Adolescents and Eating Disorders by Andjela Vulovic

Introduction

When talking about adolescence, we are referring to the period of time that happens after the onset of puberty during which an individual develops into emerging adulthood. During this time, the adolescent’s brain is working hard to establish lifelong connections, as it phases out all nonessential gray matter. Additionally, the individual is dealing with a rapid overproduction of many hormones, which affects the way in which they perceive and interact with the world. Aside from the physiological changes, the individual is also dealing with many stressful variables, such as friends, family, new love interests, a newfound sense of identity, future goals, etc. For many adolescents, this overwhelming amount of stress can lead them to develop unhealthy coping mechanisms, such as disordered eating. If not addressed, this can lead to the development of full-fledged eating disorders.

According to the National Institute of Mental Health (NIMH), eating disorders are very serious and can lead to fatal illnesses (National Institute of Mental Health, 2018). They are generally characterized by obsessions with food or body weight, however, each eating disorder is driven by a different need such as control, shame, guilt, etc. Common eating disorders, as listed by the NIMH, are anorexia nervosa, bulimia nervosa, and binge-eating disorder (National Institute of Mental Health, 2018).

Epidemiology

In accordance with the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, the following diagnostic criteria must be met in order to meet the diagnosis of anorexia nervosa:

“1.Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

2. Intense fear of gaining weight or becoming fat, even though underweight.

3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Anorexia nervosa consists of starvation, which means that an individual suffering with anorexia nervosa would be denying their body the essential nutrients it needs in order to function. As a result of this, the body attempts to save energy by slowing down all of its processes. This results in serious medical consequences, and sometimes, even death. Regardless of how physically draining this disorder is, those with anorexia nervosa will often pride themselves on the control they had over not eating. In a way, this brings them comfort. At any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa (National Eating Disorder Association, 2018). However, an ongoing study found that over the last 50 years rates of anorexia have been increasing in females 15-24 years old while other groups remain stable (Lucas, A.R., Crowson, C.S., O’Fallon, W.M., and Melton, L.J., 1999).

The following diagnostic criteria must be met in order to meet the diagnosis of bulimia nervosa:

1. Recurrent episodes of binge eating.

2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

4. Self-evaluation is unduly influenced by body shape and weight.

5. The disturbance does not occur exclusively during episodes of anorexia nervosa. (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Bulimia nervosa is mainly characterized by a series of “binge and purge” episodes. During a binge, an individual will have relatively no control over how much they are eating and will continue to do so until either the episode is over or they simply cannot eat anymore. After a binge, a purge usually ensues. During this time, the individual attempts to rid themselves of their binge in ways such as misuse of laxatives, excessive exercise, periods of fasting, self-induced vomiting, etc. After these episodes, the individual will usually feel an overwhelming sense of shame or guilt, as opposed to the pride felt in cases of anorexia. At any given point in time, 1.0% of young women and 0.1% of young men will meet diagnostic criteria for bulimia nervosa, meaning that young women are 10 times more at risk than young men (National Eating Disorder Association, 2018). However, in adolescent females, that number jumps up to 5.4% (National Eating Disorder Association, 2018)

The following diagnostic criteria must be met in order to meet the diagnosis of binge-eating disorder:

“1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

§ Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.

§ A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

2. The binge eating episodes are associated with three (or more) of the following:

§ Eating much more rapidly than normal.

§ Eating until feeling uncomfortably full.

§ Eating large amounts of food when not feeling physically hungry.

§ Eating alone because of feeling embarrassed by how much one is eating.

§ Feeling disgusted with oneself, depressed, or very guilty afterward.

§ Marked distress regarding binge eating is present.

§ The binge eating occurs, on average, at least once a week for 3 months.

In cases of binge-eating disorder, individuals will experience intense shame and guilt reactions after an episode. In severe cases, individuals my experience depressive and/or suicidal symptoms. Due to this shame response, most hide their binge-eating from loved ones. At any given point, 3.5% of young women and 2.0% of young men will develop binge eating disorder, making it more prevalent than both anorexia nervosa and bulimia nervosa ((National Eating Disorder Association, 2018).

Causes

There are many different causes for the prevalence of eating disorders in adolescents. On one hand, adolescents are hyper-aware of their public perceptions. As a result, they desire to wear the most current styles, have the most “in” hair, know the most relevant jokes, and have the most “perfect” bodies. Day in and day out, they view media produced bodies, followed by the title, “lose 10 pounds quick”. Although media has been around for many years, and people were dealing with “ideal” body types as far back as the 1930s, it was never as much of an issue as it is today. In the internet age, adolescents have the world at their fingertips, and as such are all consumed with celebrities. For example, if Kylie Jenner gets lip fillers, suddenly every young impressionable girl needs them, too.

On the other hand however, adolescents are overloaded with stress. However, their brains are not fully programmed. Their frontal lobe, which deals with decision making, is not fully formed, and decision-making related tasks are handed off to the amygdala. The amygdala, however, is not equipped to deal with this, and so it acts impulsively. Meaning that an adolescent who is stressed is more likely to lose control when eating than an adult.

Nature vs Nurture

As is the case with most mental disorders, I believe nature and nurture work in tandem when it comes to eating disorders. On one hand, an individual’s biological makeup influences the ways they go through life, such as how they respond to stress. On the other hand, however, each person’s environment and overall human experience leads them to have specific thoughts and notions. So while an adolescent’s ‘nurture’ might lead them to perceive specific situations as more stressful than others, as based off of childhood schemas, their nature might alter the way in which these stress hormones are expressed. Additionally, just as some individuals have genetic predispositions towards breast cancer, some have predispositions to develop an eating disorder. However, if their environment does not promote these predispositions, they will likely not develop. I believe it is important to note that a disorder is caused due to an influx of stimuli, rather than just one or the other. Therefore, I believe nature and nurture in tandem can result in eating disorders.

Treatment

Although the best treatment is prevention, that is simply not always an option. So how do we help an adolescent who IS suffering from an eating disorder? First, we must identify what the disorder is, as well as what health risks the client is facing. From there, we can make a treatment plan that will initially limit potential health risks in accordance with a “damage control” model, but that will ultimately teach the adolescent better coping skills. Throughout therapy sessions, it will be important to note if the individual is experiencing any comorbid disorders, as eating disorders are usually comorbid with anxiety disorders (National Eating Disorder Association, 2018).

Conclusion

In summation, being a teenager is scary. You feel like everyone is watching you, judging you, condemning you. As a result of this, you feel like you have to be perfect, and the pressure that comes with “perfect” brings overwhelming amounts of stress into an adolescent’s life. Sadly, this stress sometimes cannot find healthy outlets, and so it manifests into disorders such as anxiety disorders, mood disorders, or eating disorders. It is important for caregivers and teens to realize what normal adolescent behavior is and what disordered behavior is. Additionally, it is also important to understand the role that the media plays in an adolescent’s life, as well as how that might be affecting their everyday decisions.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Dolgin, K. (2018). The adolescent: Development, relationships, and culture (14th ed). Boston, MA: Allyn & Bacon. ISBN: 978-0-13-441529-1

Lucas, A.R., Crowson, C.S., O’Fallon, W.M., and Melton, L.J. (1999). The ups and downs of anorexia nervosa. International Journal of Eating Disorders, 26(4):397-405

National Eating Disorder Association. (2018). Statistics and research on eating disorders. Retrieved from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders

National Institute of Mental Health. (2018). Eating Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

Stice E, Marti CN, Shaw H, and Jaconis M. (2010). An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. Journal of Abnormal Psychology, 118(3):587-97. doi: 10.1037/a0016481.