Longitudinal patterns of eating disorders from adolescence to adulthood

Eating Disorders in Adolescents

Eating disorders are a big health care problem in the United States. Adolescents in particular, are a most vulnerable group and an increasing number suffer from anorexia, bulimia and other eating disorders. Primarily a psychiatric condition, eating disorders can lead to serious consequences if they are not properly identified and treated. Statistics indicate that around.5% of adolescents are Anorexics while the prevalence of Bulimia nervosa is even higher ranging between.5% and 5.8%. Statistics also indicate that around 25% of college going women have a very high risk of developing eating disorders. However the exact figures of the number of people affected by these psychiatric conditions is still elusive as most often the disorder goes unidentified. Adolescents become easy victims to these disorders particularly in our western world where beauty is associated with slim and slender figures. In view of its wide prevalence and deranging effect on the physical and mental well-being of the affected individuals as well as the hidden nature of the disorder, it is imperative to increase the awareness about these psychiatric problems among the adolescent community. A review of related literature would help provide a better perspective of the problem.

Eating Disorders (a longitudinal Study)

As discussed above eating disorders are psychiatric conditions with symptoms starting to appear predominantly during adolescent stage. A research by the American academy of child and adolescent psychiatry has identified an interesting pattern of eating disorder among children, adolescents and adults. The research studied the course of eating disorder pattern from childhood to early adulthood. For the psychiatric assessment the researchers included 800 children and their mothers. These children were followed from childhood till their early adulthood with periodic ((1975, 1983, 1985, and 1992) psychiatric assessment as prescribed by the DSM. The outcome of the study was that early adolescent bulimia nervosa increased the risk of late adolescent bulimia nervosa and early adult bulimia nervosa by 9 times and 20 times respectively. Similar observations were confirmed for anorexia nervosa. The study revealed the possible continuance of eating disorders from childhood to adulthood and that eating preferences and conflicts during childhood or early adolescence may develop into severe eating disorders in adulthood.

The researchers also discuss a similar longitudinal research by Heatherton et al. (1997) which was conducted over a 10-year period on college age students. This study has found that more 21.6% of students who were clinically qualified for bulimia nervosa continued to meet the criteria even after 10 years indicating the continuing nature of the disorder. The results also indicated that having a bulimic status during college days implied a 15 fold increase in risk for BN ten years later. Another research by (Marchi and Cohen, 1990) pointed out that eating behaviors such as 'picky eating', avoidance, etc. continued to prevail over a 10-year period. The study also offered evidence to the fact that children with negative eating behaviors such as pickiness and avoidance qualified for Anorexia nervosa ten years later indicating the strong possibility of negative eating behaviors in childhood developing into dangerous clinical eating disorders in adulthood.

In our main study all the 800 subjects were questioned for the following six eating behaviors 1)'whether meals were unpleasant', 2)'struggles over eating', 3) 'amount eaten', 4) 'picky or choosy eating', 5)' speed of eating' and 6) 'interest in food'. The results when statistically corroborated indicated a moderate stability of symptoms pertaining to eating disorders with correlation values 0.4 to 0.5 for Anorexia nervosa and 0.3 to 0.4 for Bulimia Nervosa. So the present study has also attested the continuity of symptoms from early adolescence into early adulthood and the positive link between dislikes and conflicts in eating behavior during childhood and developing eating disorders during adolescence and early adulthood. This finding has important implications because the morbidity associated with eating disorders in adults is considerably high. Hence, symptoms of eating disorders occurring in early adolescents must be thoroughly studied and effectively countered before they develop into more serious forms in adulthood. [Walsh]

Effect of Interventions study by Winzelberg et.al has proved that intervention programs aimed at alleviating symptoms of weight disorder and body image can be effectively delivered through the internet medium. Though curriculum-based weight disorder programs increased the awareness among students very little was accomplished in terms of practical results. This research by Winzelberg and group proved that customized delivery of interventional methods through the internet-based CAHE (Computer Assisted Health Education) programs had a positive impact in correcting weight disorder problems among college going women. Participants for this research were made up of students without a previous history of bulimia nervosa or anorexia nervosa and a body mass index greater than18.

Of the total of 60 students, 31 were selected for the intervention program while 29 were used as control group. The intervention program disseminated through the internet stretched over an 8-week period during which all the participants were exposed to the program which discussed beauty from a cultural context, media influence, self-image etc. All subjects had to fill up a baseline Body Shape Questionnaire and an Eating Disorder Examination-Questionnaire (EDEQ) which were used as input to statistical analysis. Once a week the subjects were expected to complete assignments that included participation in a discussion group and exchanging information with other participants. This exercise was designed to provide an emotional support medium for the participants. The significant difference between control group and intervention groups in post intervention evaluation is clearly evident. (BSQ, F (1, 41) = 5.78, p =.021. and, F (1, 41) = 4.29, p =.045) the intervention group faired better with a baseline to post intervention BSQ of.40 indicating an improvement in body image. [Winzelberg et.al]

Conclusion

Anorexia nervosa and Bulimia nervosa are very serious psychiatric conditions that require appropriate intervention at the right time. The estimated high morbidity (16% of anorexics starve to death) associated with these disorders is an indication of the consequences of delaying intervention. The three articles that were discussed above provided insight into different aspects of eating disorders. The first study by Walsh et.al, identified that disorderly eating behaviors exhibited during childhood might be potential indicators of developing severe forms of eating disorders in late adolescence and early adulthood. Pediatricians and parents of such children might use this information to induce corrective behaviors at an early stage when it is easier to rectify than let the problem develop into severe clinical disorder. Winzelberg et.al on the other hand studied the effectiveness of intervention methods disseminated using the internet media. This research offered evidence that intervention methods can work well even in the absence of direct contact with therapist and emphasized the role of an emotional support group in bringing positive outcome. Finally, McDermott et.al also provided us with valuable clue in early detection and possibility of avoiding worsening of the condition. By identifying a positive relation between laxative use and severity of disorder the study serves as a warning, indicating treatment measures for such children who abuse laxatives. These researchers have clearly stressed the importance of early detection and treatment to minimize the chances of a full blown disorder. Medicos, nursing professionals, school counselors and most importantly parents must be attentive and detect behavioral abnormalities, negative eating behaviors and other such clues at an early stage and administer appropriate medical intervention and counseling support. Parents in particular play a major role in helping the child develop a positive self-image which is the best way to avoid these dangerous psychiatric conditions.