Eating Disorders in Teens

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“… I grabbed the package of Oreos and stuffed three cookies in my mouth at once. Then I went for more. At first they tasted good, but then I didn’t even taste them. I didn’t care about what they tasted like. I just stuffed them in my mouth. Once I’d devoured the whole package, I went for a bag of chips. Next came two bowls of frosted cereal.

The whole time I was eating, I felt nothing anymore. I was good and numb. As soon as it was over, though, the panic started to set in. But I knew how to get rid of that feeling, too. I headed straight for the bathroom. After I got rid of all that damage, I had that pure, empty feeling. I actually felt good. I felt light. I went to my bedroom to look at myself in the mirror, to make sure I wasn’t fat. I checked my hipbones to make sure they were still sticking out. Then I pulled the scale out from underneath my bed, took a deep breath and stepped up onto it. I let out a big sigh. I was OK …”

From “Conquering Eating Disorders,” by Sue Cooper and Peggy Norton. Excerpted by arrangement with Seal Press, a member of the Perseus Books Group. Copyright © 2008.

In the United States, as many as 10 in 100 young women suffer from an eating disorder, according to the American Academy of Child and Adolescent Psychiatry. Overeating related to tension, poor nutritional habits and food fads are relatively common in youngsters. In addition, two psychiatric eating disorders, anorexia nervosa and bulimia, are on the increase among teenage girls and young women and often run in families.

What Is an “Eating Disorder”?
When people think of eating disorders, they typically think of anorexia nervosa and bulimia nervosa. According to the American Psychiatric Association, individuals with anorexia nervosa are unable or unwilling to maintain a body weight that is normal or expected. “Below normal” usually is defined as less than 85 percent of normal weight for one’s height.

People with anorexia nervosa also are afraid of weight gain and dread becoming fat even though they are often extremely underweight. Worries about weight and about how they believe they look have a powerful negative influence on self-esteem. People with anorexia usually minimize or even deny the seriousness of their weight loss and its health consequences. Young women with anorexia also may stop having regular menstrual periods.

The APA describes people with bulimia nervosa as regularly engaging in periods of overeating (binging), which are followed by attempts to compensate for overeating and to avoid weight gain (purging). A typical binge episode involves eating an amount of food that normally would be considered excessive. A person who has binged will report a sense of a lack of control over their eating. Binge eating is followed by purging, which is an attempt to “undo” the consequences of eating too much. People may purge through behaviors such as self-induced vomiting, misuse of laxatives, enemas, diuretics, or excessive exercising. As in patients with anorexia, extreme concerns about weight and a negatively distorted body image are characteristic of bulimia.

An important point is that someone might not fit into either of the above categories, yet may still have disordered eating. In addition, a person with an eating disorder can be underweight, overweight, or at a normal weight. At any given time, 10 percent or more of late adolescent and adult women report symptoms of eating disorders. Although these symptoms may not meet full diagnostic criteria, they often do cause distress and impairment.

If any of these symptoms are present in your child, it is important to seek medical advice. Research shows that the sooner a teenager receives care, the more easily she recovers.
Who is affected by eating disorders? Perhaps the more appropriate question to ask is, “Who is not?” Eating disorders can affect everyone, including males and females, people at all socioeconomic levels and of all races. Although the peak age of onset is during adolescence, younger children and adults also can be affected.

Warning Signs
• Avoidance of certain food groups (carbohydrates and fats, in particular),
• Dieting
• Obsessive calorie counting
• Preoccupation with weight and body image
• Complaints of feeling or being fat
• Eating alone
• Uncomfortable eating at social gatherings
• Excessive exercise
• Increased bathroom time (right after meals, in particular)
• Sadness and/or irritability
• Disappearing food
• Weight loss
• Loss of menses (periods) in girls/women
• Taking laxatives, diuretics, or weight-loss pills

What Are the Consequences?
Eating disorders are mental illnesses with significant medical consequences, and no part of the body is spared. These consequences are secondary to malnutrition and weight control behaviors, such as self-induced vomiting. Physical signs and symptoms can include depression, anxiety, irritability, constipation, cold intolerance, abnormally low heart rate, stomach pain, dry skin, extra body hair, low blood pressure, dizziness and fatigue. Anorexia can cause changes in brain structure, decreased bone density, infertility and cardiovascular instability, which can lead to death. Parents take note: The most common cause of death in people suffering from eating disorders is suicide.

Self-induced vomiting (purging) can lead to swelling of salivary glands, tearing of the esophagus or stomach and dental enamel erosion. Laxative abuse can lead to long-lasting disruptions of normal bowel functioning. Both can cause dehydration and electrolyte abnormalities. Like anorexia, bulimia can lead to life-threatening irregularities of the heart rhythm.

Fortunately, with early recognition and appropriate treatment, these effects can be prevented and most are reversible with improved nutrition.

What Is the Treatment?
Treatment should involve a team of eating disorder experts, including a physician, a behavioral/mental health professional (such as a psychologist or social worker) and a registered dietitian. The Maudsley Approach, or Family-Based Treatment, has been proven to be the most effective method for teens. This treatment is based on the belief that the family is part of the solution, rather than the problem. This is contradictory to past approaches, where the parents were viewed as part of the problem and were excluded from treatment.

Eating disorders are serious medical illnesses and should not be taken lightly.
If you are concerned that your child might have an eating disorder, call your doctor right away and ask for an appointment as soon as possible. He or she can help determine if there is a concern and can make referrals to specialists as appropriate.

Dr. Kristin Rager is the medical director of Teen Health Connection and the director of Adolescent Medicine for Levine Children’s Hospital. She and Ellen Cary work at the LCH Center for Disordered Eating, a part of Teen Health Connection, 3541 Randol