“You never listen to me.” 

“Leave me alone.”

“You never support me.” 

“I don’t want your input.”

“You don’t know what’s best for me.”

“I don’t know what to do. Why aren’t you helping?”

If you have an adolescent in your life, you’ve probably heard some version of these statements. Sometimes, the shifting perspectives and emotions of teenagers can feel like a rollercoaster, with sharp, unexpected turns, drastic highs and lows, and jolting swings forward and backward. For parents and loved ones, it can feel hard to keep up.

The wild ride of adolescence is challenging enough. When an eating disorder is along for the ride, the stakes are even higher, and the path forward can seem even more nebulous. In day-to-day life, parents of adolescents already may struggle to decipher the true desires, feelings and needs of their teenage children. When that same teenage child is suffering from an eating disorder, new layers of emotions can further obscure the truth.

As a parent or a loved one, you may see very clearly that your child is struggling with body image and eating disorder issues. Then again… you may not. Eating disorders thrive on shame, guilt, secrecy and confusion. The adolescent you know and love may appear to be going through the motions of life, and may even be excelling in their academic, social, and extracurricular pursuits. Unfortunately, eating disorders can persist, even when the surface of an adolescent’s life appears calm.

So, how do you know if a problem lies beneath the surface? Keep your eyes, ears and intuition alert:

What you may see

In some cases, you might notice a significant change in weight in your teenager. While gaining weight in teenage years is an expected part of growth and biologically important, losing weight can be a strong indicator that your teenager is struggling. Dramatic or rapid weight gain may also be an indicator, too, but it is critical that you look at more than just your child’s size before investigating potential issues further. Regardless of whether your child is gaining or losing weight, comments about their body can be extremely upsetting and can exacerbate an underlying eating disorder. Don’t make a decision based on weight alone. Other visual factors might also provide some clues. Perhaps your child has started preferring clothes that do not fit. Perhaps you’ve noticed a change in the food they allow on their plate, how much they eat, how/when/if they eat, how/when they get up from the table, and changes in bathroom behavior. Keep your eyes peeled.

What you may hear

Beyond what you might observe with your eyes, listen to your child. Increased conversation and focus on food or body image may be a strong indicator. While many adolescents struggle with negative self-talk, you might notice a particular focus on issues that relate to their perception of their body or their food choices. Listen with open ears, and strive to take a nonjudgmental approach toward your responses.

What you may sense

Sometimes, no matter how things look and sound on the surface, you just feel like something is off. Trust your instincts. Nobody knows your child better than you. If you sense significant shifts in your teenager’s personality, social preferences, and demeanor, don’t write it off as typical teenage blues. Though these stormy changes are often part of adolescent growing pains, sometimes they’re an indicator of much more.

If you believe your adolescent is struggling with an eating disorder, start by reaching out to a mental health professional for input. Share your concerns, what you’ve observed, what you’ve heard, and what you’ve sensed. Seek out advice on how to proceed.

After speaking with a professional, you may determine that your teenager needs eating disorder treatment. Guiding your adolescent to enter and participate in treatment can feel extremely daunting. Your teen may express mixed emotions about treatment, or downright resistance. How do you navigate the twists, turns, highs and lows of their emotions and preferences, while also holding true to your responsibilities as a caregiver? This is no easy task, but here are a few guideposts that might help:

Take charge, with heart.

Your child may express ambivalence or resistance to treatment. Keep in mind that they are too young, and potentially too ill, to make sound decisions. As challenging as it may be, hold firm to your choice for your child’s treatment. You know your teenager better than anyone, and as hard as it is, you are doing the right thing. Even as you hold fast to your choices, make space to listen to your child’s feelings. Your teen could be feeling any range of emotions that lie at the heart of their resistance – hopelessness, embarrassment, resignation, skepticism, defensiveness, and so much more. If you can uncover the underlying emotion behind their resistance, you may find new ways of framing your rationale for their treatment.

Bust the stigma.

Unfortunately, stigma around mental health treatment can heavily influence your teen’s emotions about treatment. Seek out examples of strong, inspiring role models in your child’s life who have spoken openly about mental health issues and eating disorders. Seek out examples of respected family and friends who’ve sought help and have shared openly about their struggles. Help your child see that they are not alone, and that their issues are ones that many of us have faced and overcome.

Focus on their priorities.

Getting a teen onboard with treatment can be challenging when their focus and priorities are elsewhere. Whether it’s socializing, academics, sports, art, or any passion pursuit, your child may feel that treatment will take away from their ability to pursue their dreams. Ask your teen about their hopes, their dreams and their passions. Then work together to uncover the ways in which treatment will open new doors to those pursuits. Beyond treatment, make commitments to your child on small steps you can take together in support of their goals. Help them see how treatment will support – not detract – from their goals and aspirations.

Last, but not least, seek support. These conversations and decisions are difficult. You don’t have to navigate these conversations alone. Enlist the support and advice of a mental health professional or your treatment provider. They will have a wealth of tips on how to approach the conversation. Also, seek support for yourself. Take care of your heart and soul throughout this trying time. Whether it’s a long walk, time with a friend, time with your partner, or time with your therapist, seek out a space to talk and share the feelings you’re going through. Eating disorders impact the whole family. And nobody – not even you – needs to be alone.