Mealtime Warning Signs: What are Abnormal Behaviors?

When a child has an eating disorder, it can be difficult to see all of the behaviors that may be happening at your dinner table.  Here are some behaviors that may indicate there is a problem.

Is your child…

  • Moving food around her plate instead of actually eating?
  • Concerned about what what put in her food?
  • Dissecting food into tiny pieces?
  • Playing with and pushing food around the plate?
  • Taking extremely small bites of food?
  • Eating very slowly?
  • Hiding, dropping or smearing food?
  • Mixing strange combinations of food?

If you begin to notice these behaviors, correct your child with the appropriate prompts.  You can say things such as “Please take a larger bite of food,” or “Our meal needs to be finished entirely in the next ten minutes.”  Rely on your family therapist for extra support on how to manage these behaviors and ways to handle your child’s resistance.  It may be challenging to confront your child’s eating disorder behaviors, but it is essential in their recovery.

Sara Sharnoff Chesley is an in-home eating disorder therapist in Charleston, SC.  For more information, contact her at

My child has an eating disorder and is going back to school soon. How do we prepare?

For teenagers with eating disorders, going back to school can bring up many stressful emotions. They spend around 7 hours a day away from their parents and have numerous opportunities to engage in their eating disorder behaviors. Here is how parents can help their children’s recovery.

1. Speak to your child’s teachers/ nurse/ guidance counselor

It is important for the people who are in charge of your child throughout the day be aware of your child’s diagnosis. Teachers often notice when a child is lethargic, isolating, or engaging in other abnormal behaviors throughout the day. Many parents tell their child’s teachers to email them if their child’s behavior is worrisome so that they can address it with their child at home and in therapy. School nurses and social workers are also great resources. If your child is having trouble finishing her lunch, many parents send their children to eat with the nurse in private to make sure their child is receiving the proper nutrition throughout the day.

2. Stay in close contact with your child’s sports coach

If your child has been approved to participate in school sports, make sure the coach is aware of your child’s eating disorder. The coach will ensure your child is properly hydrated as well as keep an eye on any excessive exercising. Sports can be a very positive outlet for many teenagers with eating disorders, particularly with those struggling with bulimia. If your child is not approved for group sports, ask your doctor about other activities, such as gentle yoga, which can be very helpful in the recovery process.

3. Involve your child’s support system

With your child’s permission (and only if you have her permission,) talk to a friend who know about her eating disorder and ask her to contact you if she ever feels concerned. This is a great way to make sure your teenager has support not only from the adults in her life but from her peers as well. It will also ensure that your daughter has people she can turn to throughout the school day if she needs support.

With a little planning and a lot of communication, your child will be ready for a success new school year.

Sara Sharnoff Chesley is an in-home eating disorder therapist in Charleston, SC.  For more information, contact her at

What are the signs of an eating disorder? Part Two.

If you missed the first half of this post, click here. 

  • Changes in beliefs around food

It is not uncommon for a teenager  with an eating disorder to begin eliminating certain types of food.  Sometimes teens become vegetarians, or only eat organic food, or become preoccupied with “good” vs. “bad” foods.

  • Changes in physical activity

They may become preoccupied in physical fitness and spend hours exercising in a ritualistic, rigid manner. They may talk about the number of calories that they burned and the time they spent exercising. They may become perturbed if their exercise routine is disrupted and eat even less to compensate.

  • Changes in mood

Parents often describe their teens are exhibiting signs of irritability, anxiety, and depression. Teens with eating disorders often isolate and decrease their socialization due to lack of interest or an increase of panic attacks/social anxiety.  As the re-feeding process begins, teenagers often report a decrease in these symptoms.

  • Changes in health/body

Your child may become very dehydrated or experience fainting.  Teens with eating disorders often have chapped lips, hair loss, graying skin, or an increase of body hair. Frequently feeling cold, even in warmer months, is often a warning sign as well. They may also experience gastrointestinal problems, constipation, an absence of periods and disrupted sleep patterns.  Without proper nutrition, teens often feel a lack of energy and typically have low blood pressure. Teen who binge often have dental issues so it is important to have a good dentist who can alert you to any abnormal dental erosion.  

There are numerous warning signs that your child could have an eating disorder, and it is also imperative to use your gut and intuition.  If your child’s behavior is raising a red flag, take notice.  The sooner a child receives help for an eating disorder, the higher the chances are that she will make a full recovery.  Do not take your daughter’s word for it, and she may honestly believe that is she fine and does not need help.  If she is restricting food, her brain is not functioning properly and she needs an adult to take over and advocate for her recovery.

Sara Sharnoff Chesley is an in-home eating disorder therapist in Charleston, SC.  For more information, contact her at


What are the warning signs of an eating disorder? Part One.

Decoding the behavior of teenagers can be challenging enough without the added stress of identifying disordered eating patterns.  How can parents tell if their child needs help? Some warning signs of eating disorder behaviors are listed below. 

  • Obsession with body image

If you find your teenager constantly talking about her body in a negative way, or spending an excessive amount of time in the mirror nitpicking certain body features, your child may be at risk.  They may comment that they are fat or dissatisfied with their appearance.  Some teenagers will begin to idolize certain celebrities’ bodies and compare themselves to photoshopped images. Other teenagers may try to conceal their body shape by wearing baggy clothing.

  • Abnormal weight fluctuation

Teenagers are still growing and it is normal that their weight will fluctuate, but if your child begins to lose drastic amounts of weight or weighs less than 85% of their ideal body weight, it is imperative to take them to their physical for further examination.  Teenagers who struggle with Bulimia Nervosa may stay at their ideal body weight or even above their ideal body weight so it can be more challenging to detect.

  • Changes in eating patterns

Has your child been skipping meals, stating excuses such as “I’m not hungry, I already ate?”  Perhaps your teen is eating very slowly, or cutting her food into tiny portions, or hiding food and then throwing it away.  Perhaps she simply stops eating altogether, or you notice that she is binging on certain foods.  One of the key signs of bulimia is vomiting after meals, so if your daughter disappears to the bathroom following each meal, that is a warning sign that she may have a problem.

Stay tuned for part 2 to learn more signs of a potential eating disorder.

Sara Sharnoff Chesley is an in-home eating disorder therapist in Charleston, SC.  For more information, contact her at


How can my marriage survive our child’s eating disorder?

When your child has an eating disorder, the entire family is affected.  Marriages can often bear the brunt of the stress as partners disagree over treatment or have a difference of opinion on how to handle their child’s eating behaviors.  Here are three tips to keep your marriage strong and your family unit intact throughout the journey.

1. Seek Professional Help

When your marriage hits a challenging time and communication between you and your spouse begins to break down, it is always a good idea to speak with a professional who can help navigate around the tough issues. A couples counselor will not pick sides or try to determine who is “right;” rather, the goal is to help each partner feel understood and validated.  Teamwork is a critical part of helping a child through her eating disorder and it is essential to maintain a united front in the face of chaos.

2. Communication is Key

Often times when parents are in the midst of their child’s eating disorder, one parent becomes more of the enforcer role and the other parent becomes the comforter.  These roles make it very difficult for the child to recover because when one parent sticks to the treatment plan, the other may overcompensate with comfort and allow the child too much leniency. When both parents stick to the treatment plan, your teenager will have a better chance of success because she will understand that pitting one parent against the other will no longer work.

3. Self Care

It is challenging for many parents to pay attention to their own needs because they feel so much stress regarding their child’s health.  A sick, worn out parent cannot be an effective family leader so it is vital that you make time for yourself.  Get a pedicure, go to the movies, or even writing in a journal each morning can help recharge your body and spirit.  When you feel energized and strong, your marriage also strengthens and you can become a partner who is tuned in and present.

Relationships can become strained during the course of your child’s eating disorder, but remember to fight for the ones who you love and you can come through the other side a more resilient and compassionate person.

Sara Sharnoff Chesley is an in-home eating disorder therapist in Charleston, SC.  For more information, contact her at


How can I learn to practice mindful eating for my eating disorder?

Mindfulness is one of the key components for dialectical behavioral therapy, or DBT. The key idea around mindfulness is to stay focused on the moment and focus on just one thing at a time. Mindfulness can be an essential tool for teens struggling with eating disorders because it can help redirect racing thoughts and ease the anxiety around eating. Here is a mindfulness exercise that can demonstrate how to apply the skill.

  1. Take out a peppermint candy and place it in your hand.
  2. Slowly unwrap the candy and inhale its scent. How would you describe its smell?
  3. Notice the colors and texture of the mint. How does it feel in your hand? What colors or patterns do you see?
  4. Put the mint in your mouth. How does it taste? Focus on the experience of having the mint on your tongue. Take a moment and describe the experience.

This simple exercise uses your five senses to focus on staying in the moment. When a child with an eating disorder is struggling through mealtime, sometimes it can be helpful to just take things one bite at a time. This technique is especially helpful for clients who binge because they must slow down to truly experience their food. While this mindfulness technique might not work for everyone, it is one of many tools that we use in DBT to keep the focus on the present and away from stressful thinking.

Sara Sharnoff Chesley is an in-home eating disorder therapist in Charleston, SC.  For more information, contact her at

How did my child get an eating disorder?

Anger.  Shame.  Disbelief. Receiving the news that your child has an eating disorder can be a very confusing and overwhelming experience. One of the most common questions that parents ask is “How did this happen? Was it my fault?”  It’s important to conceptualize an eating disorder as a “perfect storm,” meaning the perfect combination of biological, psychological, and social factors must fuse together in order to manifest an eating disorder. As a parent, it is important to understand that you did not cause your child’s eating disorder.  There are several factors that may have contributed to the diagnosis.


People who are born with certain genotypes are at heightened risk for the development of an eating disorder. This also means that eating disorders are heritable. Individuals who have had a family member with an eating disorder are 7-12 times more likely to develop one themselves.  While a genetic component can increase a child’s likelihood of developing an eating disorder, other factors are still at play.


While every child is different, there are some similarities of adolescents who are more prone to developing an eating disorder.  Some of these traits include:

  • perfectionism
  • competitiveness
  • sensitivity to reward and punishment,
  • impulsive behavior (predominantly in bulimia nervosa)
  • rigidity (predominantly in anorexia nervosa)

If your child experiences some or all of these traits, they may be more susceptible for developing an eating disorder.


Parents were often blamed as the sole cause of their child’s eating disorder. As a therapist, you sometimes hear a client’s mother describe her husband as “aloof and uninvolved,” whereas the father will describe his wife as “overbearing and too controlling.” Family dynamics are not to blame for a child developing an eating disorder, but by utilizing family therapy during treatment, the family can become a source of support and empowerment and expedite the recovery process.

Sociocultural Ideals

Technology and social media have increased the pressure of adhering to a certain “acceptable” body type or appearance. Now more than ever, young women are encouraged to take videos and pictures of themselves to post online and often receive feedback from people they know, and often, people they don’t.

Ultimately, it does not matter why a child develops an eating disorder.  The most important step is identifying that there is a problem and seeking professional help as soon as you begin to notice physical, mental, and/or behavioral changes.  Understanding the etiology will not stop your child’s destructive behaviors, but working with a knowledgeable doctor, nutritionist, and a family counselor can give you your vibrant and healthy child back.

Sara Sharnoff Chesley is an in-home eating disorder therapist in Charleston, SC.  For more information, contact her at