EATING DISORDERS

Eating Disorders and their Effects on Adolescents

Eating Disorders and their Effects on Adolescents

Introduction

Eating disorders are complex illnesses that affect adolescents with increasing frequency. 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: a restrictive form, in which food intake is severely limited (anorexia nervosa), and a bulimic form, in which binge 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 can be associated with serious biological, psychological and sociological morbidity, and significant mortality.

Thesis Statement

Eating disorders are multifaceted illnesses that affect adolescents with increasing frequency.

Diagnosis

Diagnostic criteria for eating disorders such as described in DSM-IV may not be entirely applicable to adolescents. The wide variability in the rate, timing and magnitude of both height and weight gain during normal puberty; the absence of menstrual periods in early puberty along with the unpredictability of menses soon after menarche; and the lack of psychological awareness regarding abstract concepts (such as self-concept, motivation to lose weight or affective states) owing to normative cognitive development limit the application of those formal diagnostic criteria to adolescents.

In addition, clinical features such as pubertal delay, growth retardation or the impairment of bone mineral acquisition may occur at subclinical levels of eating disorders. The use of strict criteria may preclude the recognition of eating disorders in their early stages and subclinical form (a prerequisite for primary or secondary prevention), and may exclude some adolescents with significantly abnormal eating attitudes and behaviours, such as those who vomit or take laxatives regularly but do not binge. Finally, abnormal eating habits may result in significant impairment in health, even in the absence of fulfilment of formal criteria for an eating disorder. For all of these reasons, it is essential to diagnose eating disorders in adolescents in the context of the multiple and varied aspects of normal pubertal growth, adolescent development and the eventual attainment of a healthy adulthood rather than by merely applying formalized criteria(Whitaker, 1992; Stein, 1991).

Position: In clinical practice, the diagnosis of an eating disorder should be considered in an adolescent patient who engages in potentially unhealthy weight control practices and/or demonstrates obsessive thinking about food, weight, shape or exercise and not only in one who meets established diagnostic criteria. In such adolescents, an eating disorder should be considered if the teenager fails to attain or maintain a healthy weight, height, body composition or stage of sexual maturation for sex and age.

Medical complications

No organ system is spared the effects of eating disorders. Although the physical signs and symptoms occurring in a patient are primarily related to the weight control behaviours practised, the health care professional must consider their frequency, intensity and duration, as well as the biological vulnerability conferred by the sexual maturity of the ...