Over the last few decades, as society and the media have placed much emphasis on being thin, the prevalence of eating disorders has grown so that they now rank among the most common causes of chronic disease in the adolescent age group, especially in females. Current research shows that between 0.5 to 3.7% of females in the United States will suffer from anorexia nervosa (AN) in their lifetime, while anywhere from 1.1 to 4.2 % of females will suffer from bulimia nervosa (BN). However, the true prevalence of eating disorders in the adolescent population is difficult to determine since these diseases are often kept secret. Also, individuals with disordered eating do not always meet the full diagnostic criteria for anorexia or bulimia, so, the prevalence is likely much higher than what is reported.
Eating disorders tend to be diseases of young women. Recent data shows that greater than 90 % of individuals suffering from an eating disorder are women between the ages of 12 and 25, with a bimodal peak age of onset occurring at 13 B 14 years of age and again at 17 B 18 years of age. In the US, Caucasian and Hispanic females are most commonly affected, the next most affected group is Native American females, while the least affected groups are African and Asian females. In addition, guidelines laid out by the American Academy of Pediatrics (AAP) report that 5 to 10% of eating disorders occur in males; a percentage that is higher than was previously thought.
Anorexia nervosa is a psychiatric disorder with medical consequences. Adolescents suffering from AN rigorously restrict their caloric intake because they are intensely afraid of gaining weight. They have a disturbed body image and see themselves as fat even though in reality they are below what would be viewed as normal weight. Anorexia is an “ego-syntonic” disease – e.g., they have no recognition that either their ideation or behavior is dysfunctional. Individuals suffering from AN do not believe that they have a problem or are doing anything harmful to their bodies.
There is no one clear cut cause of AN; however, many behaviors or personality traits are known to be associated with people who suffer from this and other eating disorders. Common associations are listed below.
Common associations with anorexia nervosa and other eating disorders
- Rigid personality
- Low self-esteem
- Feeling helpless
- A strong need to control one=s environment
- Social phobia
- Anxiety and irritability
- History of weight fluctuations
- Changes in appetite regulation
- Shifts in food preferences
- Counting calories
- Hoarding food
- Collecting recipes
TEACHING CAPTION: These associations are maintained without recognition of their dysfunctional nature.
An individual=s family and social environment influences one’s eating behaviors and beliefs about food. For example, children who are surrounded by friends or relatives who focus on being thin, stress dieting, and are never satisfied with their own body, are likely to develop similar beliefs and also have issues with eating and weight.
Currently, a biopsychosocial model is used to understand and explain anorexia. This model suggests that psychological, social, environmental, and biological factors interact and are involved in the development of the disease. Not all patients that have disordered eating will fulfill the DSM-IV diagnostic criteria for either anorexia or bulimia, however, they may still suffer both physically and mentally from their disordered eating behaviors.
Pediatricians serving as primary care providers for adolescent patients need to possess an understanding of and carry a high index of suspicion for eating disorders so that they will be prepared to identify disease when present and get the patient appropriate care. Eating disorders can lead to serious medical conditions and have significant morbidity and mortality associated with them. The sooner the problem is recognized, addressed, and treated, the better the chances of preventing complications and providing the patient with the best probability for a healthy future.
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