Dr Asha Pemberton
It is estimated that as many as one in every ten adolescents has had a struggle with an eating disorder, including anorexia nervosa, bulimia nervosa or binge-eating disorder. In recent clinical practice since the pandemic, it has absolutely been identified that many of our young people have these struggles. Specifically regarding anorexia nervosa, we have recognised young people locally who are subjecting or recently subjected their bodies to starvation and unhealthy disordered eating practices to manipulate their body weight, shape or size.
Eating disorders are sometimes hard to identify at first as young people become experts at hiding their abnormal eating behaviour from those close to them. Nevertheless, eating disorders are mental illnesses with high rates of death, due to many associated medical complications.
Eating disorders most commonly start in girls between ages 14 and 17 years but are also seen in adolescent boys and younger children. Although overall, girls with eating disorders outnumber boys by about ten to one we must not forget that more and more male teens are being diagnosed. The root causes of eating disorders are complex. A combination of genetics/family history, influences of social media and culture on the definition of beauty, low self-esteem and other emotional health conditions all increase the risk of these disorders.
The young adolescent mind is fragile, and constant messages that promote thinness as beauty can erode the sense of self and value of a teenagers and older children. Once these teens develop abnormal eating and exercise behaviours in response to a stress or trigger, a vicious cycle of starvation, or binging and purging develops, and leads to anorexia nervosa.
Anorexia nervosa is defined as a disorder that includes self-starvation and the relentless pursuit of thinness using many unhealthy activities to prevent weight gain. There is the extreme preoccupation with food, weight, and shape; severely erratic or inadequate food intake; and disordered emotional regulation regarding eating. Affected young people often have other symptoms of anxiety, depression, and obsessive-compulsive thoughts and symptoms.
As eating disorders develop, rapid losses of weight are often initially supported and applauded by family members and friends who are unaware of the unhealthy practices and emotional distress underlying. This initial praise unfortunately encourages young people to continue or increase their efforts. When significant weight loss occurs, affected teens become weak, unable to concentrate, and females stop having a menstrual period or it becomes irregular, which is a particularly worrisome sign of poor overall health and extreme low-body weight.
Medical complications of eating disorders
• Arrhythmias or irregular heartbeat and heart failure
• Kidney and liver injury
• Loss of muscle mass and “stick-thin” arms and legs
• Permanent loss of bone mass leading to fractures and early osteoporosis
• Destruction of teeth and damage to the lining of the stomach
• Disruption of menstrual cycle
• Delayed growth and permanently stunted growth due to under-nutrition
• Excess hair on face, arms and body
• Dry blotchy skin and cold hands/feet
• Fainting spells, seizures, sleep disruption, mental fatigue
Psychological effects of eating disorders
The medical consequences of anorexia nervosa are many but the psychological distress that young people experience is extreme. Most affected become so entrenched in their way of thinking that they believe themselves to be "fat" – while clearly underweight – and that everyone attempting to assist them is the enemy. They literally exist in a state of agony and obsession in their minds until appropriately and completely treated. It is a sad irony that teens who develop eating disorders often begin with a diet or “health plan” believing that weight loss will lead to improved self-esteem, self-confidence and happiness. There is usually a triggering statement, comment from someone or life-experience that starts them down the path. The cruel reality is that in addition to initial weight loss, the persistent undereating, binge eating and purging have the opposite effect.
Eating disordered individuals typically struggle with one or more of the following complications:
• Feeling out of control and helpless
• Extreme anxiety and self-doubt
• Guilt and shame, feelings of failure
• Hypervigilance and paranoia
• Fear of discovery
• Obsessive thoughts and preoccupations
• Compulsive behaviours and rituals
• Feelings of alienation and loneliness
Anorexia nervosa brings suffering and distress not only to the teens who have them but also their families, friends and school communities. Parents often blame themselves, disagree on the required treatment or even refuse to accept the seriousness of the diagnosis. This is partly because the initial boundary between “seeking a healthy life” and the abnormal obsessive behaviours and thought patterns of an eating disorder may be difficult to distinguish. There is an important difference between balancing nutrition and physical activity to maintain an appropriate weight, and starvation, abnormal eating behaviour, emotional distress and extreme weight loss leading to complications. It is critical to note that some teens will have less dramatic weight loss, and are then able to mask and hide their abnormal behaviour, suffering in silence.