The eating disorders called anorexia nervosa (obsessive restriction of food) and bulimia (forced purging) tend to begin in the preteen years and worsen in later adolescence. The severe weight loss associated with anorexia nervosa and sometimes bulimia results from a young girl's distorted view of her body as overweight. Ninety percent of people with eating disorders are female.

Eating disorders can affect girls as young as seven years old. Many in the medical community have gone so far as to call the increase in eating disorders in the United States over the last two decades an epidemic. Many anorexic girls literally starve themselves, giving anorexia nervosa the highest mortality rates among all childhood anxiety disorders. Obsessive exercise often accompanies the girl's starving behavior and sometimes causes parents to overlook the destructive impact of the disorder, so it's important to look beyond the generally positive effects on children of regular exercise to whether your child is keeping a minimum body weight for her age and height.

As many parents are increasingly aware, the cultural messages being received by preteen and adolescent girls often overemphasize thinness as an ideal and ridicule curves and larger-sized females. This can put enormous pressure on any young girl as she enters puberty, but for the preteen girl with OCD the stress can be especially burdensome. This issue can be made even more difficult if the child is taking a type of antidepressant that can cause weight gain as a side effect. When confronted with this delicate situation, parents need to keep the lines of communication as open as possible with their children. If you believe your child is developing symptoms of anorexia nervosa or bulimia, it is a serious issue that requires therapeutic intervention.

Obsessions with Food

Studies confirm that teenagers with OCD are at a much higher risk of developing a co-occurring eating disorder. Like many young girls and boys with OCD, children suffering from eating disorders have an intense preoccupation with food. Sufferers of both disorders often insist on cutting up their meals into small pieces, often saving their food rather than eating it at mealtimes. Many also develop irrational fears about the food they eat. These fears often involve contamination. The child may imagine germs or parasites on the food, even if there is no visible evidence to support this suspicion.

With both OCD and eating disorders, a child's food obsession can lead him to eat substantially less than he should. Both disorders can also cause an extreme self-consciousness about appearance. More information on teens with OCD and their vulnerability to eating disorders is in Chapter 13.

Body Dysmorphic Disorder (BDD)

People with BDD are plagued by a serious, persistent dislike and concern about some slight or imagined aspect of their appearance, causing them significant emotional distress and difficulties. This disorder can affect anyone, male or female, and often begins in early adolescence. BDD frequently co-occurs with eating disorders, anxiety disorders, and OCD.

Body dysmorphic disorder (BDD) shares with OCD several symptoms including an obsession with appearance, avoidance of social situations, and many repetitive behaviors, including excessive grooming, washing, and tics.