Eating Disorders in High-Achieving Girls: When Success Starts to Come at a Cost

Written by Dr. Colleen Reichmann, owner and clinical director of Wildflower Therapy

There is a particular kind of person I have met many times in my work as an eating disorder therapist. She is bright and conscientious and funny (although sometimes if feels like she has forgotten how to laugh as of late). She gets good grades and remembers deadlines. She is the one her teachers describe as mature- “an old soul,” they say. Her parents have always been able to count on her. She was never the “grey-hair-causing child,” if you catch my drift. She has always seemed to know exactly where she is going. Maybe she’s an athlete, a musician, a straight-a student, a leader among her friends, or some combination of all of these things. She has learned, perhaps very early, that being capable is a wonderful way to show up in this world.

And then, usually very subtly at first, something begins to shift.

Maybe it starts innocently enough. She wants to eat a little healthier. She becomes interested in nutrition. She decides to cut out a particular food, or starts going to the gym more regularly. Perhaps she has gained some weight during puberty and becomes uncomfortable with the (totally ordinary) experience of having a changing adolescent body. Maybe a friend makes a silly comment. Maybe social media supplies an endless stream of before-and-after photographs and wellness advice disguised as moral instruction. Or maybe she is simply anxious, and controlling her food feels like a pretty easily accessible corner of life she can make predictable.

However it starts, for the ones who end up in my office at least (and ah yes, for me when I was a teenager as well)… the rules tend to multiply quietly.

Soon there is a right way to eat and a wrong way to eat. There are foods that feel safe and foods that feel dangerous. There are workouts that are mandatory and rest days that feel like failures. There is a growing awareness of calories, portions, weight, shape, ingredients, mirrors, clothing, and photographs. Her mind becomes increasingly occupied by the body, even as the rest of life continues to look remarkably successful.

This is part of what makes eating disorders in high-achieving girls so difficult to recognize. Sometimes the eating disorder does not initially make a girl look like she is falling apart. It makes her look even more disciplined. And some people can actually go on for a startlingly long time with a very serious eating disorder on the inside brewing, while looking like they have it all on the outside.

The girl who is doing everything right

We tend to think of eating disorders as disorders of excess: too much exercise, too much restriction, too much concern with appearance. But underneath many of these behaviors, there is usually something much more complicated than a desire to be thin. What is it? Well that’s a deeply personal question, with an answer that will deep individualized and vary person to person. But some themes are things like a deep longing for certainty, a desperate desire for control, a need for safety, a pleading wish for belonging, or simply a drive to find relief from the relentless feeling that one is never quite doing enough.

For a high-achieving girl, an eating disorder can become particularly seductive because it speaks a language she already understands. This is so important to understand. It rewards effort, especially at first. It offers rules. It provides measurable goals. It turns something frightening and amorphous into a project. It allows people to narrow really scary, lonely thoughts like “will I ever be able to outrun this loneliness?” into very small, clear cut accomplishables like “swap out sauteeing for boiling anytime you eat chicken.”

High-achieving girls are often very good at clear cut accomplishables and projects. It’s just that the problem is that this project has no finish line.

There is always another food to eliminate, another number to lower, another workout to complete, another perceived flaw to correct. What begins as an attempt to feel better can slowly become a life organized around avoiding the possibility of feeling bad. The rules that were supposed to create freedom begin quietly taking it away.

This is why I pay attention not only to what a teenager is eating, but to what happens inside her when she cannot eat according to plan. What happens when the restaurant does not have a “safe” option? What happens when practice runs late and dinner happens at an unexpected time? What happens when she is invited to a friend’s house and doesn’t know what food will be served? What happens when she misses a workout because she is sick? What happens when her body changes in a way she did not authorize?

The answer tells us much more than the specific food, (or even the amount of food) that she is eating.

When perfectionism finds the body

I want to be clear that I don’t think perfectionism is inherently pathological! There are wonderful things about being a person who cares deeply, works hard, notices details, and wants to do things well. The difficulty comes when achievement becomes less about pursuing something meaningful and more about protecting oneself from the unbearable possibility of being inadequate.

For some girls, the body becomes the most available place to direct that fear.

There is something terribly appealing about the fantasy that if we can just get the body right, everything else will settle down. Maybe then we will feel confident. Maybe then we will be desirable. Maybe then people will notice us in the right way. Maybe then we will stop comparing ourselves to everyone around us. Maybe then we will finally be able to relax.

But the body is a particularly cruel place to build a perfectionistic project because it is not actually a project. Bodies are alive. They grow and age and soften and fluctuate. They respond to hormones, stress, illness, sleep, food, movement, pregnancy, puberty, medication, genetics, and a thousand other things over which we have very little control.

And a teenager’s body is supposed to change. Puberty is supposed to change it. Growing is supposed to change it. Becoming an adult is supposed to change it.

Yet our culture has become extraordinarily skilled at teaching girls to interpret those changes as evidence of failure. So a girl who has spent her childhood learning that hard work leads to success may reasonably conclude that her body should work the same way. If she tries hard enough, perhaps she can make it smaller. If she is disciplined enough, perhaps she can prevent change. If she follows the rules closely enough, perhaps she can finally arrive at the version of herself she believes will be acceptable.

But there is no arriving. Take it as someone who has been there, and who now has dedicated her life’s work to this. The goalpost simply moves.

The high-achieving girl may be the last person anyone worries about

Parents sometimes tell me that they weren’t immediately concerned because their daughter was still getting good grades. She was still going to school. She was still practicing. She was still applying to colleges. In some cases, she seemed more focused than ever! And please know how deeply I understand how frighteningly reassuring that all can be.

Eating disorders do not often cause immediate academic collapse, and a young person can remain outwardly high functioning while experiencing significant psychological and physical consequences. A girl may be terrified around food while still earning straight A’s. She may be exercising compulsively while continuing to excel on her team. She may be increasingly preoccupied with her body while appearing, to everyone around her, to be taking excellent care of herself.

Sometimes the first signs are much quieter. A girl who used to love going out with her friends begins avoiding plans involving food. She becomes increasingly rigid about meals. She is anxious when the family travels because she cannot control what will be available to eat. She becomes irritable when her routine is interrupted. She starts withdrawing from the people she loves because maintaining the eating disorder’s rules requires more and more secrecy.

There may also be physical signs: fatigue, feeling cold, dizziness, headaches, difficulty concentrating, changes in menstruation, gastrointestinal distress, or other symptoms that can accompany inadequate nutrition or disordered eating. But there is no single appearance that tells us whether someone has an eating disorder, and a person’s weight cannot be used as a proxy for psychological or medical health.

This matters enormously for parents. A child does not have to look emaciated to be sick. She does not have to have lost a dramatic amount of weight. She does not have to be purging every day or refusing every meal. Eating disorders occur across body sizes, and some of the most dangerous beliefs about eating disorders are rooted in the idea that there is a particular body that looks “sick enough.”

There isn’t.

The problem with calling it “healthy”

One of the stranger things about our current cultural moment is how difficult it can be to distinguish health from the performance of health.

A teenager can be praised for eliminating sugar, exercising every morning, choosing the “cleanest” option on a menu, or demonstrating impressive restraint. Adults may reinforce these behaviors without realizing it. We live in a culture that routinely treats thinness as evidence of virtue and restraint as evidence of character, while simultaneously telling girls that their worth should not be based on appearance.

It is a confusing message to grow up inside.

This is why I am often less interested in debating whether a particular food is healthy than I am in asking what role the food has begun to play in a young person’s life. Can she eat something she didn’t plan to eat without feeling that she has failed? Can she rest without needing to compensate? Can she participate in a family celebration without mentally calculating the consequences? Can she tolerate the discomfort of not knowing exactly what is going to happen?

Health requires some flexibility. And an eating disorder generally asks for the exact opposite.

It asks a person to narrow her life until there are fewer and fewer variables that might make her uncomfortable. The irony is that this narrowing can initially feel soothing. There is relief in knowing the rules. There is relief in knowing what is allowed and what is forbidden. But eventually the rules become the source of the anxiety they were created to prevent.

Suddenly a girl who once had an enormous life is spending an enormous amount of it thinking about food.

What I wish parents knew

If you are the parent of a high-achieving girl and you are beginning to wonder whether something is wrong, you do not need to wait until you have certainty.

You also do not need to become an eating disorder detective. You don’t have to monitor every bite or interrogate her about calories. You don’t have to prove that she has an eating disorder before you are allowed to be concerned. And you certainly don’t have to turn every family meal into a negotiation.

What can be helpful is becoming curious about the experience underneath the behavior.

A conversation might sound less like, “Why are you doing this?” and more like, “I’ve noticed that food and exercise seem to be taking up a lot of space for you lately, and I’m wondering what that has been feeling like.”

As you can probably guess (and you might even have some lived experience with this if you’ve tried to approach your kid in the past)-shame tends to make people hide. Curiosity gives them somewhere to go. The way we phrase things matter. So throw your bricks wrapped in velvet, as they say.

And sometimes, even when you phrase your questions in the best, most gentle way possible, a teenager will insist that everything is fine. Sometimes she genuinely believes it is fine. Eating disorders can distort our ability to recognize what is happening, particularly when the behaviors have been praised or rewarded by the culture around us.

A girl may not see herself as struggling because, in her mind, she is finally being disciplined.

She is finally doing what she is supposed to do. She is finally getting it right. Enter an eating disorder therapist-because that is often where the therapeutic work can begin.

Therapy is not about making her care less

I think parents sometimes worry that treatment will somehow take away the qualities they love most about their daughter. They don’t want her to lose her ambition or her drive. They don’t want her to stop caring about school or sports or the future. They may even worry that she will internalize their concern and push to get help as judgment, and that she will then turn inward.

This is, of course, not what good eating disorder therapy is trying to accomplish.The goal is not to make an ambitious girl less ambitious. It is to help her separate ambition from self-punishment.

There is an enormous difference between wanting to do well and believing that you must do well in order to deserve to exist comfortably in your own skin.

In therapy, we can begin asking different questions. What if rest isn’t laziness? What if nourishment isn’t something that has to be earned? What if a B is simply a B? What if your body is allowed to change without becoming a problem that needs solving? What if your worth doesn’t rise and fall with your productivity, your appearance, your college acceptance letter, or the number on a scale?

These are not easy questions for anyone. They can be especially difficult for a girl who has spent years receiving the message that her ability to excel is one of the safest things about her.

But there is another kind of achievement worth working toward. It is the ability to live a life that isn’t governed by fear.

To be able to eat birthday cake without turning it into a moral event. To skip a workout when your body needs rest. To wear the bathing suit. To order the thing you actually want at the restaurant. To change your plans. To disappoint someone occasionally and survive it. To let your body become a body rather than a lifelong assignment.

I desperately want that kind of success for the girls I work with. Not a smaller life disguised as a more successful one.

A bigger one. (And a genuinely more colorful one!)

When success starts to cost too much

There is a particular cultural story we tell about girls who accomplish a lot. We call them driven. We call them disciplined. We tell them that the world is theirs if they work hard enough.

I believe girls deserve ambition. I believe they deserve big dreams and difficult goals and the satisfaction that comes from becoming very good at something they love. But I also believe we have to be careful about the moment when achievement becomes a transaction: I will give you everything I have if you promise me I will finally be enough.

No grade can make that promise. No college acceptance can make it. No promotion, athletic accomplishment, compliment, number on a scale, or perfectly curated body can make it either.

And when a high-achieving girl develops an eating disorder, sometimes what she needs most is not another lesson in discipline. She needs permission to stop earning her way into worthiness.

She needs adults who can see beyond the report card, the athletic résumé, the polished exterior, and the photograph that says she is doing just fine. She needs someone to notice that the cost of success has become too high. And she needs to know that asking for help does not mean she has failed.

Sometimes it is the first deeply courageous thing she has done.

Eating Disorder Therapy for Teens in Philadelphia and on the Main Line

At Wildflower Therapy, we specialize in eating disorder therapy and body image therapy for children, teens, college students, and adults. Our clinicians have extensive experience treating anorexia, bulimia, binge eating disorder, ARFID, compulsive exercise, orthorexic behaviors, and other forms of disordered eating and body image distress.

We have an office to see people in-person in center city Philadelphia area and also in Devon, where we see people from across the Main Line. We also offer virtual therapy to clients in Pennsylvania and a few other states where our clinicians are licensed.

If you are a parent who has started to wonder whether your child or teenager’s drive, perfectionism, exercise, or relationship with food has shifted from something that supports her into something that is beginning to consume her, you do not have to wait for a crisis to reach out. Please reach out today to schedule your free consultation call with us.

Sometimes the first step is simply having a conversation with someone who understands what you are seeing. And sometimes, underneath the girl who seems to have everything together, there is a girl who is exhausted from trying so hard to get everything right.