Anorexia Nervosa and Bulimia in Adolescents

Young people with poor eating habits can develop eating disorders or these disorders may be in response to various psycho-sociological issues that arise during adolescence. Irrespective of the cause, adolescents with eating disorders run the risk of a wide range of adverse healthcare outcomes, including obesity, high blood pressure, bone loss and even death. The problem is more common than many people believe, and the prevalence of eating disorders has been increasing in recent years due in part to improved recognition of the condition by clinicians. To determine the current state of affairs with adolescent eating disorders, this paper provides a review of the relevant peer-reviewed and scholarly literature to develop a background and overview of eating disorders, their effects and how these conditions are treated. Finally, a summary of the research and important findings about adolescent eating disorders are provided in the conclusion.

Background and Overview

Professional and public awareness of eating disorders has increased significantly in recent years, but eating disorders have been known for centuries (Ray, 2009). Although more adolescent females suffer from eating disorders than males, an adolescent male was the first modern individual diagnosed with an eating disorder and about 10% to 15% of the eating disorder population is male adolescents (Ray, 2009). The prevalence of all types of eating disorders among the adolescent population has been increasing in recent years (Lopez-Guimera, Sanchez-Carracedo, Fauquet & Portell, 2011). Eating disorders such as anorexia nervosa and bulimia among adolescents can result in a wide array of health issues, including obesity, hypertension, diabetes and cardiovascular disease (Cariun, Taut & Baban, 2012) as well as bone loss, amenorrhea, hypokalemia and even death (Lock & Fitzpatrick, 2009). In this regard, Lock and Fitzpatrick report that, "The incidence rate for anorexia nervosa is just under 1%, while the incidence rate for bulimia nervosa is between 2% to 3%" (2009, p. 287). Referred to in some cases as Eating Disorder Not Otherwise Specified, partial or subthreshold cases of eating disorders represent another 2% to 5% of the adolescent population today (Lock & Fitzpatrick, 2009).

The mortality rates experienced by anorexia nervosa sufferers are among the highest for psychiatric disorders of all types and average about 8% to 12% (Lock & Fitzpatrick, 2009). In this regard, Lock and Fitzpatrick note that, "Deaths are most often due to cardiac arrest and suicide. Eating disorders, especially anorexia nervosa, are expensive to treat because of the high use of hospitalization" (2009, p. 288). Another problem that is associated with treating eating disorders is the tendency of sufferers to conceal their disorders. For instance, according to Ray, "The societal stigma surrounding eating disorders is one of secrecy and shame; as a result, eating disordered adolescents often go to great lengths to hide their condition" (2009, p. 98). This tendency, combined with the fact that eating disorders may go unnoticed for some time, means that healthcare interventions may be significantly delayed. As Enos (2013) points out, "While eating disorders often begin manifesting in adolescence, formal treatment for many individuals frequently does not occur until life-threatening circumstances compel action much later" (p. 40). The formal treatments that are commonly used for adolescent eating disorders are discussed further below.

Treating Eating Disorders

Although many treatment approaches to adolescents with eating disorders continue to be based on adult models, there have been several psychotherapeutical approaches specifically developed or modified to treat adolescent eating disorders in recent years (Lock & Fitzpatrick, 2009). In this regard, Lock and Fitzpatrick report that, "A number of specific techniques are used in the process of challenging the use of food and weight to maintain psychological and developmental deficits" (2009, p. 288). Likewise, Lopez-Guimera and her associates report that, "In general, prevention programs targeting eating problems and eating disorders have led to improvements in knowledge, though only a small number of such programs have succeeded in reducing disordered eating attitudes and behaviors from baseline scores to post-test and followup" (p. 294).

Since adolescents usually do not have substantial amounts of life experiences to draw on, healthcare practitioners frequently employ adaptive skills for treating eating disorders, especially for managing conflicts and emotional issues because adolescents suffering from anorexia nervosa typically have also experienced delays in some critical aspects of their development, including interpersonal assertiveness skills and emotion regulation (Lock & Fitzpatrick, 2009). In some cases, clinicians must employ directive approaches to overcome problems of self-care issues involving food and eating as well as other issues such as noncompliance with treatment regimens or poor hygiene (Lock & Fitzpatrick, 2009).

In some cases, inpatient treatment may be necessary for adolescents suffering from eating disorders. According to Enos (2013), "On an inpatient unit, youths are medically supervised and receive a broad-based menu of services that include cognitive-behavioral therapy, nutritional guidance, experiential therapies and family education" (p. 40). There remains a paucity of studies concerning the efficacy of these approaches, though, but the research to date indicates that cognitive-behavioral therapy is the optimal intervention for treating bulimia nervosa (Lock & Fitzpatrick, 2009). The limited about of research in this area also suggests that cognitive-behavioral therapy is as effective as family based therapy for adolescents suffering from eating disorders (Lock & Fitzpatrick, 2009).

This alternative is necessary because not all adolescents can employ family-based treatments for a number of individualized reasons (Lock & Fitzpatrick, 2009). According to Lock and Fitzpatrick, "A viable alternative is adolescent-focused individual therapy which is derived from an approach to adolescent anorexia nervosa described as ego-oriented individual therapy" (2009, p. 288). In contrast to family-based interventions, the focus of ego-oriented individual therapy is on the psychological deficits anorexia nervosa sufferers (Lock & Fitzpatrick, 2009).

The ego-oriented individual therapy model uses an extreme focus on weight and food to reinforce the avoidance of negative affective states, particularly the negative affective states that are typically of adolescent developmental tasks (Lock & Fitzpatrick, 2009). The goal of ego-oriented individual therapy is to improve self-efficacy and provide adolescents with better coping mechanisms (Lock & Fitzpatrick, 2009). According to Lock and Fitzpatrick, "To accomplish this, the therapist assists the patient to identify and define his or her emotions, with the goal of increasing tolerance to negative emotional states" (2009, p. 288). Achieving this goal requires a sound therapeutic relationship, but clinicians using this intervention may also be required to exert their authority to stress the need for healthy eating behaviors and to ensure adolescents comply with medical recommendations for gaining weight gain (Levenkron, 2001).