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Adolescence: A time where eating disorders begin
Eating disorders (EDs) tend to first appear during the adolescent years. In fact, the average age of onset for many eating disorders is between 16-18 years [ref]Volpe, U., Tortorella, A., Manchia, M., Monteleone, A. M., Albert, U., & Monteleone, P. (2016). Eating disorders: What age at onset?. Psychiatry Research, 238, 225-227[/ref].
We have some idea around why eating disorders first appear during the teen years. But before I go into detail about this, I first need to provide an overview of the different types of EDs and their symptoms that emerge during adolescence.
- Anorexia Nervosa: Anorexia nervosa is a potentially life-threatening ED characterised by persistent restriction of energy intake leading to significantly low body weight, either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain.
- Bulimia Nervosa: Bulimia nervosa is also a life-threatening condition defined by recurrent episodes of binge eating, recurrent inappropriate compensatory behaviours (e.g., self-induced vomiting, laxative misuse) in order to prevent weight gain from the binge episode and regarding weight and shape as central to one’s self-worth.
- Binge Eating Disorder: Binge-eating disorder is the most common eating disorder defined by recurrent episodes of binge eating (in the absence of compensatory behaviours) and eating large amounts of food when not feeling physically hungry.
Teenage Eating Disorder Statistics
Let’s now turn out attention towards some key figures related to the different types of EDs in the teen years. These figures are based on some well-conducted individual studies, and they clearly demonstrate just how pervasive EDs are in teen years.
Readers may refer to the following book as a guide for the following figures [ref]Le Grange, D., & Lock, J. (Eds.). (2011). Eating disorders in children and adolescents: A clinical handbook. Guilford Press[/ref].
- Incidence rates of anorexia nervosa for female teens (15-19 years old) are as high as 270 per 100,00 people and for males, they are as high as 15.7 per 100,000 people.
- Fewer than 50% of teens seek treatment for anorexia nervosa
- Anorexia nervosa is the third most common chronic illness in adolescent females.
- The lifetime prevalence rates of anorexia nervosa range from 1.8-2.6% in teens.
- Fewer than 33% seek of teens seek treatment for bulimia nervosa.
- Incidence rates for female teens (16-20 years) of bulimia nervosa are estimated at 300/100,00 person-years and for men, these rates are estimates at 6.3/100,00 person-years.
- The peak age of incidence rates for bulimia nervosa falls between 16-20 years.
- Lifetime prevalence rates of bulimia nervosa estimates to be as high as 3.2% in adolescents.
- Binge-eating disorder peaks at around 19-20 years of age.
- In both females and males, binge-eating disorder rates more than triple from ages 14 to ages 20
Causes of eating disorders
Why do eating disorders develop in youth?
This is a question asked by many, and we can answer this by delving into some of the important factors that put teens at risk for developing an eating disorder.
Eating disorders share a genetic basis – in other words, they run in the family.
Twin studies have reported heritability estimates that range from 31-76% for anorexia nervosa onset and from 28-83% for bulimia nervosa [ref]Yilmaz, Z., Hardaway, J. A., & Bulik, C. M. (2015). Genetics and epigenetics of eating disorders. Advances in genomics and genetics, 5, 131[/ref].
Even individual symptoms of ED are heritable. For example, heritability estimates for body dissatisfaction, weight preoccupation, and compensatory behaviours range from 34-65% in some studies [ref]Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. American psychologist, 62(3), 181[/ref].
Puberty is also a critical period that may determine whether someone goes onto develop an ED. This is particularly true of the person goes through puberty early.
Related to this, the rapid release of ovarian hormones during this time seem to exert a strong influence on ED development, and the important physical bodily changes can also play a role [ref]Klump, K. L., Perkins, P. S., Burt, S. A., McGUE, M. & Iacono, W. G. (2007). Puberty moderates genetic influences on disordered eating. Psychological Medicine, 37(5), 627-634[/ref].
Teens are consuming masses of information put forth by the media.
It is well known that the media can place youth at risk for an ED. The media typically reinforces the so-called appearance ideals, which are a set of implied rules for what men and women should look like in order to achieve health, happiness, and success.
For example, studies have shown that more than two-thirds of popular children’s cartoons linked thinness and physical attractiveness with positive personality traits, while three-quarters of the cartoons linked obesity with unfavourable traits [ref]Herbozo, S., Tantleff-Dunn, S., Gokee-Larose, J., & Thompson, J. K. (2004). Beauty and thinness messages in children’s media: A content analysis. Eating Disorders, 12(1), 21-34[/ref].
Teens who buy into this notion that they ought to look a certain way are at increased risk of EDs because they are more likely to engage in a range of unhealthy control behaviours.
More and more teens globally are going on a weight loss diet. This is a problem because dieting plays an important role in causing EDs in teens.
Teens usually go on a diet to modify their appearance in some way. However, dieting enhances our preoccupation with food and increases our body image concerns.
The issue with diets is that they tend to be practised very rigidly, hardly sustainable. When the diet fails, people find themselves going through cycles of binge eating and purging [ref]Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour research and therapy, 41(5), 509-528[/ref].
Stress and negative mood
How we feel can put us at risk for an ED.
Teenage years can be stressful and emotional. How a person can handle these tough years can influence whether or not an ED will develop.
Teens who find themselves not equipped to deal well emotionally to negative situations, events, or circumstances are more likely to turn to food for comfort in these situations. Over time, this can develop into a habit, which can then lead to a clinically significant ED [ref]Stice, E. (2002). Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological bulletin, 128(5), 82[/ref].
Teenage girls are the group most likely to scrutinize their weight. The severity of weight concerns is linked to ED onset in youth.
Weight concerns seem to lead to ED onset because it leads to a depressed mood and unhealthy dieting practices. In that way, it is not weight concerns per se that are directly causing the ED, but rather its influence on these two other important risk factors [ref]Stice, E. (2002). Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological bulletin, 128(5), 82[/ref].
Consequences of Eating Disorders in Adolescents
There is a wide range of physical, social, and psychological consequences experienced by youth who are dealing with an ED.
Let’s take a look at some of these well-known consequences;
- Abnormal glucose metabolism
- Respiratory failure
- Enamel erosion
- Gastric dilation
- Thyroid dysfunction
- Decreased bone mineral density
- Depression and anxiety
- Substance use and abuse
- Poor self-esteem
- Interpersonal breakdowns
- Social isolation
- Poor schooling achievements
Treatments for Adolescent Eating Disorders
Luckily, effective treatments for adolescents with eating disorders exist.
Recovery is possible.
The best chance of recovery will occur if the ED is caught early and treated as soon as possible.
Let’s take a look at what the two most effective treatments for adolescent EDs are.
Family therapy can be effectively used for adolescents with bulimia nervosa and anorexia nervosa.
Family therapy includes the entire family within treatment sessions because it assumes that structural changes within the family system could have a positive impact on the ED.
Family therapy lasts around 12-15 sessions and can be broken up into three phases.
Phase one focuses on supporting the parents and their efforts to assist their offspring in recovering from the ED
Phase two aims to transition control overeating to the child.
Phase 3 is brief and introduces adolescent developmental tasks once the symptoms have largely subsided.
There is some good quality evidence showing that family therapy is effective for adolescent EDs. For example, recovery rates are as high as 45%, improvements in body weight and core ED symptoms are generally sustained one year after treatment, and many patients report liking this style of therapy [le Grange, D., Crosby, R. D., Rathouz, P. J., & Leventhal, B. L. (2007). A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Archives of General Psychiatry, 64(9), 1049-1056].
Cognitive-Behavioural Therapy (CBT)
CBT can be used as a treatment for any adolescent ED.
CBT contains a collection of different strategies, each designed to target the factors that are maintaining the ED.
It usually lasts about 20 sessions, and some of the key strategies of CBT include:
- Self-monitoring of eating behaviour
- Implementing a pattern of regular eating
- Problem solving
- Weekly weighing with a therapist
- Problem solving
- Cognitive restructuring
- Relapse prevention.
CBT has produced recovery rates of 40% in adolescents with EDs, and there is some evidence showing that these improvements can also be sustained one year after treatment ends [ref]Le Grange, D., Lock, J., Agras, W. S., Bryson, S. W., & Jo, B. (2015). Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, 54(11), 886-894/ref].
It’s fantastic to learn that there is evidence that family therapy can help kids with eating disorders. My son is struggling with eating a lot of food and I was wondering what I can do to help him if he has an eating disorder. I’ll be sure to try family therapy to see if we can help with his overeating.
Dr Jake Linardon
Indeed, Steve. Family therapy has arguable the most evidence supporting its use in children. Really try to instill a positive home environment where you lead the way and model what it looks like to have a healthy relationship with food and body image. Family therapy can be incredibly useful for providing specific instructions to parents.
Best of luck.
I was chatting with my friends the other day and they were all giving out tips about preventing their kids from developing eating disorders and so I became curious as to why this was such a hot topic. It really helped when you talked about how negative emotions and large amounts of stress can lead to eating disorders because most of us already have teenage children and teenagers are faced with multiple sources of negative emotions more as they grow up, so I’ll have to be on the lookout for that. I’ll be sure to look for any clinics that can give advice and maybe even treatment regarding this. Thank you!
Dr Jake Linardon
Thank you for taking the time to comment and on your experience!
SITI AISYATUL AMIRAH BINTI ABDUL HALIM
how about the body shaming can make the children had eating disorder?
Dr Jake Linardon
Indeed! Body shame is a very strong risk factor. Addressing shame early on is very important for potentially preventing the onset of an eating disorder.
I am a Psychology PhD student from the UK and I was wondering what your thoughts on the Transdiagnostic model of eating disorders are? Or your thoughts on the findings that many people who experience AN or BN will also go on to experience the other. I’m not sure of the best way to get in contact but would be very curious to hear your take. Your research is fascinating 🙂
Dr Jake Linardon
Thank you for your message. I am a big proponent of the transdiagnostic model. There is growing evidence to support the idea that eating disorders may better represent one type of illness, rather than a range of diverse subtypes. The strongest evidence for this comes from the fact that (1) treatments that target proposed transdiagnostic mechanisms are effective for all ED subtypes and (2) we see that diagnostic cross-over is the norm rather than the exception. Obviously much more work is needed to be done, but I think it’s an excellent starting point for better understanding eating disorders.
Thank you so much for your positive feedback!