Addressing Eating Disorders In Adolescence

Body image is a concept that refers to the perceptions, feelings, and thoughts that individuals have with respect to their bodies. When a person internalizes a beauty ideal, they may compare their body to it and develop body dissatisfaction because the ideal is often impossible to achieve. In adolescents, this body dissatisfaction can lead to several serious problems, including low self-esteem, depression, compromised emotional well-being, and disordered eating. All these combined can cause an adolescent to develop an eating disorder. In this article, you will learn about the different eating disorders that an adolescent may develop and how early treatment can help bring a child from coping to healing.

What is an eating disorder? 

An eating disorder is a serious psychiatric illness that typically develops during adolescence or young adulthood. When it comes to adolescent eating disorders, such as anorexia nervosa, bulimia nervosa, compulsive or binge eating disorder, and other eating disorders like restrictive food intake disorder, early intervention is key. Eating disorder interventions soon after recognition can facilitate more effective healing and recovery. Accordingly, early intervention* also increases the chances that children, adolescents, and adult samples with eating disorders will achieve long-term recovery. 

*Mental health research is constantly evolving, so older sources may contain information or theories that have been reevaluated since their original publication date.

Types of eating disorders

Anorexia

Anorexia nervosa, or anorexia, is an eating disorder wherein the person is extremely afraid of gaining weight and has an altered perception of their body. A person with anorexia obsessively watches the number of calories and types of food they eat. Those with anorexia may have difficulty maintaining a normal weight due to the number of restrictions they place on their diets, which in turn can lead to significant medical consequences such as an irregular menstrual cycle or loss of menstrual periods, loss of muscle mass, and nutritional deficiencies.

People with anorexia tend to avoid food, exercise compulsively, binge eat, and purge by way of vomiting or using laxatives. Anorexia can affect anyone at any time, no matter their age, gender identity, race, or ethnicity.

People with anorexia restrict their calories which often leads to significantly low body weight, although this is not always the case. Adding to this restriction is an intense fear of gaining weight and often persistent behaviors that interfere with gaining weight and body fat.  

Bulimia

Bulimia nervosa, or bulimia, is a severe and potentially life-threatening eating disorder. A person with bulimia eats a large amount of food in a short period and then immediately purges the food to avoid gaining weight, usually by way of forced vomiting. Other methods of purging the food include excessive exercise and overuse of laxatives and diuretics.

There is also the less common non-purging form of bulimia, wherein the person will engage in excessive exercising or fasting and avoid food altogether. Here, the more typical forms of purging are not relied upon, but they may still be infrequently incorporated.

Often, those living with bulimia will binge and purge in hiding. Because of this, they may struggle with bulimia for an extended period before anyone begins to suspect anything, often making early diagnosis challenging. That is what makes bulimia so dangerous. By the time symptoms and physical signs begin to appear, the individual may already be close to a medical emergency. At the very least, it may take longer to treat the condition with nutritional rehabilitation and other forms of treatment, as the pattern of bulimic behavior has been given a longer time to develop.

In addition to attempting to control their weight, those who have bulimia often turn to this behavior as a way of coping with a difficult situation or life change. The act of binging and purging allows them to feel a sense of control. Bulimia can also result from poor self-esteem or distorted body image, abuse*, or professions or other activities wherein a performance's appearance or performance is at stake, such as celebrities or athletes. This study from Br J Psychiatry (The British Journal of Psychiatry) looks at the link between abuse and eating disorders.

Causes of eating disorders in adolescence

Adolescents can develop an eating disorder for a variety of reasons or a combination of many factors. Children with an eating disorder are more likely to have come from families with a history of eating disorders, physical illness, and mental health disorders (including substance use or mood disorders). 

An adolescent may develop an eating disorder due to the following:

• Low self-esteem
• Poor body image
• Genetic predisposition
• Trauma
• Societal pressures and bullying
• Abuse

These catalysts are not limited to adolescents. People of any age can be exposed to trauma or develop low self-esteem. These things can lead to a host of psychiatric disorders that include but are not limited to an eating disorder.

Signs of adolescent eating disorders

Eating disorders can affect any person and are not limited to any gender identity, ethnicity, or sexual preference, although they tend to be most common in teenage girls. If you notice any of the following in your child or adolescent, then your child may be dealing with, or in the early stages of, an eating disorder:

• Obsession with body shape and weight
• Scarring on the back of fingers (from self-induced vomiting)
• Depression and/or anxiety
• Unusual eating habits or rituals, such as only eating certain foods
• Binge eating
• Purging after eating (vomiting or using laxatives)
• Excessive exercise or fasting in attempts to lose weight
• Eating in secret
• Being obsessed, afraid of, or avoiding food
• Counting calories

Fear of food can be one of the first signs to spot in a child that may be developing an eating disorder, specifically anorexia nervosa and bulimia nervosa, although it’s also possible to develop other psychiatric disorders like avoidant restrictive food intake disorder. Kids who fear eating foods that are high in fat may learn that they can control their anxiety by simply avoiding these kinds of foods altogether. This process of learning through avoidance is known as "negative reinforcement."

Humans need food to survive and think properly. Those who do not consume the required number of calories each day may change their thought patterns for the worse. This is due to the cells they need to produce energy being starved, which can lead to changes in a person's brain chemistry. These changes can either create or contribute to food phobias and an inability to think clearly, particularly about a person's perception of their body image.

Treating eating disorders in teens

Untreated eating disorders are often complex illnesses that can produce significant consequences for the child in the present and as they mature. These include medical complications and potential emergencies. In many cases, eating disorders get worse before they get better. Most adolescents with eating disorders require treatment by professionals. In some cases, a treatment team may be most effective.

In addition to the support network provided by the child's family, the following medical professionals may also be consulted about treating an eating disorder:

• A physician
• A psychologist or psychiatrist
• A dietitian
• A physical therapist

The child must first be assisted in reaching a healthy weight before any medical complications have the chance to develop (or before presenting medical complications are exacerbated). This may require the help of a physician, as changes in metabolism or medical complications are not easy to overcome without professional help. Similarly, a physician can monitor the child's organs and bones for signs of damage and then treat the child accordingly.

A psychologist or psychiatrist can provide the child with strategies for developing healthy coping mechanisms designed to combat negative behavior, distorted thought processes, and any potential triggers that may have led to the eating disorder in the first place. Cognitive behavioral therapy is relied on often, as this type of therapy helps patients recognize negative thinking patterns and develop positive coping mechanisms, rather than the eating disorder that may serve as a negative one.

When it comes to treatment, children recover at a more significant pace when their families are involved in their treatments, so family therapy can be helpful. A child with a family who also learns coping strategies and how to reinforce them at home can encourage the child to continue seeking treatment. This reinforcement provides the child with an improved sense of self-esteem and self-worth while they feel valued and supported along their way toward achieving long-term recovery.

Obesity and eating disorders

Childhood obesity is certainly an issue in the United States and it is important that we pay attention to the problem to improve the health of children. However, in certain respects, putting childhood obesity in the spotlight can have the reverse effect on a child to the point where they develop a poor self-image and a tenuous relationship with food— both of which can eventually lead to an eating disorder.

The pressures that being obese puts on a child are significantly greater than if the child was a normal weight. For example, bullying is often worse for an overweight child and can have a large negative impact on their still-developing body image and self-esteem. 

Couple bullying with the societal pressure that is put on children via social media, television, and magazines and it is easy to understand how a child who is still developing their body image can be influenced into believing that they will never be skinny enough to be accepted by their peers. This can lead to the development of an eating disorder, and they may do whatever it takes to achieve an “acceptable" weight - a number that may not be appropriate for their proportions.

Adolescent eating disorder statistics

In the United States, eating disorders affect millions of adolescents and young adults, and the number of children and adolescents who are being diagnosed with an eating disorder is on the rise. Because of the serious medical complications that can arise from an eating disorder, it is crucial to diagnose and treat the condition as soon as it is realized. The earlier the diagnosis, the more likely the person will receive proper treatment and fully recover.

John Hopkins All Children’s Hospital released the following statistics insofar as the prevalence of eating disorders in adolescents:

• 95 percent of people who suffer from an eating disorder are between the ages of 12 and 25 years old.
• Of all mental illnesses, eating disorders have the highest risk of death.
• Eating disorders affect all races, all genders, and every ethnic group.

Perhaps the most unsettling is that between one-third to one-half of all teenagers rely on unhealthy behaviors to control their weight, such as skipping a meal, fasting, smoking cigarettes, or purging. In some cases, consistently using laxatives to purge can constitute substance abuse.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Online therapy with BetterHelp

In many cases, parents and adolescents cannot overcome an eating disorder on their own. Eating disorders may need to be treated by a licensed professional and, in some cases, necessitate hospitalization. If you or someone you love is living with an eating disorder, consider reaching out to a BetterHelp counselor. You can message the therapists at BetterHelp 24/7, meaning you’re able to reach out in times of distress or when you’re experiencing new symptoms. Talking about your experience with an eating disorder can be difficult, but online therapy may make you feel more comfortable opening up since you can choose how you connect with your counselor.

The efficacy of online therapy

In a study of twenty trials assessing the effectiveness of web-based interventions for the treatment of eating disorders, several were found to be successful. For example, one program delivered online CBT to individuals experiencing an eating disorder and found that participants experienced reductions in weight concern and drive for thinness. Other studies showed positive results in treatment and relapse prevention, showing the efficacy of online therapy for addressing disordered eating.