Teen Body Image: What’s Normal and What’s Not

As parents, we always think our children are beautiful.  We can see them for the whole person they are and for the potential they have to do great things in the future.  Because of this, we may struggle to understand how our teenage daughter, who wears a size 4, can look in the mirror and say that she is fat or that she needs to lose weight.  We may feel frustrated that no matter what we say, we cannot seem to influence her opinion of herself.  We may worry that her concern with her appearance is unhealthy or that she is at risk for an eating disorder.  While we have reason to be worried, it isn’t because this attitude is abnormal.

In truth, the size 4 teen who is worried about being overweight is fairly typical.  In our society, one of the ways we define attractiveness is size and there is no question that there are social advantages to being considered attractive.  Attractive people tend to be more popular, get better grades, and are more likely to be hired for a job.  The pressure to be attractive, especially during the teen years, can be overwhelming.  This is likely why research indicates that only two out of every ten girls are happy with the way they look when they look in the mirror.  However, even though this attitude might be normal, it doesn’t mean it is healthy. 

Unfortunately, the definition of attractive has become so narrow in our culture that it has become virtually unattainable for most of us, especially when it comes to weight and body type.  The images held up as examples of the ideal body represent only 5% of the female population.  This means that the other 95% of women are striving to become something that is almost impossible to achieve.   For teens, this is often where the trouble starts.

Research has shown that when people have a negative body image, it increases their risk factors for unhealthy behaviors like extreme calorie restriction, compulsive exercise, vomiting, and laxative abuse.  Additionally, the more people think about their appearance, the more dissatisfied they become.  Negative body image can become a vicious cycle that leads to eating disorders, depression, anxiety, and other dysfunctional behavior.  This is why the size 4 teenager’s attitude may be normal, but it isn’t healthy.

There are a number of factors that influence how we see ourselves.  The images of the ideal presented by the media mentioned above are one factor.  Another important factor is the messages we get from the other people in our lives like parents and peers specific to ourselves.  In some ways, these messages carry more weight than those from the media because of their specificity.  It is one thing to feel inadequate in comparison to a movie star or model; it is another to feel inadequate because someone who knows you tells you that you are.  For this reason, the most important thing parents can do to boost their teens body image is to monitor the messages they are sending.  If you have concerns about your teen’s body image or are concerned that their body image is contributing to other problems, talk to a mental health professional to determine the best course of action.


What Every Parent Needs to Know about Eating Disorder Symptoms

Picnic plate full of assorted food.

As a parent, do you know the warning signs of eating disorders? (Photo credit: Wikipedia)

Millions of people in the U.S. are impacted by eating disorders every year.  This includes those suffering from the eating disorder as well as their family members and friends.   Unfortunately, many people who have these disorders do not get the help, support, and treatment they need to be healthy.   Recent research indicates that as many as half a million teenagers may be suffering from an eating disorder but according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD) on average only 1 in 10 people with these conditions get treatment.  This means we all need to do a better job of identifying those who are in trouble, preventing disorders from developing, and treating those who are struggling; the consequences of doing any less are simply too high.

Prevention and early detection are critical to minimizing the long term damage suffered by those who are dealing with these potentially life-threatening conditions.  The key to early detection is to know what to look for and what actions to take if you suspect that someone in your life is suffering from an eating disorder.  To help, here are the most common immediate symptoms of the most prevalent eating disorders.

Anorexia Nervosa

  • Unusual eating habits or patterns, may skip meals and/or avoid certain foods
  • Eating only small amounts
  • Weighing and measuring food
  • Obsessive calorie counting
  • Excessive exercise
  • Intense fear of gaining weight

Bulimia Nervosa

  • Bingeing or eating excessive amounts of food in a single sitting
  • Inability to control their bingeing
  • Self-induced vomiting
  • Abuse or misuse of laxatives or diuretics
  • Skipping meals
  • Excessive exercise
  • Intense fear of gaining weight

Binge Eating Disorder

  • Bingeing or eating excessive amounts of food in a single sitting
  • Inability to control their bingeing
  • Eating to discomfort and eating when not hungry

These behaviors and symptoms can indicate the presence of an eating disorder and if you are concerned that your teen may be struggling with any of these disorders, you should make an appointment to discuss your concerns with their doctor.

The longer term symptoms and consequences of these eating disorders, which are outlined below, are increasingly more serious which underlines why prevention and early detection is so critical.

Anorexia Nervosa

Bulimia Nervosa

  • Dehydration and electrolyte imbalance
  • Constipation, bloating, and diarrhea
  • Dental problems including loss of enamel, gum disease, and cavities
  • Throat and esophageal problems including tears and ruptures
  • Anemia
  • Dry skin
  • Vomiting blood
  • Irregular heart beat
  • Low blood pressure
  • Heart failure

Binge Eating Disorder

  • Obesity
  • Type 2 Diabetes
  • High blood pressure
  • High cholesterol
  • Gallbladder disease
  • Heart disease
  • Specific kinds of cancer

What is IOP?

Teen Advisory Committee-13

Doorways Arizona currently offers two ongoing IOP groups. (Photo credit: Vancouver Public Library)

To most people, there are two kinds of mental health treatment. First, there is inpatient treatment where you live at a facility for weeks to months and which includes treatment for chronic issues or addictions and secondly, Outpatient treatment, which is meeting with a group or an individual provider, typically once a week. Here at Doorways, we understand that there are times where adolescents and young adults need more than a weekly one on one with a therapist or other provider, but who don’t need to be in an inpatient program.  In an effort to fill this need, we developed an adolescent and young adult-specific Intensive Outpatient Program (IOP) that target specific disorders.

IOPs meet several times over the course of a week and participants are part of several different kinds of therapy each day.  These programs enable us to provide more comprehensive treatment options in the specific areas where a more intensive experience is warranted.

Doorways currently offers two ongoing IOP groups, the Young Adult Trauma IOP and the Adolescent Eating Disorder IOP.  These specialty groups each meet three days a week and have rolling, open enrollment.

The Young Adult Trauma IOP is for those ages 17-25.  The program requires 10 hours a week spread over a three day period.  Each week, attendees participate in the following different types of therapy and group sessions.

  • Art Group – These groups are designed to enhance and reinforce positive emotion.  Participation helps promote peace and calm.
  • Process Group – These groups help participants practice identifying and expressing emotions, learning to let go of shame, and how to build relationships with interpersonal skills.  By sharing their experiences, participants grow and learn to trust others.
  • Yoga and Mindfulness – This group uses yoga and mindfulness practice to increase participants’ awareness of thoughts, feelings, urges, and actions in an observational and non-judgmental way.
  • DBT Skills Group – These groups use the concepts and theories from Dialectical Behavior Therapy to help participants develop effective life coping skills.
  • Skills Card Process Group – This group expands on the skills learned in the DBT Skills Groups and helps participants learn to process thoughts, emotions, feelings, self destructive behaviors, and urges.  The emphasis is to put the skills, learned in the DBT Skills Groups, into practice.
  • Voice, Power, & Trust Group – This group provides participants with a place to tell their story in a safe space and is designed to help trauma victims recover their voice and learn to trust again.
  • Trauma Theory – This session combines psychoeducation and processing in an effort to explore a model of trauma and how it is manifested in adulthood.

The Adolescent Eating Disorders IOP is for those ages 13-18.  The program requires 13 hours a week spread over a three day period.  Each week, attendees participate in a variety of therapy and group sessions.  In addition to the Process Group, Yoga/Mindfulness Group, and DBT Skills Group outlined above, this IOP also includes the following:

  • Group Meals – Each meal or snack is an Exposure with Response Prevention (ERP) session supervised by a dietician or therapist.  ERP is a premiere method of learning to tolerate the kind of anxiety often experienced with eating disorders.
  • Nutrition Group – This group’s focus is promoting a healthy, balanced approach to eating that is supported by the latest research and is taught by a registered dietician with years of experience treating children and adolescents with eating disorders.
  • Body Image Group – This group provides participants with a place to tell their story in a safe space and is designed to help those with eating disorders recover their voice.
  • CRT Group – Cognitive Remediation Therapy (CRT) is on the cutting edge of eating disorder treatment.
  • Parent Group – The goal of this group is to give parents and guardians the necessary information to assist in their loved one’s recovery process.  This group is for parents and guardians only.
  • Parent Update – The focus of this group will be to discuss client progress, barriers, obstacles, concerns, and expectations for the weekend while establishing the type of structure that is conducive to the recovery process.

Sam Lample Presents at the 45th Annual Southwestern School for Behavioral Health Studies

978200f0009e4de2ada8172dd480fdddThe 45th Annual Southwestern School (SWS) for Behavioral Health Studies conference will once again be held at Loews Ventana Canyon, August 18 – 22, 2013, in Tucson, Arizona.

This year’s theme is: Embracing Recovery and Wellness –Where Hope Stems from Within.

August 18, 2013 @ 9:00 am – 1:00 pm

Southwestern School for Behavioral Health Studies

7000 North Resort Drive

Tucson,AZ 85750

This interactive demonstration of action methods will allow attendees to witness, practice, and experience strength-based structures that capitalize on clients’ strengths to put recovery and wellness into action.

This is one of the many spectacular sessions offered at the 45th Annual Southwestern School for Behavioral Health Studies. A great way to get your continuing education in the splendor of the Loews Ventana Canyon Resort in Tucson.


Sam Lample will present on Trauma, Relational Intimacy and Eating Disorders: A New Look at an Old Problem at the 45th Annual Southwestern School (SWS) for Behavioral Health Studies conference. 

Session 1

The first session will offer an alternative definition of trauma before describing the five key elements of createdness that become wounded when traumatic events occur.  This will lead into a discussion of relational intimacy and its connection to eating disorders before the session ends.

Session 2

The second session will briefly summarize the previous session before spending the majority of the time exploring the intricacies between eating disorders and relational intimacy. Some time will also be dedicated to recognize the biological components of eating disorders by highlighting the role of the insula in body image distortion.


  1. Learners will be able to understand the predictable impact of trauma on one’s sense of self.
  2. Attendees will be able to explain how eating disorders create a false sense of relational intimacy.
  3. Participants will be quipped with effective therapeutic strategies to restore relational intimacy.


How Parents Can Help Prevent Eating Disorders

Mom and teenager

What messages are you sending to your teen impacting their self-image?  (Photo credit: Tammy McGary)

When it comes to preventing a child or teen from developing an eating disorder, the best place to start is with their parents.  According to the National Eating Disorder Association (NEDA), studies have shown that eating disorder prevention programs can help keep disordered eating from developing by shifting perspectives, changing attitudes, and discouraging disordered eating behaviors.  As parents play an important role in establishing and developing healthy attitudes about food and weight, their influence can make a real difference as their child moves through adolescence.

Follow these suggested tips and strategies to make sure you are doing everything you can to try and prevent your child or teen from having to deal with an eating disorder.

  1. Take a long look in the mirror.  Your attitude about your own weight has a direct impact on child.   Your attitudes about exercise, food, and weight will shape how your child feels about these things.   If you are obsessed with your weight, participate in yo-yo dieting, avoid any physical activity, talk negatively about other people’s bodies, or have a disconnected perspective of your own weight, your child may, too.
  2. Watch what you say.  Whether you are making disparaging comments about your own weight, your child’s weight, or the weight of that celebrity on television, you are telling your own child that weight is somehow related to worth.
  3. Focus on what you want.  Whether you are worried that your daughter wants to be too thin or that your son is overweight, the best approach is to focus on what you want for them rather than on what you don’t.  This means keeping your focus on developing and maintaining behaviors that promote health rather than focusing on how much they weigh.
  4. Make sure you send the right message.  We, as people, are less likely to feel pressured to change to meet the ideals of others if we feel like we are fine just the way we are.  This is the most important message parents can give their kids to keep disordered eating from developing.
  5. Be a role model.  Actions speak louder than words and if you want your child to live an active lifestyle filled with healthy food and healthy attitudes, you need to live in that world first and show them how.
  6. Don’t be a food dictator.  Help your child develop healthy eating habits by supporting their exploration into their own tastes.  Encourage them to stay tuned in to their body so that they can learn how to eat when they feel hungry and to not eat when they don’t.  Instead of requiring clean plates, suggest smaller serving sizes.  Rather than counting their calories, get them involved in meal planning and preparation and choose healthy nutritious options together.
  7. Be accepting.  Help your child develop a strong sense of their own self-worth by showing them it is ok to be who they are, no matter what that means.  Be accepting of other people and celebrate differences so that your child grows up understanding that who people are is more important than how they look.

Causes of Eating Disorders


Do you know all the variables that can cause an eating disorder in your teen?  (Photo credit: andrefaria)

When a teenager is diagnosed with an eating disorder one of the most common questions parents ask is what caused the disorder to develop.  This is an understandable response, but the unfortunate fact is that there isn’t a simple answer to this question.  Disordered eating is a complex problem and there are many factors that can contribute to its development.   According to the National Eating Disorder Association (NEDA), eating disorders evolve out of a combination of behavioral, biological, emotional, psychological, interpersonal, and social factors.   This means that each individual that is diagnosed has their own set of circumstances within those common factors that lead to the development of their disorder.

Many people assume that when a person struggles with disordered eating it is about the food, their weight, or even their appearance.  On the surface the outward symptoms of an eating disorder might support that assumption.  For example, someone who is suffering from anorexia nervosa may seem obsessed with their weight and their caloric intake.  They might track every calorie they ingest, worry about getting fat, and obsess about exercising.   All these seem to support the assumption that the person has an issue with their weight.  However, most experts agree that many people with eating disorders use food and their control over food as a coping mechanism.   The exertion of extreme control over their diet can help them feel in control when other things are out of control, overwhelming, or too emotionally charged to handle.

Although there is often no clean, simple cause to blame when an eating disorder is diagnosed, there are some common factors that are known to contribute to their development.

Biological Factors

  • Some people that suffer from eating disorders have a chemical imbalance in their brain associated with the neurological chemicals that control things like appetite and hunger.
  • There appears to be a significant genetic component to disordered eating.
  • More research needs to be done in this area to study how genetics and neuro-chemicals can contribute to disordered eating.

Emotional Factors

  • There is evidence that stressful times, major life changes, and traumatic events can lead to the development of an eating disorder.  If you consider that disordered eating is about establishing a feeling of control over one’s life, it makes sense that events that shake up a person’s world or alter it altogether could lead to the development of these conditions.

Psychological Factors

  • Issues with self-confidence, self worth, and self-esteem can contribute to disordered eating.
  • Feelings of hopelessness, inadequacy, anxiety, and loneliness can also lead to the development of a disorder.
  • Mental health conditions like depression and anxiety might also precede or go hand in hand with the development of an eating disorder.

Interpersonal Factors

  • Problems interacting with other people and trouble with personal relationships can be a contributing factor along with struggling to express emotions and difficulties dealing with feelings.
  • A history of being bullied, especially if the bullying behavior centered on weight.
  • A history of some form of abuse including physical, sexual, or emotional abuse.

Social Factors

  • Cultural messages that value beauty over other attributes and that associate beauty with a specific body type.
  • Stress related to prejudice, discrimination, bullying, or other forms of harassment and abuse.

Eating disorders are very serious, often life-threatening. A person struggling with an eating disorder needs professional help; they can’t win this battle on their own. If you know someone you suspect may be struggling with an eating disorder, or if you have any questions about how to know for certain, please give us a call. We would love to help. Their life could depend on it.

Dating Violence and Teens

Teenagers of various backgrounds in Oslo, Norw...

Though technology affords teens the ability to interact without being together, teen violence and abuse still readily exists.. (Photo credit: Wikipedia)

Times have changed since today’s parents were teenagers and the rules about almost everything seem to be different.  Parents who used to spend hours hanging out with their friends at the arcade or the mall now wonder if their child is well-adjusted and socially engaged because they don’t seem to hang out with their friends much at all.  What many parents don’t realize is that the way teenagers interact and engage with each other is completely different from their own experience.   Teens used to need to be separate from their parents physically in order to interact with other teens without parental awareness or involvement.  But now, all they need is an internet connection and a smart phone and they can get that separation without ever having to leave the living room.

These differences cross all the different types of relationships teenagers engage in, including dating.  Where parents “went out” with each other, figuratively and literally, today’s teens may never go “out” on what their parents would recognize as a date.  So much has changed in the span of a generation that it can be difficult for parents to understand their teen’s relationships or even recognize when they are involved in one.  Even though technology affords teenagers the ability to interact with one another without leaving their own family’s living room, they may still meet up with each other outside of their home and possibly get involved in behavior that could be dangerous, even though it wouldn’t be recognized as a typical dating scenario. Unfortunately, there is one thing about teen relationships that hasn’t really changed in the face of technology, the possibility that a teenager’s relationship will become abusive.

According to the Centers for Disease Control, 9% of teenagers report that they have experienced some form of physical abuse in the past 12 months.   If you factor in other forms of partner abuse including emotional, sexual, and psychological, 1 in 4 teens report some form of dating violence each year.  The long term consequences of dating violence amongst teens are significant.  Teenagers who experience or witness dating violence can find it difficult to excel academically and may be more likely to skip school or drop out.  Victims of this kind of abuse are more likely to smoke, use illicit or illegal drugs, struggle with eating disorders, and consider suicide.  The pregnancy rate amongst teen girls who have been victims of dating violence is 3 times higher than their peers.

What Parents Can Do

One of the most important things parents can do is to talk to their teenagers about dating violence.  Teaching teens what is and is not a healthy relationship helps them see when a boyfriend or girlfriend’s behavior crosses the line.  Teach teens these warning signs that their relationship is becoming or has become abusive:

  • Being called names
  • Being embarrassed, put down, or degraded in front of others
  • Possessiveness including non-stop texting and calling, demanding to know whereabouts and who they are with
  • Threats
  • Controlling behavior
  • Any physical violence
  • Pressure to have sex or forced sex

Additionally, parents need to know which warning signs to watch for so that they will know if their teen is in trouble but unable or unwilling to report it.  Parents need to be alert for:

  • Rapid drops in grades
  • Changes in mood or personality
  • Struggling to make decisions
  • Hesitant to offer their opinion, even when asked
  • Signs of physical abuse
  • Negative attitude and talk towards themselves

If your child is being abused, contact the police department immediately.