bone mass.⁵Up to 60% of adult mass is gained during adolescence. By age 18, about 90% of peak bone mass has been achieved, making an eating disorder during this period particularly damaging to bone mineral density density.⁶

Altered brain development

Eating disorders in childhood may alter brain development. 11.6% of adolescents with anorexia nervosa and 14.4% with bulimia nervosa report at least one day when they could not perform normal activities.⁷

From childhood to late adolescence, essential developmental tasks occur in the brain related to cognitive, social, and emotional growth. Eating disorders may disrupt this vital developmental period, causing neurologic and developmental delays.⁸

Risk Factors for Eating Disorders in Adolescents

Multiple risk factors can raise a teen’s likelihood of developing an eating disorder, including genetics, co-occurring mental health issues, social pressures and participation in certain sports.

Genetics

Research is still emerging on how genetics influence eating disorders. Twin, adoption and molecular genetic studies suggest that a substantial portion of the risk for developing an eating disorder during adolescence may be inherited.⁹

Dual diagnosis

Research shows that 55–95% of those diagnosed with an eating disorder also meet criteria for another psychiatric condition, called a dual diagnosis.¹⁰ Co-occurring conditions in adolescents frequently involve traits like impulsivity, anxiety or obsessive behaviors, which can worsen eating disorder symptoms or lead teens to use disordered eating as a way to cope.

The thin ideal

The “thin ideal” promotes unrealistic body standards, causing children to believe that thinness equals beauty or worth. The “thin ideal” is often reinforced by social media, peers, and family members. This pressure can lead to body dissatisfaction, low self-esteem and fear of gaining weight. As a result, children might adopt harmful eating behaviors, increasing their risk of developing eating disorders.

Gender differences in body image

Boys and girls experience differences in how they view and internalize their bodies. Boys often want to be larger or more muscular, while girls tend to want to be thinner.^8,9 Media and societal messaging more consistently promote a single thin ideal for girls, and girls are more likely to feel worse after exposure to idealized media images, which may explain the differences in their desired appearance.^11,12

Learn more about eating disorders in boys.

Athletics

Participating in sports that judge based on aesthetics or are weight-dependent can lead young athletes to believe there's an athletic advantage to losing as much weight as possible and inadvertently encourage unhealthy ways to achieve weight loss.

Assessing Teens for Eating Disorders

For older children and teens, the American Association of Child and Adolescent Psychiatry recommends other assessments.⁸ Alongside the use of pubertal milestones, assessments are to be used to determine whether an eating disorder could be present.

Pubertal milestones

Puberty also demands a lot of energy and nutrients, and without them, the body cannot meet its needs for normal hormonal function, leading to a slowing or cessation of puberty.

Girls typically begin puberty between ages 8-13 and start their menstrual cycle around age 12, while boys hit puberty a little later between ages 9-14.⁸ Providers should use a sexual maturity rating to determine whether a teen is developing unusually slow or not at all, as critical pubertal milestones often overlap with the onset of an eating disorder.⁸

Eating Disorder Examination Questionnaire

The Eating Disorder Examination Questionnaire (EDE-Q) is a 28-item self-report questionnaire, adapted from the semi-structured interview, the Eating Disorder Examination (EDE). The questionnaire is designed to assess the range, frequency and severity of behaviors associated with a diagnosis of an eating disorder.

Eating Disorder Inventory

The Eating Disorder Inventory (EDI) is a standardized self-report measure that assesses attitudes and thoughts about weight and shape, as well as psychological characteristics associated with eating disorders.

Eating Attitudes Test

The Eating Attitudes Test (EAT-26) is a preliminary screening tool to identify individuals who may be at risk for developing or already have an eating disorder, behaviors and traits.

Laboratory testing

Providers can use laboratory testing to monitor luteinizing hormone (LH), follicle-stimulating hormones (FSH), estradiol and/or testosterone, hormones critical to sexual function and development.⁸

Treating Eating Disorders in Teens

Early intervention offers the best chance at recovery for teens and adolescents.

Nutritional rehabilitation

Providers should take into account The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines as they initiate nutrition to avoid refeeding syndrome in pediatric patients.

Patients identified as being at risk for refeeding syndrome, excluding young patients with anorexia nervosa, should initially receive conservative calories. They should be closely monitored for electrolyte abnormalities and treated appropriately according to established standards of care.¹⁴

Patients with low electrolyte levels before starting feeding should receive more aggressive supplementation than usual in stable conditions. The severity or speed of electrolyte decline and the risk of refeeding syndrome may influence whether electrolytes should be normalized before beginning any calories or increasing calorie intake.¹⁴

Psychotherapy for teens with eating disorders

There are multiple therapies that can help young people recover from eating disorders. Family-based treatment and cognitive behavioral therapy are at the top of that list.

Family-based treatment

Family-based treatment (FBT) is one of the most successful psychotherapy treatments for eating disorders in children and teens. FBT brings effective interventions from higher-level care settings into the home, where parents can serve as agents of change. With love, care and knowledge, families are encouraged to adapt these interventions in a way that suits them and respects the uniqueness of their family and child.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a primary treatment for eating disorders. CBT is a type of psychotherapy that targets challenging and changing cognitive distortions and their related behaviors. It can help children improve emotional regulation, develop effective coping skills and respond to challenges more effectively.

Getting Eating Disorder Treatment for your Teen

Eating disorders are serious medical and psychiatric illnesses that require timely intervention. Eating disorders can disrupt normal development and puberty in children, which can impact them well into adulthood. All eating disorders are treatable with evidence-based care. Medical stabilization and nutritional rehabilitation are essential to address and prevent further medical complications.

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References

1. World Health Organization: WHO. (2022, June 8). Mental disorders. https://www.who.int/news-room/fact-sheets/detail/mental-disorders
2. Eating disorders. (2025). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/eating-disorders#part_2573
3. Rienecke, R. (2017). Family-based treatment of eating disorders in adolescents: current insights. Adolescent Health Medicine and Therapeutics, Volume 8, 69–79. https://doi.org/10.2147/ahmt.s115775
4.  American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
5. Workman, C., Blalock, D. V., & Mehler, P. S. (2019). Bone density status in a large population of patients with anorexia nervosa. Bone, 131, 115161.
6. Golden, N. H., Abrams, S. A., Daniels, S. R., Abrams, S. A., Corkins, M. R., De Ferranti, S. D., Golden, N. H., Magge, S. N., & Schwarzenberg, S. J. (2014). Optimizing bone health in children and adolescents. PEDIATRICS, 134(4), e1229–e1243. https://doi.org/10.1542/peds.2014-2173
7. Swanson, S. A., Crow, S. J., Grange, D. L., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents. Archives of General Psychiatry, 68(7), 714. https://doi.org/10.1001/archgenpsychiatry.2011.22
8. Mehler, P. S., & Andersen, A. E. (2022). Eating disorders: A Comprehensive Guide to Medical Care and Complications. JHU Press.
9. Cohane, G. H., & Pope, H. G. (2001). Body image in boys: A review of the literature. International Journal of Eating Disorders, 29(4), 373–379. https://doi.org/10.1002/eat.1033
10. Hambleton, A., Pepin, G., Le, A., Maloney, D., Aouad, P., Barakat, S., Boakes, R. A., Brennan, L., Bryant, E., Byrne, S. M., Caldwell, B., Calvert, S., Carroll, B., Castle, D. J., Caterson, I. D., Chelius, B., Chiem, L., Clarke, S., Conti, J., . . . Maguire, S. (2022). Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. Journal of Eating Disorders, 10(1). https://doi.org/10.1186/s40337-022-00654-2
11. Voges, M. M., Giabbiconi, C., Schöne, B., Waldorf, M., Hartmann, A. S., & Vocks, S. (2019). Gender differences in body evaluation: Do men show more Self-Serving double standards than Women? Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00544
12. He, J., Sun, S., Zickgraf, H. F., Lin, Z., & Fan, X. (2020). Meta-analysis of gender differences in body appreciation. Body Image, 33, 90–100. https://doi.org/10.1016/j.bodyim.2020.02.011
13. Lock, J., & La Via, M. C. (2015). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 412–425. https://doi.org/10.1016/j.jaac.2015.01.018
14. Da Silva, J. S. V., Seres, D. S., Sabino, K., Adams, S. C., Berdahl, G. J., Citty, S. W., Cober, M. P., Evans, D. C., Greaves, J. R., Gura, K. M., Michalski, A., Plogsted, S., Sacks, G. S., Tucker, A. M., Worthington, P., Walker, R. N., & Ayers, P. (2020). ASPEN Consensus Recommendations for Refeeding Syndrome. Nutrition in Clinical Practice, 35(2), 178–195. https://doi.org/10.1002/ncp.10474