I was 13 years old the first time I put my fingers down my throat.

Over the next few years, the practice of forcing myself to vomit became an everyday — sometimes every meal — habit.

For a long time I hid it by taking a shower and counting on the running water to mask the sounds of my disorder. But when my dad overheard me and confronted me when I was 16 years old, I told him it was the first time I’d ever done it. That I’d just wanted to try and I would never do it again.

He believed me.

I started driving to fast food restaurants every night, ordering $20 worth of food and a large coke, dumping the soda out, and vomiting into the empty cup before going home.

In college, it was Ziplock bags sealed and hidden in a trash bag under my bed.

And then I was living on my own and I no longer had to hide.

No matter where I was, I found ways to evacuate my meals in secret. Bingeing and purging became my routine for over a decade.

Looking back now, there were so many signs. So many things anyone paying attention should have seen. But I didn’t really have that either — people looking closely enough at me to notice. And so I was able to hide.

As Mom to a little girl today, my number one goal in life is saving her from going down a similar path.

I’ve done the work to heal myself so that I can set a better example for her. But I also strive to make sure she’s seen, so that if anything like this ever does come up, I’m able to catch it and address it early.

Jessica Dowling, an eating disorder therapist in St. Louis, Missouri, says that eating disorders develop primarily in the teen years, with the peak age range between 12 and 25. But she believes the numbers are underreported, “due to the shame associated with being honest about eating disorder behavior.”

Because, like me, a lot of kids hide.

And then there’s the societal acceptance, and even praise, of striving to be thin.

“Some eating disorder behavior, like restriction and over-exercising, is praised in our society, which leads many adults to assume that a teen doesn’t have an eating disorder,” Dowling explained.

When it comes to how teens might work to cover up their eating disorder behavior, she said that some may claim to have eaten at a friend’s house when they haven’t eaten at all, or they may hide food in their bedroom or car to binge on later. Others may wait for their parents to leave the house so they can binge and purge without fear of getting caught.

“These are extremely secretive disorders because of the shame associated with bingeing, purging, and restricting,” Dowling explained. “No one with an eating disorder actually wants to live this way, and they have to hide what they are doing so as to not increase their feelings of shame and regret.”

As a psychiatrist and scientist who’s been treating patients with eating disorders since 2007, Michael Lutter says that with anorexia, it might start with skipping lunch, which is easy enough for a teen to hide from their parents.

“Having a small breakfast or no breakfast is also very easy to get away with,” he explained. “And at dinner, you might notice children trying to hide food, take smaller bites, or move food around on the plate without taking a bite.”

With both anorexia and bulimia, he said that vomiting, taking laxatives, and engaging in excessive exercise can all occur as the person tries to lose weight.

“Bingeing is also very common in bulimia, binge-eating disorder, and sometimes anorexia. Patients usually hide the binges, but parents will find food disappearing from the pantry (often bags of chips, cookies, or cereal) or find wrappers in the bedroom,” he said.

Lutter explained that older patients may go buy food themselves at convenience stories or fast food locations, “So there may be unusually large charges on credit cards or money that goes missing, as it can be quite expensive.”

There are a lot of potential risk factors for developing an eating disorder.

For me, a chaotic home life meant I was searching for control anywhere I could find it. What I put into my body, and what I allowed to remain there, was something I had power over.

It wasn’t even about my weight at first. It was about finding something I could control in a world where I otherwise felt so very out of control.

Dowling says there are often many factors at play. “In teens, it may be entering puberty before peers, social media usage, abuse at home, bullying at school, and having parents with an active eating disorder.”

She explained parents also need to be aware of how athletic coaches are treating their kids.

“Many times, teens do not want to discuss the ways coaches pressure them to stay at a certain weight (water loading, body shaming in front of teammates, etc.). These types of abusive coaching strategies lead to eating pathology,” she said.

Lutter went on to add that there’s a genetic risk as well, with possibly 50 to 70 percent of eating disorders developing in people who have a family history.

Beyond that, he said, “We know that the biggest risk for anorexia nervosa are negative energy states — that is any condition where you burn more calories than you take in.”

He explained that restriction diets to lose weight can be a trigger, but so can endurance sports like cross country, swimming, or dance, as well as certain medical illnesses (especially those impacting the gastrointestinal system).

“Western ideals of thinness also contribute to the drive for thinness,” he said, citing ballet, cheer, and dance.

There’s no doubt people living with eating disorders are great at hiding. But there are signs that can indicate a problem.

I personally have recognized eating disorders in teens I’ve met after seeing things I used to deal with — small cuts and bruises on their knuckles, a seeming obsession with chewing gum, or the faint smell of vomit on their breath.

More than once I’ve been able to gently bring these things to the attention of a parent who had concerns already, but hadn’t wanted to be right.

The National Eating Disorders Association (NEDA) also has an extensive list of signs parents can watch for. It includes things like:

  • being preoccupied with weight, food, calories, fat grams, and dieting
  • developing food rituals, like eating foods in a certain order or excessively chewing each bite, something I actually used to do, trying to chew each bite at least 100 times
  • withdrawing from friends and activities
  • expressing concern about eating in public
  • having difficulty concentrating, dizziness, or sleep problems

I’ve also found that dentists are often great at recognizing some of the signs of bulimia, especially. So, if you think your child may be bingeing and purging, you might want to consider calling their dentist ahead of their next appointment and asking them to discretely look for signs of excessive vomiting.

But what do you do with those suspicions when you realize they’re founded?

Lutter says the worst thing a parent can do is “confront” their child with their suspicions, as doing so can make the shame and guilt that much worse, causing a child to simply work harder at hiding their eating disorder behaviors.

“I always recommend simply stating facts and observations and then asking if there is anything they can help with instead of jumping straight to an accusation,” he said.

So instead of accusing the child of being anorexic, he says it’s better to say something like, “Sarah, I’ve noticed that you’ve only been eating egg whites and vegetables lately and you’ve been dancing a lot more too. You’ve lost a lot of weight. Is there anything you want to talk about?”

When in doubt, he said that many treatment centers will offer free evaluations. “You can always schedule an evaluation if you are worried. Sometimes children will open up more to a professional.”

Dowling agrees that parents should proceed with caution when expressing their concerns.

“Many times, parents are so concerned that they try to scare their teen into getting help,” she said. “This will not work.”

Instead, she encourages parents to try to meet their teens in the middle and see what steps they can take together. “Teens with eating disorders are scared and they need supportive parents to slowly help them seek treatment.”

In addition to seeking help from an eating disorder specialist, she suggests giving family therapy a try. “Family-based therapies are extremely helpful for teens, and parents need to play a very active role in helping their teen recover.”

But it’s not just about helping the teen recover — it’s also about making sure the rest of the family has the support they need in navigating that recovery. Include younger children, whom Dowling says may sometimes feel forgotten about as a parent tries to help their older sibling toward recovery.

Tips for parents

  1. State facts and observations, such as letting your child know that you’ve noticed they’ve been exercising a lot and that they’ve lost a lot of weight.
  2. Avoid scare tactics. Instead, meet your child in the middle and look for ways you can work together.
  3. Offer support. Let your child know that you’re there for them.
  4. Consider family therapy. Playing an active role in your child’s recovery can help.
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Almost 10 years went by between the first time I forced myself to vomit and the moment I truly committed myself to getting help. In that time, I also developed a habit of cutting myself and attempted to take my own life at 19 years old.

Today I am a 36-year-old single mother who likes to think of myself as being in a relatively healthy place with my body and food.

I don’t own a scale, I don’t obsess about what I eat, and I try to set an example for my daughter by never painting any food as good or bad. It’s all just food — nourishment for our bodies, and sometimes a treat to simply enjoy.

I don’t know what, if anything, could have started me down the road to recovery sooner. And I don’t blame my family for not pushing harder at the time. We all do the best we can with the tools at our disposal, and back then, eating disorders were a much more taboo subject than they even are today.

But the one thing I know for sure is that if I ever suspect my daughter is going down a similar path, I won’t hesitate to get us both the help we need. Because if I can save her from the years of self-loathing and destruction I once inflicted upon myself, I will.

I want more for her than having to hide in her own misery.

Leah Campbell is a writer and editor living in Anchorage, Alaska. She’s a single mother by choice after a serendipitous series of events led to the adoption of her daughter. Leah is also the author of the book “Single Infertile Female” and has written extensively on the topics of infertility, adoption, and parenting. You can connect with Leah via Facebook, her website, andTwitter.