The Hidden Cost of Girlhood: What Adults Get Wrong About Adolescent Eating Disorders

As a teacher my favorite hour of the day was around 2:30 pm. In our school, last period was—depending on a student’s grade—either a free block or a mandatory study hall. Girls would gather in my classroom, the afternoon light filtering in soft and golden, music streaming from somebody’s iPhone: Maggie Rogers, Billie Eilish, Bea Miller. They’d doodle on the whiteboards and huddle around my desk, and—all pretense of productivity abandoned, everyone tired from a day that began at 6 am—we’d just chat. It was the kind of nothing time that turns out to be the most meaningful.

I often kept candy in the bottom drawer of my desk. The girls knew where to find it, and on these afternoons we’d slowly pick through Kit-Kats and Reese’s and waxy bars of milk chocolate, a little sugar to get the day over the finish line. A former student told me that the first time she saw me unwrap a peanut butter cup with them, it was a revelation. She eats that? she remembered thinking.

As a teacher you become by default a role model. On paper, I was hyper-positioned for this: a young woman with a gold-plated degree, a former Division I athlete who still ran loops around campus after school, fast. That this—these achievements, this sort of mostly-external capture of some ideal—would appear to be in contrast with eating cheap candy is a line of thinking I recognize as not unique to this 17-year-old. I recognize the thinking as my own.

I played lacrosse in college. So much of myself was (and remains) bound up in my athleticism. The fall of my sophomore year I suffered an injury that required two surgeries and nine months away from my sport. That I could not train at the level I was used to—a routine begun as early as 11 or 12 years old, always doing as much physical activity as my body could possibly bear—caused a swift and sudden descent into chaos. No doubt I was depressed. No doubt I was desperate for any sense of control, having lost it over the thing I had always painstakingly commanded: my body.

On recommendation from the athletic department, I saw a sports psychologist retained by the university. Her office was across the street from a natural grocer’s. At Andronico’s I would nick two or three rings of dried sugared pineapple from the bulk foods aisle and eat them, furtively, as I walked to session. I stole the pineapple slices not because I could not afford them—what could they have cost, a dollar? Two?—and not because who hasn’t sampled from the bulk foods but because I could not bear the humiliation of interfacing with the cashier, who would then know: I was a girl who ate food. Could there be anything worse?

In therapy we never talked about the pineapple. It would be years before I would tell anyone that I struggled with disordered eating. In the prolonged space of recovery and relapse, I would live in three different states and meet the man I would eventually marry and find a new therapist, the exact right person at the right time. My prefrontal cortex would finish developing. I would return to my truest athletic love, running. No single element heals; all of it matters. But what would matter most of all is that I would spend my days in the company of young women.

According to statistics available from the National Eating Disorders Association, over 60 percent of teenage girls report trying to lose weight (compared to 29 percent of teenage boys). In one study, 13 percent of girls experienced eating disorder symptoms by age 20. Rates of clinical anorexia are as much as 20 times higher in women than in men. While men and boys do suffer from disordered eating—and suffer perhaps worse social stigma—it is nonetheless more prevalent among women. In a society that still struggles to give mental health concerns their proper weight, the fact that this particular disorder is a more typically female problem surely plays a role in our limited capacity to legitimize the experience. We downplay issues with food as just par for the course, the cost of doing business in girlhood.

In my work I could see that this was real. The girls I taught talked about it all the time. Sometimes explicitly: bodies, workouts, lunches, elaborate descriptions of dinners, every side dish and course meticulously explained. Sometimes they talked to me about how their family talked about food or bodies: Mom always eats her burger without a bun, Dad wears his Garmin even on the family walk around the neighborhood. Behind their stories I heard: Am I supposed to be that way? How do I not? What if I am already having a hard time with my body, and I do not have the resilience to put those thoughts somewhere else?

Was I projecting? Or was I learning to listen? Were my efforts to legitimize for them, my students, or for myself?

At the peak of my eating disorder I ate apples and carrots, foods that required slow chewing. I took Adderall not because I needed help focusing but because it is—like cocaine—an appetite suppressant, and allowed me to spend whole days not thinking about food. If I did eat I stuck my finger and then my toothbrush and then—my gag reflex obliterated—whole fists down my throat.

On the days I deemed good ones, I sought nourishment in the square of my kneecap, the right angles of my wrist, the cut of my clavicle. I ignored the swell of my cheeks (from the vomiting), the elevated heart rate. It feels important to clarify that for those years I was not consistently in possession of a body you might have identified as anorexic (and I do not use this word to describe myself; it doesn’t cover all the bases). It feels important to clarify this because we over-emphasize body type as an indicator of disordered eating. Anyone who has lived in these trenches would want you to know: It is never only about the body. It is barely about the ways it ravages you internally, the fact that you can die from a binge, that the strain of regular vomiting can tax the heart literally to the point of attack. Like addiction or OCD, an ED is a physical manifestation of a psychological burden; it’s the thoughts we wish we could manage, not our bodies.

I sense myself beginning to rationalize, pleading. Let me explain. This is real. I recognize the desperation to be heard and validated as not only my own, not only applicable to disordered eating.

The psychologist Lisa Damour writes in her book Untangled about the myth of “hormones” as the reason for teenage mood swings. It is less about hormones, she explains, and more a matter of actual brain activity: Compared to children and adults, teenagers have hyper-reactive amygdalae, the part of the brain responsible for emotion; at the same time, the prefrontal cortex is still developing. This means that limbic system responses are more powerful than the part of the brain that manages decision-making. In other words: The emotions a teenager feels and expresses are absolutely real; they are not false flags created by hormones—a comfortable misconception that allows us to discredit what an adolescent reports—but rather the result of a brain that is differently-calibrated than our adult ones.

The problem here—the mislabeling of teenage emotions—seems particularly pertinent to teenage girls, who will grow into a world that will see their emotions (any emotions) as a liability, a weakness, as code for overreacting. It would not be a stretch, either, to trace this line of thinking—it’s just hormones—to the ways our society discounts or refuses to wholly imagine women’s experiences. It is a diminishment of interiority that begins in adolescence.

As a teacher, it often seemed to me that the most important thing I could do was be a safe space for my students. It is a hard thing to learn but sometimes all they needed was someone to hold their pain with them, someone to say yes, this is real. I am not saying I ever nailed it. But with each cohort of students I got a little better at it, slowly chipped away at the impulse to fix and grew more comfortable just listening. Sometimes the best action really does involve inaction: just sitting with their feelings.

When supervisors observed my classes, they often noted: I took my students so seriously. Meaning: I treated their ideas as worthy and valid. I thought of them as scholars, as whole people. That this was in any way a noteworthy behavior should tell you something about how we think about teenage girls.

For years I externalized my behavior. I offered compassion because it’s what I believed I owed to my students. It did not occur to me that I owed it to myself. I would eat the cupcake at the class birthday party because I would—as a visiting psychotherapist explained in a school workshop—normalize eating cake for the girls. It did not at all occur to me that I was normalizing it for myself. I wrote a novel about teenage girls because I believed in validating the experience of girlhood. It seemed to me—a writer, who best contributes through her art—a way to ally, to advocate for young women, whose struggles and triumphs our society views only conditionally.

In my experience, a necessary aspect of disordered eating is the capacity to compartmentalize. I became a master at separating myself into discrete parts, my worst impulses cordoned off and hidden in bathrooms, shower stalls, bottles of laxatives, the labels peeled off. Even as I moved through recovery I continued to partition: I kept my 19, 20, 22-year-old selves beneath trap doors in the darkest parts of my brain. I eyed them warily, like demons that might emerge at any point.

I’ve returned me to myself slowly.

I was 23 the last time I purged, 24 the last time I kept a food diary. I wish I could say that in the years since I have achieved Brené Brown-levels of self-compassion and shame resilience. I am not yet there. Still it is hard for me to be weighed at the doctor’s office. Still I have to eat lunch intentionally. What I can say is that I now see that in wanting the world for my students I came to want it for myself. I see that teaching and mentoring young women is to receive daily lessons in empathy. I understand that my efforts to bear witness to their stories became an endeavor to corroborate my own.

There is also this: Late in our summer-that-wasn’t, I spent an afternoon at a lake house with some of my former students. Mostly I listened as they talked about college, boyfriends, ill-fated plans for in-person learning in the fall. This is upstate New York: the air in late August already starting to turn. We wore sweatshirts as we sat six feet apart on the dock.

I found myself thinking, throughout the day, how lucky I am to know these girls. How wonderful they are. How long ago it seems to me that I was them, and also not at all.

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All Girls: A Novel is available from St. Martin’s Press, an imprint of St. Martin’s Publishing Group. Copyright © 2021 by Emily Layden.