Why do teenage girls have highest risk of developing eating disorders? Dr. Hersh explains
What are eating disorders?
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an eating disorder is “a behavioral condition characterized by severe, persistent disturbance in eating behavior and is associated with distressing emotions and thoughts,” and these impair health and/or psychosocial function.
Eating disorders are common, with a lifetime prevalence of up to 8% in females and 2% (and recently increasing) in males. Teenage girls are at highest risk for developing eating disorders (for example, anorexia nervosa usually begins shortly after puberty but sometimes later — even into one’s 20s), although other age groups and males can also have this disorder.
What are some eating disorders?
Anorexia nervosa, which is characterized by the patient chronically restricting their total energy intake from foods despite not maintaining their body weight at or above the 85th percentile of the expected average for their height; a fear of gaining weight or becoming fat despite having this very low body weight; and a disturbance in how they view themselves (for example, even at this suboptimal weight, they may see themselves as fat, or dislike the shape or look of their body). Some patients may also undertake ritualized exercise regimens. Avoidant/restrictive food intake disorder is a related disorder that does not fulfill all of the requirements for a diagnosis of anorexia nervosa.
Bulimia nervosa, which is characterized by recurrent episodes (at least twice a week for three months or more) of self-induced vomiting (called purging), often after binge eating (rapidly eating large amounts of food, for example over 1000 kcal in just a couple of hours). Rather than purging, some people with bulimia will abuse laxatives or diuretics. Binge eating is a related disorder that does not fulfill all of the requirements for a diagnosis of bulimia nervosa.
Pica, which is characterized by repeatedly eating non-food substances.
Earlier: Dr. Hersh examines factors that can stop hair growth
Why do people develop eating disorders?
The cause of eating disorders is thought to be multifactorial, including biological (including genetic factors, especially for anorexia and bulimia, and others), sociocultural and psychological factors.
For example, anorexia is usually not just about the patient’s weight; it is typically about reacting to psychosocial issues (such as depression, insecurity, feeling like they have no control of their lives, and/or feeling like they cannot live up to the level of perfection they feel they need to) in an unhealthy manner. Anorexics may take control of their eating as a way to exert control of some aspect of their lives; in fact, some patients consider anorexia their "friend." Anorexics will often hide their eating issue, sometimes having secret eating rituals. They commonly deny there is an eating issue.
Complications of eating disorders
There are many complications of eating disorders, including possible heart problems, anemia, loss of muscle mass, kidney issues, liver disease, osteoporosis, growth issues, hormonal issues (for example, females may cease to have their periods, other issues), immune system compromise, electrolyte abnormalities, psychological effects, social issues, others. In studies of people suffering from eating disorders, over 6% die from complications of it.
How to treat eating disorders
There are treatment programs for people with eating disorders. These typically rely on an interdisciplinary team including counseling/consultation from mental health clinicians (for example, cognitive behavior, psychodynamic and/or other therapies), dietician consultations (for nutritional rehabilitation), family therapy and other interventions.
About half of anorexics will fully recover with appropriate treatment, another third getting significantly better. Unfortunately, this means up to 20% do not respond well to treatment, and remain significantly ill with their condition.
If you have any suspicion that you or someone you know has an eating disorder, seeking clinical evaluation is a crucial first step. There are screening questionnaires that have a high accuracy of identifying people who may have an eating disorder. These questionnaires may be administered by your clinician and will ask about:
Certain physical pain complaints (such as stomach, back, arm/leg, menstrual, head, chest pain, others), dizziness, fainting, bowel movement issues, changes in energy levels, weight changes, others.
Psychosocial issues, such as depression symptoms, anxiety symptoms, mood changes, sleep disturbances, concentration issues, suicidal thoughts and others.
And of course, about eating habits, purging, etc.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
This article originally appeared on MetroWest Daily News: Why people develop eating disorders and how to treat them: Dr. Hersh
