Eating disorders are complex and yet very common conditions, affecting adolescents all around the world. They rank as the third most common chronic illness in adolescent females, with an incidence of up to 5%, a rate that has increased dramatically over the past three decades. Two major subgroups of the disorders are recognized:
%26bull; A restrictive form, in which food intake is significantly limited (anorexia nervosa)
%26bull; A bulimic form, in which eating episodes are followed by attempts to minimize the effects of overeating via vomiting, catharsis, exercise, or fasting (bulimia nervosa)
Both anorexia nervosa and bulimia nervosa are associated with serious biological, psychological and sociological morbidity, and significant mortality. Eating disorders affect a person%26rsquo;s physical and emotional health. These dangerous illnesses can be fatal if left untreated.
Eating disorders are more common in cultures focused on weight loss and body image. %26ndash;Fortunately, an increased awareness about these types of illnesses is noticeable; people seem to realize that it is a very serious problem.
Possible causes of eating disorders
There are many different theories regarding the causes of eating disorders. Most likely, eating disorders are caused by a combination of psychological, family, genetic, environmental, and social factors.
Family history of mood disorders
Eating disorders are often associated with feelings of helplessness, sadness, anxiety, and the need to be perfect.
This can cause a person to use dieting to provide a sense of control or stability. Teens who participate in competitive sports, such as ballet, running, gymnastics, or skating, are more likely to develop an eating disorder.
Anorexia Nervosa
An estimated 0.5 to 3.7 percent of women suffer from anorexia nervosa in their lifetime.
Symptoms include:
%26bull; Almost absolute resistance to maintaining body weight at a minimally normal weight for age and height
%26bull; Intense fear of gaining weight
%26bull; Infrequent or absent menstrual periods
The most common characteristic is the fact that these people see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession. Most people with anorexia develop unusual eating habits, such as avoiding certain kinds of food or eating in extremely small quantities. They might repeatedly check their body weight, practicing other techniques to control their weight such as intense and compulsive exercise, vomiting and abuse of laxatives, enemas, and diuretics.
The course and outcome of anorexia nervosa vary across individuals: some fully recover; some have a fluctuating pattern of weight gain; others experience a chronically course of illness over many years. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.
Bulimia Nervosa
About 1.1 to 4.2 percent of women suffer from bulimia nervosa in their lifetime.
Some of the most common symptoms include:
%26bull; Eating excessively in a short period of time
%26bull; Inappropriate compensatory behavior, such as self-induced vomiting, or misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise
%26bull; Self-evaluation unduly influenced by body shape and weight
Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height.
What is EDNOS (Eating Disorder Not Otherwise Specified)?
EDNOS represents an condition showing some, but not all, symptoms of anorexia or bulimia. This may result in a very low body weight, but not technically anorexic.
Diagnosis
Diagnostic criteria for eating disorders may not be entirely applicable to adolescents.
Some of the symptoms which could hardly be applied to adolescents are:
%26bull; Wide variability in the rate, timing and magnitude of both height and weight
%26bull; Absence of menstrual periods in early puberty
%26bull; Unpredictability of menses soon after menarche
%26bull; The lack of psychological awareness regarding abstract concepts (such as self-concept, motivation to lose weight or affective states) owing to normative cognitive development
In addition, clinical features such as pubertal delay, growth retardation or impairment of bone mineral acquisition could be seen as the part of the sub-clinical level of eating disorders.
In clinical practice, the diagnosis of an eating disorder should be considered in an adolescent patient who:
%26bull; engages in potentially unhealthy weight control practices
%26bull; demonstrates obsessive thinking about food, weight, shape or exercise
%26bull; fails to attain or maintain a healthy weight, height, body composition or stage of sexual maturation
Medical complications
An eating disorder affects almost all the organs in the body. Fortunatelt, the majority of physical complications in adolescents appear to improve with nutritional rehabilitation and recovery from the disorder. However, once the line is crossed, some may be irreversible.
Potentiallt irreversible medical complications in adolescents include:
%26bull; growth retardation (if the disorder occurs before closure of the epiphyses)
%26bull; pubertal delay or arrest
%26bull; impaired acquisition of peak bone mass during the second decade of life
%26bull; increased risk of osteoporosis in adulthood
The treatment should be taken seriously, and extended until the adolescent has demonstrated a return to both medical and psychological health.
Psychosocial disturbances
Eating disorders that develop during adolescence interfere with adjustment to pubertal development. As such, they also interfere with several important developmental tasks necessary to become a healthy functioning adult. Also, isolation and family conflicts often arise, even though this is a time when families should provide a milieu that supports development. All this leads to the impaired issues related to self-concept, reduced self-esteem, autonomy, separation from the family, reduced capacity for intimacy, and various affective disorders; sometimes even substance abuse and suicide. That's why all patients should be evaluated for psychiatric illness, including disorders of anxiety, depression, and dissociation. Early mental health intervention for adolescents with eating disorders could be extremely helpful, and sometimes is the only cure. Family therapy should also be considered an important part of treatment.
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