Eating Disorders among Teenagers
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Eating disorders are serious mental illnesses that cause severe distortion in the eating habits and body weights of individuals. Eating disorders affect people of different ages and genders. Many people tend to believe that eating disorders only affect females, which is not true. Anyone can develop an eating disorder and any time, which needs to be treated as fast as possible with the proper procedures before they proceed to fatality. Everyone desires to achieve a body image that they admire, which could be defined by weight, their body’s shape, and looks, among other features. Exercise and diet play a significant role in weight gain and loss. Based on age, health and other factors, different individuals require a certain amount of food and exercise to keep their body functioning well. Some people have a distorted image of their body, which could lead to severe eating disorders. For example, a person may feel that they are too fat even though they may be at the right weight for their age, height and body type. Such distorted images could push individuals to extremes in dieting and exercise as they try to lose weight. Important areas of focus in eating disorders include DSM-V diagnostic criteria, prevalence and treatment of the disorder.
The DSM-V gives specific diagnostic criteria for eating disorders. The manual classifies eating disorders into different categories. Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder are the most common and are referred to as the typical eating disorders. Pica, ruminating disorder and restrictive food intake disorder are also defined in the manual. Other disorders apart from these are known as ‘other specified feeding or eating disorders’ (OSFEDs). These atypical eating disorders are defined as “feeding and eating disorder that causes clinically significant distress or impairment in social life but does not meet the full criteria for typical eating disorders” (Galmiche et al. 2019). All of these eating disorders have specific diagnostic criteria that are outlined in the DSM-V.
Pica is an eating disorder characterized by a persistent intake of nonfood items with no nutritional value for a period of more than a month. These items cannot sustain the growth of the individual. The third criterion for pica is that any cultural or social practices do not support the abnormal eating behaviour. When pica occurs alongside another mental disorder or medical condition, it requires additional medical attention. Rumination disorder is the second eating disorder in the DSM-V. The first characteristic of this ED is that individuals affected regurgitate food for at least a month (American Psychiatric Association, 2013). This regurgitation is not related to any gastrointestinal or other medical condition. Avoidant or restrictive food intake disorder involves eating disturbances such as lack of interest, food avoidance and concern for adverse effects of food intake. Because of these disturbances, the individual fails to meet their required energy and nutritional needs. This leads to serious consequences such as significant weight loss, nutritional deficiency, dependency on oral supplements and interference with psychosocial functioning. The second criterion for this disorder is that the disturbed eating patterns are not explained by a lack of food or any cultural practice. Third, the eating pattern is not exclusive to anorexia and bulimia nervosa. Finally, restrictive food intake disorder is not attributed to any other medical condition or mental illness.
The DSM-V gives three main criteria by which anorexia nervosa is diagnosed. Anorexia is one of the most common eating disorders. The first diagnostic criterion is that individuals with this order restrict their energy intake relative to requirements, resulting in low body weight based on their age, health, gender and development. Anorexia bulimia is also characterized by an unusually intense fear of gaining weight, leading to behaviour that prevents gaining weight even though the individual might have significantly low weight. The third criterion for diagnosing anorexia nervosa is a disturbance in the way a person views their weight or body shape, which greatly affects how their self-evaluation(American Psychiatric Association, 2013). The individual also fails to recognize the significance of their very low weight. Anorexia bulimia can either be defined as restrictive or binge-eating types, based on behaviour observed over a period of three months. Under the first category, the individual loses weight primarily through excessive dieting, fasting and exercise. The binge-eating type of anorexia nervosa involves purging behaviour such as self-induced vomiting, laxatives, enemas, among other methods.
Bulimia nervosa is another severe eating disorder with several diagnostic criteria. The first is recurring episodes of binge-eating, marked by feelings of lack of control over eating behaviour and consumption of large portions that most individuals cannot eat in a similar amount of time. The second criterion for bulimia nervosa is persistent behaviour to prevent weight gain, such as induced vomiting, excessive exercise and use of medications. The abnormal eating behaviour is observed at least once weekly for three months (American Psychiatric Association, 2013). Third, the individual puts a lot of emphasis on their weight and body shape. These characteristics of bulimia nervosa do not only appear during episodes of anorexia bulimia. The severity of bulimia nervosa is based on the frequency of inappropriate compensatory behaviour; for example mild cases have an average of 1-3 episodes per week, while a severe case has more than 14 episodes per week.
Binge-eating disorder is the third of the most common eating disorders, including anorexia nervosa and bulimia nervosa. The disorder shares one feature with bulimia nervosa, which is consuming large amounts of food within a period that other individuals would not eat within similar circumstances and a comparable period. The individual also feels like they have no control over their eating at the time. To meet the criteria for binge-eating disorder, an individual must meet three or more of the following. These are eating until one feels uncomfortably full, feelings of guilt and disgust after eating, eating alone due to shame of how much food one consumes, eating faster than normal, and eating even one does not feel hungry (American Psychiatric Association, 2013).. The third diagnostic criterion for binge-eating is distress about binge episodes. To be diagnosed with binge-eating disorder, the behaviour must be observed at least once weekly for three months. Finally, the signs of binge-eating disorders should not be exclusively associated with anorexia and bulimia nervosa.
The DSM-V classifies other eating disorders that do not meet the criteria for the above disorders as other specified feeding or eating disorders (OSFEDs). Individuals who experience feelings or eating disorders which affect their functioning, such as social or occupational functions, and also cause clinical distress can be diagnosed with OSFEDs. The differentiating factor is that the symptoms do not fully fit into the other eating disorders with defined criteria (American Psychiatric Association, 2013). For example, a person presenting signs of atypical anorexia nervosa is diagnosed with OSFEDs. The person could meet most of the criteria for anorexia, but their weight is still within the normal range despite their significant weight loss. They might meet all of the criteria for bulimia, but the behaviour is observed less than once weekly and for less than the three-month specified period.
The frequency and prevalence of eating disorders vary based on population. Some countries and regions have a higher rate of eating disorders than others. Ward et al. (2019) conducted a study in the United States to examine the prevalence of eating disorders in the nation’s population. They found that roughly one in 7 males experienced an eating disorder by the age of 40. Among females, this number was higher, with about 1 in 5 females experiencing an eating disorder in the same age range (Ward et al., 2019). The study involved 100000 individuals, half being male and the other half being female. The data was collected between 2007 and 2011, taking into account four major EDs; anorexia nervosa, bulimia nervosa, binge eating disorders and OSFEDs. The study also found that most individuals experienced eating disorders at the age of 21 (Ward et al., 2019). Most people develop eating disorders during their late teen years and young adulthood, supported by findings from the study.
Another study conducted in Switzerland allows comparison between the prevalence of eating disorders in different countries. Mohler-Kuo et al. conducted a study involving a representative sample of the country’s population. 10038 residents of Switzerland took part in the study, which examined the prevalence of anorexia nervosa, bulimia nervosa, and binge-eating disorder. The study found the average prevalence rate for any eating disorder to be 3.5%. Rates varied among men and women. Among women, AN, BN, and BED were found to have a prevalence rate of 1.2%, 2.4%, and 2.4%, respectively. Among men, the rates were lower, averaging 0.2%, 0.9%, and 0.7%, respectively (Mohler-Kuo et al., 2016). The findings from the US and Switzerland studies prove that the prevalence of eating disorders varies between countries.
Eating disorders are most prevalent among adolescents and may go on into young adulthood. Mairs and Nicholls analyzed the prevalence and treatment of eating disorders among adolescents. The study focused on anorexia nervosa, bulimia nervosa, binge-eating disorder and avoidant-restrictive food intake disorder. The study found that the average prevalence of eating disorders among adolescents is 13% (Mairs, & Nicholls, 2016). Dahlgren et al. also analyzed 19 studies conducted into the prevalence of eating disorders in different countries. They found that prevalence varied significantly in the studies involved. On average, the lifetime rates of anorexia bulimia among females ranged between 1.7 and 3.6%. Point prevalence rates for binge-eating disorder ranged between 0.62 to 3.6 % in females (Dahlgren et al., 2017). In general, most studies focused on the prevalence of eating disorders among females.
Treatment of eating disorders among adolescents involves different parties. The first step in treatment is the diagnosis of an eating disorder. Parents and family members play an essential role in noticing the signs of an eating disorder among adolescents. For example, a parent, guardian or sibling may notice a change in the eating habits and other concerning behaviour around food and body image. The adolescent may pay more attention to their weight and body image, complain about being fat, restrict their food intake, and lose significant amounts of weight. Most adolescents will not admit that they have an eating disorder and require the intervention of professionals. Forest et al. found that only about twenty percent of adolescents with eating disorders seek treatment for their illness (Forrest et al., 2017). Girls are also 2.2 times more likely to seek help for an eating disorder compared to boys. Different eating disorders also have different rates of help-seeking. For example, teens are more likely to seek treatment for anorexia and bulimia nervosa than binge-eating disorder, at the rate of 27.5% and 22.3% vs. 11.6%, respectively (Forrest et al., 2017). Eating disorders require extensive treatment from different professionals.
Mairs and Nicholls offer a comprehensive guide to the treatment of eating disorders. Some of the professionals involved in the treatment process include family therapists, psychologists, psychiatrists, nurses, and dieticians. The first step is a visit to a doctor or pediatrician who plays a critical role in recognizing signs of an ED and recommendation of services. This first meeting usually involves a reluctant teen and their family, and it is meant to establish a good rapport and engage the patient. The doctor assesses the patient’s physical, social and psychological state (Mairs & Nicholls, 2016). There are both individual and family meetings with the health provider as the patient will be reluctant to disclose concerns about weight and body image with their family present (Forrest et al., 2017). The doctor will then analyze the risks of the eating disorder. Some reporting measures used include the Development and Wellbeing Assessment, Eating Disorders Examination, Eating Attitudes Test and Self-Report Questionnaires. With these, a comprehensive plan is created to address the eating disorder. A food plan is created with the guidance of a dietician. Parents and family members are crucial in giving information about the patient’s eating habits and offering support during and after mealtimes. The acceptance of a new eating plan takes time and could require interventions such as cognitive-behavioural therapy. The involved parties monitor the patient’s progress, and treatment continued as needed.
In summary, eating disorders are serious mental illnesses that require timely diagnosis and treatment before they progress into a severe state. The DSM-V gives comprehensive criteria for the diagnosis of eating disorders. The DSM-V eating disorder criteria cover pica, avoidant-restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge-eating disorder and other specified feeding and eating disorders. Eating disorders are most common among adolescents and require a team of professionals to treat. Given the severe effects of eating disorders, recognizing the early signs and seeking treatment are imperative.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Dahlgren, C. L., Wisting, L., & Rø, Ø. (2017). Feeding and eating disorders in the DSM-5 era: a systematic review of prevalence rates in non-clinical male and female samples. Journal of eating disorders, 5(1), 1-10.
Forrest, L. N., Smith, A. R., & Swanson, S. A. (2017). Characteristics of seeking treatment among US adolescents with eating disorders. International Journal of Eating Disorders, 50(7), 826-833.
Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. The American journal of clinical nutrition, 109(5), 1402-1413.
Mairs, R., & Nicholls, D. (2016). Assessment and treatment of eating disorders in children and adolescents. Archives of Disease in Childhood, 101(12), 1168-1175.
Mohler-Kuo, M., Schnyder, U., Dermota, P., Wei, W., & Milos, G. (2016). The prevalence, correlates, and help-seeking of eating disorders in Switzerland. Psychological medicine, 46(13), 2749.
Ward, Z. J., Rodriguez, P., Wright, D. R., Austin, S. B., & Long, M. W. (2019). Estimation of eating disorders prevalence by age and associations with mortality in a simulated nationally representative US cohort. JAMA network open, 2(10), e1912925-e1912925.