Eating Disorders in Children and Adolescents: An Overview for Primary Care Providers in Nevada

Eating disorders are serious mental health conditions that threaten physical health, emotional well-being, and social functioning. Eating disorders most often emerge in adolescence, but can begin in childhood and persist if unrecognized or untreated. Early identification and evidence-based care are critical for recovery.

In this guide, we’ll detail the different types of eating disorders, their causes and comorbidities, screening criteria, treatment protocols, and other relevant information. For a printable, at-a-glance screening guide, please see our Eating Disorders: Screening & Treatment Guide for PCPs.

I. What are the major eating disorders and their prevalence in youth populations?

Eating disorders involve disturbances in eating behavior or weight-related thoughts that cause impairment or distress. The core DSM-5 diagnoses relevant to children and adolescents include:

1. Anorexia Nervosa (AN)

Definition: Persistent restriction of energy intake leading to significantly low body weight for age/height, intense fear of gaining weight, and disturbance in valuation of weight/shape.

2. Bulimia Nervosa (BN)

Definition: Recurrent episodes of binge eating followed by compensatory behaviors (e.g., self-induced vomiting, laxatives, excessive exercise) to prevent weight gain.

3. Binge Eating Disorder (BED)

Definition: Recurrent episodes of eating large amounts of food with a sense of loss of control, without compensatory behaviors.

4. Avoidant/Restrictive Food Intake Disorder (ARFID)

Definition: Restrictive or avoidant eating that results in inadequate energy intake, weight loss, nutritional deficiency, or psychosocial impairment without weight/shape concerns typical of AN or BN; often driven by sensory avoidance, fear of aversive consequences, or low interest in food.

5. Other Feeding-/Eating-related Conditions (OSFED)

Definition: OSFED is a heterogeneous category capturing clinical eating-related dysfunction not meeting full syndrome criteria (e.g., atypical anorexia, subthreshold BED) — often common in practice. 

As you’ll see in the prevalence data in the next section of this guide, it’s important to note that these conditions (collectively called OSFED) may be more prevalent and severe than core DSM-5 diagnoses. For instance, a 2021 metaanalysis found that atypical anorexia nervosa (AAN) occurs more frequently than anorexia nervosa (AN), but tends to be underdiagnosed because it occurs in individuals with normal or higher-weight bodies. 

What are the prevalence rates of eating disorders in US adolescents? 

Eating disorders affect approximately 2.7% of American adolescents each year. An analysis by by the Addiction Group shows prevalence rates of eating disorders by category as follows:  

• Anorexia Nervosa (AN): Affects roughly 0.3% of teens; historically viewed as predominantly female, but community surveys suggest similar prevalence in girls and boys.
• Bulimia Nervosa (BN): About 0.9% among adolescents, with females experiencing BN at about 4–5 times the rate of males.
• Binge-Eating Disorder (BED): Roughly 1.6% of teens meet lifetime criteria, making BED more common than anorexia or bulimia in strict diagnostic terms.
• OSFED (Other Specified Feeding or Eating Disorder): Encompasses atypical or partial-syndrome presentations; accounts for 40–50% of all adolescent ED cases.
• ARFID (Avoidant/Restrictive Food Intake Disorder): A newer diagnosis that can represent 5–22% of pediatric eating disorder cases in clinical settings.

II. Causes and comorbidities

Peak age of onset for many eating disorders is adolescence, with risk increasing sharply during puberty. About 50% of lifetime eating disorders begin by the mid-teens, and many earlier cases are missed or misattributed to “picky eating,” anxiety, or growth changes.

Eating disorders arise from a complex interplay of biological, psychological, and social risk factors including:

Biological/Genetic

• Family history increases risk.
• Neurobiological factors (e.g., reward processing, appetite regulation) and genetic vulnerabilities contribute to susceptibility.

Psychological

• Low self-esteem, perfectionism, and difficulty regulating emotions can predispose to disordered eating.
• Anxiety, obsessive-compulsive features, or trauma histories are common.

Social/Cultural

• Societal emphasis on thinness or dieting pressures can contribute, especially in adolescents.
• Peer dynamics and media exposure may intensify concerns about weight/appearance.

Comorbidity

Co-occurring mental health conditions are frequent across eating disorders:

• Depression and anxiety disorders are the most prevalent comorbid disorders with ED. 
• In ARFID, anxiety and neurodevelopmental conditions (especially autism) are frequently seen. 

III. Diagnosis & recommended screening

Diagnostic Criteria

ED diagnosis is based on clinical evaluation and DSM-5 criteria, including:

• Behavior patterns (restriction, bingeing, compensatory behaviors)
• Impact on weight, growth, and functioning
• Psychological features relevant to body image (for AN/BN/BED) or sensory/avoidance (for ARFID)

Screening Tools

While eating disorders are impairing and underdiagnosed, the U.S. Preventive Services Task Force (USPSTF) notes that evidence is currently insufficient to recommend universal screening at this time. 

If a clinician suspects — or a family member indicates — that a patient may have an eating disorder, a clinician may use validated screening tools appropriate to age. 

The following comparison chart provides an overview of available ED screens, applicable age ranges, diagnoses, and other differentiating factors between screens:

IV. Evidence-based treatment protocols

The best outcomes are achieved through multidisciplinary, developmentally appropriate care, including:

Psychotherapy

• Family-Based Treatment (FBT): Especially effective for adolescents with AN and other restrictive patterns by empowering caregivers in re-establishing healthy eating
• Cognitive Behavioral Therapy (CBT): A first-line approach for BN and BED.
• Dialectical Behavior Therapy (DBT)-adapted models may help those with emotion-dysregulation.

Medical/Nutritional

• Ongoing monitoring of growth, vital signs, labs, and electrolytes.
• Dietitian-led nutritional rehabilitation and meal planning.
• Hospitalization may be needed for medical instability.

Pharmacotherapy

• May support treatment of anxiety, depression, or binge-eating behaviors in conjunction with psychotherapy. (More on this topic below.)

ARFID-Specific Care

• Tailored feeding approaches, sensory work, and gradual exposure; often involve dietitian and occupational therapy in addition to mental health care. 

Pharmacological treatments for Eating Disorders: 

Medication is rarely the first or sole treatment for EDs in youth. Rather, psychotherapy and medical/nutritional management are foundational. 

There are very few medications formally approved by the FDA specifically for eating disorders in children and adolescents:

• AN & ARFID: No medications are approved to treat the core symptoms of anorexia or Avoidant/Restrictive Food Intake Disorder in pediatric populations. Medications may be used off-label to address comorbid symptoms, but not to treat the condition itself.
• BN: Fluoxetine (an SSRI antidepressant) is FDA-approved for the treatment of bulimia nervosa, including its use in adolescents in practice (though pediatric ED drug trials are limited, clinical guidance supports it).
• BED: Lisdexamfetamine dimesylate (Vyvanse) is FDA-approved for moderate to severe Binge-Eating Disorder — but the approval is for adults, not pediatric patients specifically. However, Vyvanse is approved for use in children for ADHD and is sometimes considered clinically for BED under specialist guidance. 

V. Outcomes and expectations

Eating disorders are serious but treatable. Some individuals fully recover and maintain healthy patterns long-term, while others may experience fluctuating symptoms over time. For many, eating disorders resemble chronic health conditions wherein ongoing vigilance and supportive strategies can reduce relapse risk.

Early intervention and sustained, appropriate care improve long-term prognosis significantly.

With evidence-based treatments, what are ED recovery rates?

The prognoses reported for adolescents with eating disorders vary widely, depending on research methodology, definitions of recovery, and duration of follow-up. However, below are some key findings from a 2021 review published by the AAP which provide clarity and context:

• Adolescents generally have better recovery outcomes than adults with eating disorders, with recovery rates approximating 70%.  
• Two significant predictors of weight recovery were a higher percentage of median body weight at initial presentation and shorter duration of symptoms. This finding further highlights the importance of early identification of EDs. 
• At 1-year follow-up, those with ARFID were the least likely (43%) to have regained ≥90% MBW and were also more likely to be younger, have had a longer duration of symptoms, and have left treatment prematurely. 
• Receiving a higher level of care (eg, partial hospitalization and/or residential care) did not increase the likelihood of weight recovery. 
• There were no significant differences in outcomes between treatment programs, despite various treatment modalities.

The AAP’s analysis also provides another important insight about the risks of EDs: 

“Mortality rates among individuals with eating disorders are substantially elevated in comparison with those of the general population, with death typically occurring in adulthood. Premature death is 4 to 5 times higher for patients with AN and 2 to 3 times as high for those with BN.200–203  Suicide rates are increased among patients with eating disorders204  and, in one study, accounted for 30% deaths.203  In a national survey of adolescents, 35% of those meeting criteria for BN, 15% of those meeting criteria for BED, and 8% of those meeting criteria for AN reported having made a suicide attempt.205  The risk of suicide among patients with eating disorders appears to be declining and has been attributed to an increased recognition of eating disorders and effective treatment.206“

VI. What to do if you suspect an eating disorder

For Families & Individuals:

1. Start with a trusted clinician (pediatrician, primary care provider, or mental health professional).
2. Share specific behaviors (restriction patterns, bingeing, compensation, marked fear of food/weight).
3. Seek evaluation promptly; early care improves outcomes.
4. In possible medical emergencies (e.g., fainting, rapid weight loss, marked electrolyte abnormalities), getting urgent medical care is essential.

For Clinicians:

1. Maintain a high index of suspicion in adolescents with weight changes, amenorrhea, GI complaints, anxiety, depression, or social withdrawal.
2. Use screens and collateral history from families.
3. Coordinate care with dietitians and specialists experienced with pediatric eating disorders.

A special note for Nevadans: 

There is no evidence that Nevada’s youth have statistically higher rates of eating disorders than peers elsewhere in the U.S. However, Nevada’s service access gaps and treatment capacity challenges are especially relevant for clinicians serving these populations.

Nevada faces mental health and specialist care access challenges that indirectly affect youth eating disorder care. For instance, health workforce shortages are especially acute in northern and rural parts of the state, which can delay timely referral and treatment access. Similarly, only a limited number of child and adolescent psychiatrists and specialized eating disorder treatment resources are available statewide, so clinicians may need to use telehealth or cross-state referral resources as part of care planning. 

This is one of many reasons why NV PAL is critical in helping clinicians and families throughout Nevada gain access to the specialized care required to effectively diagnose and treat mental health conditions, including Eating Disorders.