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Anorexia nervosa in teenagers

Anorexia nervosa is a main stream in teenagers’ eating disorders, Simon G. Gowers and Lynne Green stated in their book Eating Disorders Cognitive Behaviour that “The key diagnostic features of anorexia nervosa are a distorted body image, extremely low body weight, significant dieting, exercise or purging, and endocrine disturbance.” As is well noticed by the general public, anorexia nervosa is more commonly seen in girls than boys for girls tend to care more about their body shape and weight especially in adolescence.

As Gowers and Green clearly listed in the book that our features need to be present to make a diagnosis of AN:

1) Over evaluation of importance of weight and shape; that is, judging self-worth largely or even exclusively, in these terms. This is often expressed as an intense fear of becoming fat and sometimes referred to as a distortion of body image.

2) The maintenance of an unduly low body weight (that is less than85 percent of that expected, or a body mass index (BMI) below the 2nd percentile for age).

3) Active control of weight by dietary restriction, exercise, vomiting or purgation.

4) A widespread endocrine disturbance involving the hypothalamic-pituitary-gondola axis. This is manifest at as amenorrhea in post-pubertal females, pubertal delay in pubescent females and as impotence and lack of sexual interest in males.

With the help of statistics, the serious condition od anorexia nervosa in teenagers can be detected. In 2003, “Teen” magazine reported that “at least 35% of girls age six to twelve have dieted at least once and that 50% to 70% of those who were of normal weight thought they were overweight.” It has to be emphasized that some teenagers gain a sense of control by refusing the demand of normal food needed by their body and this often reaches the point of serious damage to the body, in fact, in a small number of cases it may lead to death.

Stacy Beller Stryer argued that “the reasons for anorexia nervosa in teenagers fall in many parts and current emerging stream is the effect of media on teenagers especially on girls”. A large part what we formed unconsciously in our mind to be the ideal woman today comes from what we see and read in the mass media and entertainment industry. The media has been responsible for advertising and promoting an unrealistic picture of the perfect women. Considering the current trends mass media has brought to teenage girls, Stryer argued that “ an obvious example of women image provided by mass media and entertainment is the Barbie doll. Barbie totally represented how ridiculously women are portrayed. Barbie has the perfect body that if she were made into a life sized woman, would be 5 feet 6 inches tall, 110 pounds, with a 39-inches bust, an 18-inch waist and 33-inches hips, which is unrealistic.” On the other side, real life beauties, such as models, playboy centerfolds, and Miss America pageant contestants are also becoming thinner and are setting a standard that is difficult to emulate, not to mention the fact that it is extremely bad for health.

Not only has exposure to the media been associated with an increased risk of body dissatisfaction and anorexia in both girls and boys, but the media personalities are also much more likely to be diagnosed with it, and some have even died from it . Karen Carpenter was a well known singer ho appeared on magazine and TV shows during the 1970s and early 1980s. She had many gold and platinum albums, and also won several Grammy awards. In 1983, she collapsed and died from cardiac arrest secondary to either chemical imbalance from medicine abuse or from the strain on her heart because of her anorexia. This singer severed as the first publicized celebrity who has died from anorexia nervosa. Joan Jacobs Brumberg pointed out that “while the entertainment and media industries are largely responsible for providing unrealistic and dangerously thin role models for teens in our society, they are also partially responsible for instigating, encouraging, or, at the very least, ignoring disordered eating and anorexia nervosa in those who work for them.” In his research, “Certain groups are known to support thinner participants than others, including gymnasts, ballet dancers, models, actress, and professional skaters. “

Stryer argued that “the clinical features of anorexia nervosa is that there is a sustained and determined pursuit of weight loss and, to the extent that this pursuit is successful dieting tends to be viewed as an accomplishment; as a consequence, young people with anorexia nervosa generally have a limited desire to change. In anorexia nervosa, the pursuit of weight loss is successful, and a very low weight may be attainted through severe and selective restriction of food intake, foods viewed as fattening being excluded.” What we can conclude form him is that anorexia is not usually a feature; rather, dietary control results in hunger, reinforcing fears of loss of control. Dietary restriction may also be an expression of other motives, including asceticism, perfectionism and competitiveness. Some young people engage in a driven type of exercising that also contributes to their weight loss. Some have episodes of loss of control over eating, although the amount eaten is often not objectively large. In another aspect, Brumberg has the opinion that “depressive and anxiety features, irritability, impaired concentration, loss of sexual interest and obsessional symptoms are frequently present. Typically, these features get worse as weight is lost and improve to a large extent with weight restoration. Interest in outside world also declined as patients become underweight, with the result that most become socially withdrawn and isolated. This, too, tends to reserve with weight gain and provides a degree of reinforcing momentum to treatment. As body weight is maintained at least 15 percent below that expected, pubertal development is stunted or reversed. This results in either a delay in the menarche or secondary amenorrhea in those who have completed puberty.”

Bulimia nervosa in teenagers

According to Gowers and Green which mentioned above in anorexia nervosa, the key diagnostic features of bulimia nervosa are “distorted body image, binge eating, significant dieting, and vomiting or laxative misuse.”

Three features are required to make a diagnosis of bulimia nervosa.

Overevaluation of the importance of shape and weigh.

The presence of recurrent binge eating, a ‘binge’ being of food is eaten and eating during which an objectively large amount of food is eaten and there is a sense of loss of control.

The presence of extreme weight-controlling behaviour, such as strict dietary restriction, recurrent self-induced vomiting or marked laxative misuse.

(Gowers & Green, 2009).

The purging of bulimia presents a serious threat to a teenagers’ physical health, including dehydration, hormonal imbalance, the depletion of important minerals, and damage to vital organs.

Myra Cooper wrote in the book Treating Bulimia Nervosa and Binge that “Eating In bulimia nervosa, attempts to restrict food intake are interspersed with repeated episodes of binge, eating with the result that patients may see themselves as failed anorexics. The great majority of these young people are distressed by their loss of control over eating, and this makes them services, although because of associated shame and secrecy, they rarely do so on their own account before they reach adulthood.”

The aim of young people with bulimia nervosa is generally to adopt the eating behaviours seen in anorexia nervosa. But unlikely the very disciplined restricting anorexics, their attempts to restrict food intake are punctuated by repeated episodes of binge eating. The amount consumed in these binges varies but is typically between 1000 and 2000 kcals per episode, and their frequency ranges from once or twice a week (the diagnostic threshold) to many times a day. In most cases, each binge is followed by compensatory self-induced vomiting or laxative misuse, but a small subgroup do not “purge”, but control their weight with exercises or longer periods of abstinence. The weight of most of these young people is in the healthy range (giving a body mass index between the 25th and 75th percentiles), as the under-eating and over-eating cancel each other out. Gowers and Green concluded that “As a result, patients with bulimia nervosa do not experience the secondary psychosocial and physical effects of maintaining a very low weight though the disorder has its own adverse consequences. Depressive and anxiety symptoms are prominent in bulimia nervosa – and a number of teenagers engage in substance misuse and self-farm.”

The exact cause of bulimia is unknown. As with other mental illnesses, there are many possible factors that could be counted in the development of eating disorders, such as genes, certain behaviours, psychological disorders, and family and societal influences.

In terms of biology, there may be genes that make some people more vulnerable to developing eating disorders. People with first-degree relatives (siblings or parents) with an eating disorder may be more likely to develop an eating disorder too, suggesting a possible genetic link. It's also possible that a deficiency in the brain chemical serotonin may play a role in the development of bulimia.

In the behaviour part, certain behaviours, such as dieting or over-exercising, can contribute to the development of bulimia. For example, dieting is a primary factor in triggering binge eating. In addition, dieting helps encourage rigid rules about food, which when broken can lead to loss of control and overeating.

Emotional health is also of great essence and this is most seen and discussed in movies or media mass. Copper argued that “people with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behaviour, anger management difficulties, family conflicts and troubled relationships, for instance, the modern Western cultural environment often cultivates and reinforces a desire for thinness. Success and worth are often equated with being thin in popular culture. Peer pressure and what people see in the media may fuel this desire to be thin, particularly among young women.”

Eating disorders in teenagers

Adolescence may be the most important period of time in our life, just as the famous psychoanalyst, author and feminist scholar Louise.J.Kaplan once presented “adolescence represents an inner emotional upheaval, a struggle between the external human wish to cling to the past and the equally powerful wish to get on with the future.” People form the basic view of world in their mind during this golden period which will surely have great impact on their future path. However, teenagers undergoing such mental health problem called eating disorders which mostly refer to anorexia nervosa and bulimia nervosa are arousing more and more concern. According to South Carolina Department of Mental Health, statistics collected from teenagers pointed out that anorexia is the third most common chronic illness among adolescents while 95% of people who have eating disorders are between the ages of 12 and 25. Government of Canada also released data in 2006 announcing that 1.5% of Canadian women aged 15 to 24 years had an eating disorder. The prevalence of anorexia and bulimia is estimated to be 0.3% and 1.0% among adolescent and young women respectively. Prevalence rates of anorexia and bulimia appear to increase during the transition from adolescence to young adulthood.

As mentioned above, eating disorders among teenagers are becoming a problem which attracts more and more attention worldwide these days. They are fascinating mental health problems in a number of respects which comprise anorexia nervosa, bulimia nervosa and their variants. “They typically develop in adolescence or early adulthood but sometimes arise in late childhoods. According to Simon G. Gowers and Lynne Green, who wrote Eating Disorders Cognitive Behaviour, “The aetiology of eating disorder is thought to be multi-determined, and the same is probably true of the belief in the importance of weight and shape that underlies these orders while a genetic component probably plays a part in the aetiology of both waiting disorders.” What’s more, this may apply to its effect in ways from inclining to physical vulnerability factors (an inclination to obesity or early puberty) or to certain personality variables might then lead to an over awareness of the importance of weight or restraint, both of which can result in dieting behaviours. Gower and Green also pointed out that “Dieting is generally an early feature of both anorexia nervosa and bulimia nervosa, both of which conditions can be seen as lying on a continuum of preoccupation with control”.

Different from most others, teenagers who are undergoing eating disorders tend to evaluate their self-worth to a large extent, or even entirely or selectively, in terms of their body shape and weight as well as the ability to control their shape and weight while most people judge themselves based on their detected performance in a variety of domains of life such as the quality of their relationships with their families and friends, their achievements in work and studies, their performance in sports and so on. The over evaluation of shape and weight may result in a pursuit of weight loss and intense fear of weight gain and fatness or, on the opposite side, loss of control on eating foods. It is no doubt that this kind of value may have serious typically in teenagers.

Among those teenagers who have eating disorders, many defined adverse physical and emotional states incorrectly as “feeling fat” and treat it equal as “being fat”. Many teenagers have the habit to examine their weight on a daily basis while some of the teenagers actively avoid knowing their weights in the cases of those who have eating disorders. As a matter of fact, the former may have the possibility to develop anorexia nervosa and the latter may develop bulimia nervosa.

The reasons why eating disorders in teenagers should be given deep concern are due to the warning signs of anorexia nervosa and bulimia. Take the case of teenagers with anorexia nervosa for instance, unnatural concern about body weight even if the teenager is of healthy weight scientifically should be noticed because the teenager may avoid obsession with calories, fat grams and food or use of any medicine to keep from gaining weight as diet pills, laxatives and water pills. As a matter of fact, more serious warning signs may be hard to detect for the fact that teenagers who have eating disorders may be trying their best to keep these signs from being known by others such as: throwing up after they have had food or the refuse of eating or lying about how amount of food they had eaten and eventually, increased anxiety about weight which may lead to over exercising or fainting.

Treatment of eating disorders in teenagers

With the awareness of the serious results eating disorders can bring to teenagers, scientists and health workers including doctors and nutritionists have developed a suitable treatment for teenagers with eating disorders called CBT which stands for “Cognitive Behaviour Therapy”.

According to Gowers and Green, “When a teenager develops a behavioural or emotional disorder, it is assumed that their cognitive beliefs or problem-solving capacities are impaired, or that they lack the appropriate behavioural repertoires to address their difficulties. Cognitive difficulties may reflect deficiencies or distortions in thought processes. In the field of adolescent mental health, it is often assumed to be cognitive distortions that create problems, reflecting as they do irrational or flawed attitudes and beliefs”.

It is also argued that, “In anxiety disorders, exaggerated perceptions of danger and fear are coped with lack of confidence in the teenager’s ability to cope with threats. An anxious teenager might develop schemata based around threat- of harm, in generalized anxiety disorders; or loss. In separation anxiety, the subject suffers dysfunctional cognitive distortions and misperceives social and interpersonal relationships, leading to the characteristic avoidance responses of anxiety and phobic conditions” are conclusions gather by Gowers and Green when they came to the processing of CBT in teenagers.

In general terms, CBT endeavours to provide help to teenagers by easing the development of new treating ways and providing them with alternative experiences to bring about cognitive change and challenge established schemata.

In all, eating disorders in teenagers deserve greater attentions from the whole society. People always consider teenagers as the future of our countries, though a lot of attentions have already been given to them in all aspects, eating disorder still remains a field which requires more awareness and focus.

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