Eating Disorders in Adolescence

Eating Disorders in Adolescence

• Eating disorders have increased threefold in the last 50 years.
• 10% of the population is affected by an eating disorder.
• 90% of cases are adolescent girls.
• Up to 21% of college women show sub-threshold eating disorder symptoms.
• 61% of college women show some sort of eating pathology.

Types of Eating Disorders

• Anorexia nervosa: Characterized by a pursuit of thinness leading to self-starvation.
• Bulimia nervosa: Characterized by a cycle of bingeing followed by extreme behaviors to prevent weight gain, like purging.
• Binge-eating disorder: Characterized by regular bingeing but no purging.

Anorexia Nervosa

• Self-starvation: Essential nutrients are denied, slowing down bodily functions to conserve energy.
• Health consequences: Low blood pressure/heart rate, muscle loss/weakness, dehydration, fainting/fatigue, dry hair and skin.
• 90-95% are female, 5-10% male.
• Characteristics: Preoccupation with weight; males may have body building preoccupation, compulsive exercise, frequent weighing, distorted body image.
• Onset: Individuals initially restrict certain foods (like high-fat foods) and food intake becomes severely limited.
• Health Effects: Increased risk of infection, low white blood cell count, low body temperature, electrolyte disturbance (low calcium/potassium), skin changes (dry, cold, discolored), muscle weakness, decreased size of brain, low energy, depression, poor coordination, dizziness, fainting, poor sleep, risk of suicide, low blood pressure, slow/irregular heartbeats, cardiac arrest, bloating, constipation, kidney failure, lack of menstruation (amenorrhea), infertility, decreased testosterone, decreased testicular size, decline in sex drive, swollen legs, fluid retention, excess fluid in cold feet, loss of calcium, osteoporosis, and increased risk of fractures.

Bulimia Nervosa

• Qualitatively distinct from anorexia: Binge eating, marked by a feeling of being out of control.
• Binge: May or may not be planned, usually lasts until the individual is uncomfortably full; usually of high caloric foods and large amounts.
• Purging subtype: Self-induced vomiting or laxatives to get rid of ingested calories.
• Non-purging subtype: Fasting or excessive exercise to offset binges.
• Frequency: 80% are female.
• Characteristics: Feelings of shame after binges, keeping behavior secret, adherence to a pattern of restricted caloric intake, usually preferring low calorie foods between binges, later age at onset of the disorder, more likely to maintain a normal weight.
• Health consequences: Swollen salivary glands, ruptures in the esophageal wall, inflammation of the esophagus, gastric reflux, dehydration, hypokalemia, abnormal heart rhythms, peptic ulcers, constipation. Irregular heartbeat = heart failure = death, tooth decay, ulcers.

Binge Eating Disorder

• Most common eating disorder, affecting about 3% of adults.
• Signs and symptoms: Eating a large amount of food quickly during a binge, eating until uncomfortable fullness, eating alone due to embarrassment, feelings of guilt/depression.
• Large amounts of food (binge), but no purging. This is different from bulimia.
• Complications: Type 2 diabetes, high blood pressure, high cholesterol, heart disease, certain cancers.

Risk Factors

• Personality/psychological factors
• Family influence
• Media
• Subcultures within society

Personality/Psychological Factors

• Sense of self-worth based on weight
• Use of food to gain control
• Perfectionism
• Poor impulse control
• Inadequate coping skills

Media and Cultural Factors

• Culture-bound syndrome
• Belief that thinness is the answer to all problems is prevalent in western culture
• Bulimia can be influenced by social norms.
• Behavior learned through modeling

Impact on Women

• Studies show high levels of perceived excess weight amongst women (55% of college women felt they were overweight, although only 6% were considered overweight).
• Many women desire a smaller size than their current size.
• Many women would rather be hit by a truck than be perceived as fat.

Treatment Challenges

• Lack of motivation to change
• Intrinsically reinforced by weight loss
• Denial of the existence or severity of the problem
• Lack of insight
• Not truly about food.

Clinical Management (Anorexia Nervosa)

• Treatment focuses on three primary issues:
  • Restoring weight
  • Modifying distorted eating behaviors
  • Addressing psychological and family concerns.
• Typical methods include: Nutritional rehabilitation, psychotherapy, and medication.

Clinical Management (Anorexia Nervosa) - Nutritional Rehabilitation Goals

• Restore weight.
• Normalize eating patterns.
• Reestablish normal perceptions of hunger and satiety.
• Correct biological and psychological consequences of malnutrition.

Restoring Weight

• Weight gain is 1-2 pounds per week for inpatients and 0.5-1 pound per week for outpatients.
• Physical activity should be monitored and restricted if it interferes with weight gain.