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Eating Disorders in Adolescents

The eating disorders anorexia nervosa and bulimia nervosa are complex psychosomatic illnesses. Underlying biological diatheses related to the regulation of mood, hunger, satiety, weight control, and metabolism, combined with psychological and sociocultural vulnerabilities, place an individual at risk for developing an eating disorder (Kaplan and Garfinkel, 1993). The American Anorexia Nervosa Association defines anorexia as a serious illness of deliberate self-starvation with profound psychiatric and physical components.

It is a complex emotional disorder that initiates its victims on a course of unsettled dieting in pursuit of excessive thinness (Neuman and Halvorson, 1983). The intense fear of obesity that anorexics experience takes on the qualities of an obsession. Anorexics seem to have a greater fear of getting fat than of dying from the effects of their self-imposed starvation (Neuman and Halvorson, 1983). Another unusual twist occurs in relation to this fear of growing fat.

The average person concerned about weight gain will feel a sense of relief as he/she loses weight. However, the anorexic is unlike other people in this respect: for them, the fear does not diminish (Neuman and Halvorson, 1983). The disturbance of body image in anorexia is an unclear circumstance. Most anorexics have distorted perceptions of themselves. Some insist that their wasted bodies are repulsively over-fleshed. According to some researchers, however, the more distortion present, the worse the prognosis (Neuman and Halvorson, 1983).

Weight loss of at least 25 percent of original body weight or, if under 18 years of age, weight loss from original body weight plus projected weight gain expected from growth charts may be combined to make 25 percent (Neuman and Halvorson, 1983). The primary symptom of anorexia nervosa is severe weight loss. While this is one of the major criteria for making the diagnosis, it is believed the 25 percent reduction to be misleading (Neuman, 1983). It is often incorrectly assumed that anorexics were previously obese.

While the disorder is often preceded by normal dieting, only one-third of anorexics have been overweight and most of these only mildly so. Two-thirds have never been overweight, although they may have been the targets of comments regarding their physical development (Neuman, 1983). Anorexia is often preceded by a stressful life situation. This may range from a family conflict or major changes such as a change in schools, a family move, the loss of a boyfriend or girlfriend, or an illness. Change, in general, seems to be particularly stressful for anorexic individuals.

The childhood history of those who develop anorexia typically reveals a model child. Many anorexics describe themselves as people pleasers. As children, they are often described by parents and teachers as introverted, conscientious, and well behaved. They tend to be perfectionists and compulsive, and thus, overachievers (Neuman, 1983). Depressive, obsessional, hysterical, and phobic features are also common with anorexia. Bulimia, also known in the media as bulimarexia, binge-vomiting and gorge-purging, is an eating disorder similar to chemical dependency (Cauwels, 1983).

Bulimia victims regularly fill themselves with food, especially high-calorie food, for periods lasting up to several hours. To avoid gaining weight, they purge themselves after each binge through self-induced vomiting and/or laxative and diuretic abuse (Cauwels, 1983). Some bulimics alternate their gorging with amphetamine-boosted fats or excessive exercise. At some point their concern with weight becomes irrelevant, for they are hooked on the hypnotic effects of gorge-purging.

Most of them eventually learn to vomit by simple reflex action, as though it were normal. They have condemned themselves to a routine cycle of guilt, self-loathing and devastating isolation (Cauwels, 1983). Bulimia is a closet illness a shameful secret from family and friends and most of its victims become expert at hiding it (Cauwels, 1983). As such it contrasts with anorexia nervosa, the self-starvation that glamour-hungry young women inflict upon themselves because of their obsession with thinness.

About half of anorexia victims have bulimia as one of their symptoms and are often referred to as bulimic anorectics (Cauwels, 1983). Very often bulimics alternate fasting with bingeing. Unlike anorexics, those caught up in the syndrome of bulimia usually maintain a normal or near normal body weight, perhaps are even somewhat overweight, with the primary symptom being gorging rather than starvation (Neuman and Halvorson, 1983). Bulimia tends to run a chronic course often diffused with periods of remission, while anorexia is more often a single episode (Neuman and Halvorson, 1983).

During periods of remission, however, eating is seldom normal for the individual afflicted with bulimia. The remission is from binge-eating and purging only, not from dieting behavior (Neuman, 1983). While bulimia predominantly affects females, the disorder is not peculiar to women. According to statistics from The National Association of Anorexia Nervosa and Associated Disorders (ANAD), 5 to 10 percent of bulimias victims are male. Many of these men are involved in sports or professions in which weight plays an important role, such as wrestling.

Induced vomiting might seem, for example, to be a relative harmless trick for meeting weight requirements, but in vulnerable individuals, this behavior can trigger a vicious cycle which becomes a trap for the victim (Neuman and Halvorson, 1983). In a study published in the Journal of Youth and Adolescence, findings of the development of disordered eating in pre- and early adolescents were presented. Fifth and sixth-grade girls and boys were evaluated on depression, body image, self-esteem, and eating behaviors (Keel, 1997).

Understanding the etiology of eating disorders such as anorexia nervosa and bulimia nervosa requires identification of the precursors to those disorders within the course of normal development. These precursors then can be used as signs in screening for at-risk adolescents. Some research has demonstrated that girls display initial signs of eating disturbances at 11. 7 years. Therefore, it seems advisable that direct investigations begin with pre- and early adolescents. (Keel, 1997).

Several studies of eating disturbances in early adolescence have evaluated the possible contribution of puberty, depression, self-esteem, and body image. Findings for the influence of pubertal development have not been consistent. Some investigations of adolescent females suggest that pubertal status may play a role in the onset of disordered eating patterns (Attie and Brooks-Gunn, 1989). Studies of adolescent girls also suggest that depressive affect may contribute to the development of eating disorders (Allgood-Merten, 1990).

Additionally, low self-esteem has been found to be related to depression and poor body image. Factors that contribute to disordered eating may change in the course of development as adolescents experience physical and cognitive maturation (Allgood-Merten, 1990). It was reported that girls were more likely to experience dissatisfaction, depression, and lower self-esteem, and recommended more disordered eating items than boys (Keel, 1997). Girls also indicated spending significantly more time dieting, wishing they were thinner, feeling pressured to eat, and feeling guilty after eating sweets than boys.

These differences reflect both attitudes and behaviors consistent with disordered eating (Keel, 1997). Further findings also indicate that neither body mass index nor pubertal development is significantly associated with girls body image or self-esteem in early adolescence. However, body image and self-esteem may gain importance in older girls (Keel, 1997). This study indicates that low self-esteem and depression did not contribute directly to disturbed eating patterns for girls or boys.

Results also revealed that how boys feel about their bodies influences their support of attitudes and behaviors consistent with disordered eating (Keel, 1997). Adolescent years are a time when important choices must be made from an overwhelming number of options. There is no one right way of viewing the world and doing things. One of the most common ages for developing anorexia nervosa coincide with points of transition: the 14 year old is often moving from a junior high setting to high school (Neuman and Halvorson, 1983).

Unfortunately, anorexia and bulimia victims are often well-mannered children who take school seriously and who are seemingly successful. As a result, we are shocked to discover that they have such a strange problem. According to Dr. Neuman and Dr. Halvorson, it is essential to educate parents as to (1) the nature of eating disorders, (2) the growing-up needs of their children, (3) healthy modes of family functioning, (4) the importance of building self-esteem (Neuman and Halvorson, 1983). An individual who is confident about him/herself is unlikely to develop anorexia or bulimia.

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