How Eating Disorders Develop In Teens
The seeds for eating disorders in adolescence are often planted in early childhood, especially among girls. By age 6, girls begin to express awareness and concern over their weight, and 40–60% of girls in elementary school are concerned about becoming “too fat.” Approximately 42% of 1st- to 3rd-grade girls want to be thinner. Even among girls with a healthy weight, one-third report dieting.
As unhealthy attitudes about eating and weight gain progress, the odds of a clinical disorder increase. It can begin with a preteen making a few small diet changes — before long, they can be psychologically-impaired from these thoughts.
Eating Disorders and Body Image
One can’t walk outside or turn on the TV without seeing gratuitous images of fit, good-looking people. For a young person, especially girls, this can seem like the ideal (or even expected) body image. Actors, actresses, models and sports stars are put on a pedestal. In emulating these public figures, children can start to feel inadequate or ugly by comparison. The average Miss America winner, for example, is tall and ultra-thin (more than 40 pounds lighter than the average adult woman).
Among the young American girls who read magazines, 69% say the photos influence their concept of body image, and 47% say the photos make them want to lose weight. Magazines that target females also contain 10.5 times as many diet promotions as magazines designed for males. Around 83% of teen girls read fashion magazines on a regular basis.
Television also plays a role. On average, children of both genders watch 5 hours of TV a day, which can bombard them with unrealistic depictions of physical health. Just as girls will typically want to weigh less, boys end up wanting to be bigger and stronger. According to a number of studies, the effect of the media on ideal body image is strongest in people younger than 19 years of age.
The role of media in stirring body image issues cannot be overstated. And in school classrooms and hallways, young people can feel an unshakable need to match their “ideal” body shape. This pursuit can become an obsession that contributes to an eating disorder.
Eating Disorders and Social Media
With the Internet’s newfound ubiquity, today’s kids are exposed to an entirely new kind of pressure — in addition to the continued popularity of movies and magazines. More than half of kids use social media (e.g. Facebook, Twitter, Instagram) by age 10, and by high school, more than 90% of teens today have social media accounts.
Social networks expose young people to hundreds if not thousands of photos and videos, which can assault them with depictions of body image (both good and bad). Teens can also join online discussion forums where people compare weights, binge together or help each other avoid eating. Through links found on friends’ social media accounts, teens can access these “pro-ana” (pro-anorexia) or “pro-mia” (pro-bulimia) websites where these self-destructive habits will be encouraged.
“Images of spindly legs, concave stomachs and jutting ribs emerge on various sites by searching hashtags like #thinspogram #thighgap or #bonespo,”
according to USA Today.
“The disturbing photos are often accompanied by even more shocking “thinspirational” messages — ‘Pretty girls don’t eat,’ ‘Skip dinner, be thinner’ and ‘You have to exercise for a week to work off the thigh fat from a single Snickers.’”
A 2011 study showed that the more time teen girls spend on Facebook, the higher the risk of developing eating disorders and negative body images. Girls might see their friends or classmates posting photos of themselves and receiving positive feedback (i.e. comments and “likes”), and feel a desire to compete by posting their own attractive photos. In many cases, they won’t have the confidence to do so until they are pencil-thin.
“I have often scanned for hours through images… hoping that one day I would look like these girls or have this ‘perfect figure’ that many people would comment on,”said Kerry Hooton, a recovering anorexic, who once reduced her diet to 200 calories a day.
“I would become more upset and disappointed when the image staring back at me in the mirror did not reflect this.”
If competing with others doesn’t stir up these thoughts, then being bullied by their peers for being out of shape might. In the past year, more than 43% of teens were victims of “cyberbullying” — the term given to being harassed online by peers. Kids may post insults on a classmate’s public account or send mean-spirited messages. And while 81% of these kids engage in cyberbullying because they think it’s funny, they fail to realize the psychological harm they may be inflicting on others.
Are Eating Disorders Genetic?
Genetics don’t play a major role in teen eating disorders, as they do in some other mental health disorders. With that being said, a family history of eating disorders can contribute to a child’s likelihood of developing one. The environment that a child grows up in can also be a big influence — for instance, if a teen’s parents are health-obsessed and don’t eat a large amount of food, or are overweight and eat excessively, this can plant the seeds for unhealthy attitudes toward diet and nutrition in a child.
Some parents may hold their children towards unrealistic standards, and this environment can be just as significant as bullying in stirring up eating disorders. Families who model healthy eating and don’t change their eating habits based on emotion can be a positive influence, and children from these families are less likely to develop eating disorders.
What Defines An Eating Disorder?
Eating disorders are mental health problems caused by destructive dieting habits, usually where someone eats a dangerously small or large amount beyond their control. It’s a problem that affects 20 million females and 10 million males in the U.S. alone. Young women have the highest risk — 10% of American college-age women struggle with a clinical or near-clinical eating disorder — but young males also suffer from these problems, with an equal amount of potential risks.
While many people exhibit inconsistent dietary habits from time to time, those with diagnosable eating disorders have issues at a psychological level that need to be addressed. Eating disorders, if left untreated, can cause serious harm and lead to additional life-altering problems.
Types of Eating Disorders
Bulimia and anorexia are the most well-known eating disorders, affecting 2–3 in 100 American women and one in 200 American women, respectively. Bulimia (or bulimia nervosa) is marked by random binges on food, following by guilt and self-induced vomiting or fasting. Anorexia (or anorexia nervosa) causes its victims to lose their appetite entirely and refuse to eat, mostly in an effort to lose or keep off weight. White adolescents report the highest rates of anorexia, while Hispanics report the highest rates of bulimia.
There are several other classifiable eating disorders, each with its own traits and potential dangers. These include:
- Binge Eating Disorder – frequently overeating and feeling out of control, followed by strong feelings of shame
- Atypical Anorexia Nervosa – avoiding food or having no appetite but maintaining a healthy weight
- Purging Disorder – self-induced vomiting and purging without binge eating
- Night Eating Syndrome – wherein excessive and routine nighttime eating occurs
- Avoidant/Restrictive Food Intake Disorder – avoiding food due to unreasonable fears or preferences, with serious nutritional consequences
- Pica – regularly consuming non-food items
Binge eating disorder is actually more common than both anorexia and bulimia. Approximately 3.3% of women and 0.8% of men struggle with this disorder. Around 25% of college-age women attempt binging and purging as a dieting technique.
History of Eating Disorders
Accounts of anorexia or starving oneself date back centuries. Women originally practiced this as a display of self-discipline — Saint Catherine of Siena, for example, refused to eat as a “spiritual denial of self.” Over time, the decision to not eat came to be known as “wasting disease.”
In the early 20th century, doctors considered anorexia a hormone disorder. More and more case studies were published, and the public grew more aware about eating disorders and their actual causes (e.g. self-image, anxiety). In 1979, the first clinical paper on bulimia was published.
Through the 1970s and 1980s, particularly in America, reports of eating disorders began to skyrocket along with the obesity rates. In 1983, the famous singer Karen Carpenter died from complications caused by anorexia at age 32. This was perhaps the highest profile death related to eating disorders up to that point, and brought national attention to these diseases and their serious risks.
As the availability of unhealthy foods continues to spread, so do unrealistic body standards and the pressure to be thin — for males and females alike. Now more than ever, it’s easy for someone to become obsessed with food or the avoidance of it, ignoring the possible health risks of either.
Myths about Eating Disorders
If you’ve heard of eating disorders, you may have a preset image of the usual offender: an upper-class white teenage girl. This and other myths about eating disorders cause parents, friends and teachers to ignore the signs in someone who doesn’t necessarily fit that mold. Young people of all demographics can develop serious eating disorders, and anyone who does is at risk for the life-threatening side effects.
Another myth about eating disorders is that they’re a choice — a selfish, cosmetic decision that’s under control. This mental health stigma prevents teens and loved ones from reaching out for help. But a clinical eating disorder is a disease just like any other mental illness. It is not your fault, and it is not your child’s fault. If your teen struggles with an eating disorder, act quickly to get them the help they need.
What Are the Effects of Eating Disorders on Teenagers?
In cases of teenage eating disorders, the risks involved range from mild to severe. As a disorder progresses, teens can risk serious health problems and complications in every aspect of their life.
Effects on the Brain
Chemical imbalances — especially with regards to chemicals that control hunger, appetite and digestion — are observed in the brains of some individuals with eating disorders.
Abnormalities with certain neurotransmitters, the brain’s chemical messengers, may play an important role in eating disorders. These chemicals — serotonin, norepinephrine and dopamine — are involved with several essential brain functions, as well as the production of happiness. People with eating disorders often lose their sense of pleasure from food, which can be traced to reduced amounts or imbalances of these chemicals. They can also have higher rates of stress hormones, and lower rates of thyroid, reproductive and growth hormones.
Teens with severe anorexia can suffer nerve damage that directly affects the brain. This can lead to conditions such as disordered thinking, seizures, and numbness or odd nerve sensations in the hands or feet. Structural changes can also occur in certain parts of the brain. Some changes may be undone when the individual gets back to a healthy weight, but some damage may be permanent.
Effects on the Body
The mortality rate among young women with anorexia is 12 times higher than all other causes of death. Research shows that anorexia has the highest death rate of any psychiatric disorder — 5–10% of patients die within 10 years of being diagnosed, and 18–20% die within 20 years.
Diets play an immeasurable role in our general health. When a person don’t get enough nutrition (or eats far too much, in other cases), their body is susceptible to serious issues.
Health consequences of eatings disorders can include:
- Slow heart rate and low blood pressure
- Heart failure or stroke
- Osteoporosis (low bone density)
- Muscle loss and weakness
- Severe dehydration
- Kidney failure
- Fainting, fatigue and overall weakness
- Dry hair and skin
- Tooth decay
- Ulcers and pancreatitis
- Digestive problems
- Reproductive problems
Specific to binge eating disorder, additional health risks include:
- High blood pressure
- High cholesterol levels
- Heart disease
- Gastric rupture
- Gallbladder disease
Death is a legitimate risk inherent of any serious eating disorder. From 2008–2009, there were nearly 30,000 hospital stays for patients with eatings disorders — a 24% increase in a 10-year period.
An eating disorder might begin slowly — soon enough, it can become a debilitating obsession that impacts school performance and relationships, and can even lead to self-harm or suicidal thinking.
Anorexia, in particular, has a significant impact on the brain and its learning capabilities. Malnourishment from refusing to eat can leave the thought process a jumbled mess, impairing memory and judgment along the way. These individuals dedicate 90–100% of their mental energy to food, weight and diet — compared to the 10–15% a healthy individual spends — and things like studying and homework can take a backseat as a result. On top of decreasing performance in school, eating disorders can make teens withdrawn, apathetic and irritable, and they’ll often engage in fewer social interactions. This can cause friendships or romantic relationships to suffer dramatically.
Teen Suicide and Self-Harm
The intense lack of self-esteem that usually either precedes or develops from eating disorders is a recipe for self-harming behaviors. Self-harm involves inflicting pain on oneself, usually through burning or cutting, as a response to extreme shame and guilt. When self-harm is not enough, and the weight of these emotions becomes unbearable, suicide can seem like the next logical step.
Among people with eating disorders, rates of suicide attempts are 13–31%. One study showed that 25% of teens with eating disorders either attempted suicide or engaged in self-harm. Suicide attempts are twice as likely in anorexia patients than bulimia patients. In any case, a history of attempting suicide is a significant predictor of future attempts. If a loved one appear to be battling a potential eating disorder, you need to address the situation as quickly as possible.
When two or more disorders exist simultaneously, they’re known as co-occurring disorders. It’s often difficult to tell which disorder came first, and treating a person with overlapping problems is extremely troublesome. The longer an eating disorder goes untreated, the greater the risk your teen will develop a second disorder as a side effect. Anxiety and depression — also known as anxiety disorders and depressive disorders — are observed alongside eating disorders in countless cases.
Eating Disorders and Depression
Depression affects teenagers — whether or not it’s related to body image issues — and is a mental health problem all its own. Serious depression affects 2% of young children and at least 8% of teenagers. It’s known to make teens feel sad and worthless and leave them with very low energy. A depressed teen can also lose their appetite and avoid food, or self-medicate by overeating in some cases.
Among troubled adolescents, eating disorders and depression are often co-occurring disorders. If depression doesn’t exist prior to an eating disorder, it can easily come about as a symptom of one.
Eating Disorders and Anxiety
Teen anxiety disorders are mental health problems that cause constant worry and trouble focusing, along with troublesome nervous behavior. These illnesses affect 18% of the U.S. population, and one-half of those with depression also have some form of anxiety. Unhealthy eating habits and attitudes about weight may be traced back to anxiety disorders in some individuals. Research shows that nearly two-thirds of people with eating disorders have an anxiety disorder at some point in their lifetime, and 42% had developed an eating disorder during childhood.
Other Co-Occurring Disorders
Common disorders that co-occur with eating disorders include:
- Obsessive-Compulsive Disorder (or OCD) – recurring thoughts that lead to obsessive, ritualistic behaviors and routines. It’s believed that two-thirds of patients with anorexia and up to one-third of patients with bulimia have some degree of OCD
- Phobias – irrational fears, such as social phobias that make someone fearful of being humiliated or judged in public
- Panic Disorder – periodic and unpredictable attacks of intense anxiety and terror, also known as panic attacks
- Post-Traumatic Stress Disorder, or PTSD – the constant reliving of a traumatic experience that impairs daily behaviors and attitudes
- Body Dysmorphic Disorder, or BDD – a distorted view of one’s body, sometimes with a perceived deformity in one area
- Muscle Dysmorphia – a form of BDD obsessed with muscle mass (or lack thereof), the results in excessive attempts at bodybuilding
Eating Disorders and Substance Abuse
When an eating disorder — or any mental disorder — co-occurs with a comorbid substance use disorder, it’s called dual diagnosis. According to the National Eating Disorders Association, people with eating disorders are 5 times more likely than the general population to misuse drugs or alcohol — as high as 50% of these individuals have a substance abuse problem. Teens may abuse over-the-counter medications (e.g. diet pills, laxatives, caffeine supplements) to enhance their weight loss, but these drugs can be just as dangerous as other substances. They may also turn to things like alcohol or illicit drugs (e.g. marijuana, crystal meth, heroin) to self-medicate.
Blinded by their eating disorder, and the guilt or shame that come along with it, a struggling teen can make some dangerous decisions against their better judgment. But while they may turn to drugs or alcohol for a brief reprieve, it can spiral into an entirely new disorder: addiction. When a teen becomes dependent on a substance to get through their day, and spends all their money and time on the pursuit of more, this is an addiction. Burdened by both disorders, the chances of a major emergency are increased significantly.
Symptoms of Eating Disorders
If your son or daughter develops an eating disorder, you may not be able to tell just from their weight. The weight loss or weight gain in certain cases is minimal or slow to come about. There are other obvious symptoms you may notice. If you observe signs such as these, it may indicate a potential problem.
Symptoms specific to anorexia can include:
- Refusal to eat in front of others
- Ritualistic eating, such as cutting food into small pieces
- Hypersensitivity to cold, and cold or swollen hands and feet
- Yellowish skin
- Infrequent or absent menstrual periods (in girls)
- Stomach problems
- Slowed or confused thinking, and poor memory or judgment
- Excessive thinness
Symptoms specific to bulimia can include:
- Large amounts of food suddenly disappearing
- Going to the bathroom right after meals
- Broken blood vessels in the eyes
- Dry mouth
- Diseased gums, cavities and tooth enamel erosion caused by excessive vomiting
- Rashes and pimples
- Empty packages for laxatives, diet pills, emetics (drugs that induce vomiting) or diuretics (drugs that reduce fluids)
Compulsive exercising, to a sometimes unhealthy extent, is a regular symptom of both anorexia and bulimia.
Symptoms of binge eating disorder include:
- Regularly eating what others would consider an excessive amount
- Feeling out of control in regards to how much they eat
- Being uncomfortably full after a meal
- Eating at a fast, unsettling pace
- Seeking out more food even when not hungry
- Choosing to eat alone
- Feelings of guilt, disgust and depression after eating
- General low self-esteem
- Constant fluctuations in weight
Eating Disorder Treatment
To determine the extent of their eating disorder, teens need to undergo extensive screening, A doctor can diagnose eating disorders through a series of exams, tests and questionnaires — these will assess the patient’s physical health compared to a healthy individual, as well as their mental state in relation to eating, body image and exercise. If a teen is diagnosed, the doctor will refer them to treatment.
Recovering from an eating disorder is often done at eating disorder rehab centers. Inpatient eating disorder treatment is provided at a residential environment where a teen is removed from the influences and temptations of their daily life, and eased back into a proper lifestyle. Their diet will be strictly regimented and monitored, and they’ll work with dietitians and nutritional counselors to reshape their attitudes towards eating right. This is called nutritional rehabilitation counseling.
Therapy and counseling are also essential to eating disorder recovery. Whether through inpatient or outpatient drug rehab, where the teen still lives at home, sessions with a therapist can help uncover the underlying causes of their eating disorder. They can also mold positive behaviors and improve a teen’s self-image. Family therapy may also be recommended, to bring together a troubled teen’s loved ones and open up communication between them, as well as prepare them for the recovery path that lies ahead. Medications such as antidepressants may be prescribed in certain cases, but there’s limited evidence that these have a significant effect on curing eating disorders.
If a teen does not respond well to treatment, their weight continues to fall and their depression remains severe, hospitalization may be required. This can last 10–12 weeks, which allows doctors to offer full nutritional support and get them back to their ideal weight.
Is Rehab An Option For My Teen?
As a parent, you play a critical role in your family’s diet and their attitudes about weight. From an early age, your children will look to you for lessons on how to eat right, and also that beauty isn’t skin deep. Help prepare your children to take the images they see each day with a grain of salt. Also make sure they realize that “healthy eating” does not mean eating the minimal amount.
In the event your son or daughter struggles with their weight, or develops an eating disorder at some point, open a dialogue with them. Research any troubling signs they exhibit, either physically or emotionally, and speak with your family doctor if you believe something is wrong. The recovery specialists at TeenRehabCenter.org are available to speak with you about the options available for your teen. Rehab or counseling may be the turning point in your teen’s eating disorder. Whatever you do, don’t let symptoms of a problem fly under the radar. Any significant changes to your teen’s diet, exercise habits or general happiness should not be taken lightly.
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