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Anorexia and bulimia among adolescent girls i
Anorexia and Bulimia Among Adolescent Girls
Jennifer Gavrilko
CSU, Monterey Bay
CHHS 302- Professional Writing for Health and Human Services
April 2, 2012
Anorexia and bulimia among adolescent girls ii
Table of Contents
Table of Contents.......................................................................................................ii
A Growing Problem.................................................................................................. 3
Factors Influencing Anorexia and Bulimia............................................................... 3
Effects of Anorexia and Bulimia............................................................................... 5
Treatments and Solutions......................................................................................... 7
Conclusion............................................................................................................... 8
References............................................................................................................. 10
Appendix.................................................................................................................11
Anorexia and bulimia among adolescent girls 3
A Growing Problem
Living in our society, it’s not surprising that young girls feel pressure to look a
certain way in order to feel beautiful. Our society’s emphasis on appearance and
idealization of thinness promotes dangerous dieting behaviors. The things adolescent
girls are doing to keep up with their idea of beauty are slowly killing them and parents
need to be more aware. Counting calories and skipping meals in order to lose a few
pounds can quickly spiral out of control and turn into an eating disorder, such as
anorexia or bulimia. “Over one-half of teenage girls... use unhealthy weight control
behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking
laxatives” ("Teens health," 2011).
Eating disorders are so much more than skipping a couple meals to lose a few
unwanted pounds. Anorexia and bulimia are extremes in dieting behavior- the diet that
never ends or gets severely more restrictive over time, for example. The Diagnostic and
Statistical Manual of Mental Disorders, fourth edition (DSM-IV) says individuals with
anorexia keep their body weight below a minimal normal level by exercise, control of
food intake, and other means. Individuals with bulimia control their body weight in spite
of binge overeating by purging (self-induced vomiting) or use of laxatives, diet pills or
other means (American Psychiatric Association, 2000).
These disorders take over the lives of adolescent girls. As a result, every thought
ends up centered around the disorder. Their lives become focused on their eating,
shape and weight, dietary control, thinness and weight loss; ‘fatness’ and weight gain
are constantly avoided. Anorexia and bulimia are not new in our society. They have
been around for years and are most prevalent in adolescent girls. Without early
detection and treatment, anorexia and bulimia can become life-threatening, and yet so
many of these girls are going without professional treatment. Only 13 percent of those
struggling with an eating disorder receive professional services (Caldwell, 2004). Given
the persistence of eating disorders (anorexia and bulimia) in adolescent girls, it is
imperative that we do a better job of educating parents about the importance of
identifying and seeking professional treatment for eating disorders, as well as informing
parents of the treatments that are most effective.
Factors Influencing Anorexia and Bulimia
There is no single known cause of any eating disorder, but it is known that they
exist mainly in prosperous cultures where there is plenty of food. Why voluntary
behaviors, such as eating smaller or larger amounts of food than usual, morph into an
eating disorder for some people is unknown. According to Derenne and Beresin (2006),
many clinicians now believe that eating disorders, previously thought to be caused by
dysfunctional family dynamics, are multifactorial in origin. People with anorexia have a
real fear of weight gain and a distorted view of their body size and shape. As a result,
they are unable to maintain a normal body weight. Many adolescents with anorexia
restrict their food intake by dieting or fasting. Bulimia is similar to anorexia. Someone
with bulimia might binge eat and then, in order to compensate, they will force vomiting
or exercise excessively to prevent weight gain. They may also use laxatives or
excessive exercise. Adolescent girls with bulimia typically feel powerless to stop the
eating and can only stop once they're too full to eat any more. Over time, these steps
can be dangerous — both physically and emotionally. Eating disorders can be difficult to
Anorexia and bulimia among adolescent girls 4
overcome due to the social stigma surrounding the affected individuals. This stigma
prevents open discussion, acknowledgement, and treatment of the disorders
Family Factors
Family members are a huge influence in an adolescent girl’s life. They are the
people these girls are spending the majority of their time with, which means that these
are the people the girls are learning from. Negative influences within the family may play
a major role in triggering and perpetuating eating disorders. Parents who put an
emphasis on looks and dieting or criticize their children's bodies are more likely to have
a child who ends up struggling with an eating disorder. If children perceive that they are
failing to live up to family expectations, they may turn to something that seems more
easily controlled and at which they may be more successful, such as food restriction or
weight loss. Caldwell & Kirkpatrick (2004) suggest that people with bulimia may be more
likely than average to have an obese parent or to have been overweight themselves
during childhood. Marital discord, domestic violence and divorce are also not
uncommon family issues for those suffering with an eating disorder. In addition, some
people turn to an eating disorder after they've experienced a family trauma such as
sexual or physical abuse, or neglect.
Cultural Factors
Culture is thought to play a significant role. Today’s culture is unique in that the
media (including television, internet, movies, and print) is a far more powerful presence
than ever before. Women, especially, are conditioned at a young age to think they have
to be skinny in order to be beautiful (Ebneter, 2011). They are pressured to fit a model
of beauty that is defined by body weight. This bombardment of images of thinness from
magazines and television produces a feeling of dissatisfaction with ourselves and our
bodies. There is a significant dichotomy between society’s idealized rail-thin figure and
the more typical American body (Watson, 2011). Vulnerable young girls do not see the
horrors that anorexia and bulimia can bring. Instead, they are impressed that someone
can “eat all she wants” and still lose weight just by sticking her finger down her throat
and vomiting. The media also tends to glorify eating disorders. Talk show hosts present
guests with eating disorders to create a sensation. The presentation of an emaciated
girl with anorexia, hanging onto life by a thread, creates a powerful image. But instead
of educating the public about the negative aspect of eating disorders, this image has the
opposite effect. It teaches onlookers how to lose weight dramatically (Derenne, 2006).
Although it is tempting to blame today’s media for perpetuating and glorifying unrealistic
standards of physical beauty, the truth is far more complicated and there are a number
of other factors that contribute to the development of an eating disorder.
Biological Factors
Biology may also be a factor. Caldwell and Kirkpatrick (2004) say anorexia is
eight times more common in people who have relatives with the disorder, and some
doctors believe that genetic factors are the root cause of many cases of eating
disorders. Appetite control and the regulation of food intake is very complex, with many
hormones in the brain and the body contributing to signals of hunger and fullness
Anorexia and bulimia among adolescent girls 5
("Teens health," 2011). According to Soyka, Grinspoon, Levitsky, Herzog, & Klibansky
(1999), research suggests that people with anorexia have increased activity in the
brain's dopamine receptors. This overactivity may explain why people with anorexia do
not experience a sense of pleasure from food and other typical comforts.
Other circumstances factor in, too. Eating disorders can be triggered by stress,
social difficulty, loneliness, depression or dieting itself. Dietary restriction can lead to a
repetitive pattern of self-deprivation, which can result in binging, weight gain, and
worsening self-image.
Effects of Anorexia and Bulimia
Eating disorders are serious medical problems. Anorexia nervosa, bulimia
nervosa are types of eating disorders that can be potentially deadly. Eating disorders
most often develop during adolescence or early adulthood, but can occur during
childhood or later in adulthood. Females are more likely than males to develop an
eating disorder.
Symptoms of anorexia may include:
● refusal to maintain body weight at or above a minimally normal weight for age
and height
● intense fear of gaining weight or becoming fat
● extreme influence of body weight or shape on self-evaluation
● infrequent or absent menstrual periods
● use of either food restriction or excessive exercising to limit body weight
● feeling cold or lethargic, caused by drop in body temperature as weight loss
advances
● growth of hair all over the body
● dry, yellowish skin
● severe constipation (Caldwell, 2004)
Symptoms of bulimia may include:
● recurrent episodes of binge-eating, characterized by consuming an amount of
food larger than most people could eat in a short amount of time
● the feeling that one cannot stop eating or control how much is being eaten while
binging
● behavior to prevent weight gain; purging is most common, laxatives and
excessive exercise may be used
● extreme influence of body weight or shape on self-evaluation
● chronically inflamed sore throat
● swollen glands in the neck or jaw
● dehydration due to purging of fluids
● kidney problems from diuretic abuse (Caldwell, 2004)
Medical care, including hospitalization to treat malnutrition or create weight gain,
is sometimes necessary in anorexia. Eating disorders can lead to serious physical
health problems, such as heart conditions or kidney failure. Someone whose body
Anorexia and bulimia among adolescent girls 6
weight is at least 15% less than the average weight for that person's height may not
have enough body fat to keep organs and other body parts healthy (Soyka, 1999). In an
article written by Soyka, Grinspoon, Levitsky, Herzog & Klibansky (1999), it is stated,
A severe degree of decreased bone mass has been reported even in young
adolescents with a brief duration of illness. Adolescence represents a critical time
in bone metabolism, as most bone mineral is accumulated during the teenage
years, and deficits incurred during this time may be permanent.
In severe cases, eating disorders can lead to severe malnutrition and even death. For
females between the ages of 15 and 24 who struggle with anorexia, the mortality rate
for their illness is 12 times that of all other causes of death (Lock, 2011).
Chart 1
Note: Chart 1 is an illustration describing the effects anorexia has on the entire body. Retrieved from
http://www.womenshealthzone.net/eating-disorders/anorexia-nervosa/effects/
With anorexia, the body goes into starvation mode. Without proper nutrition, the
body can react with an inability to concentrate, anemia, drop in blood pressure, pulse
and breathing rate, light headedness. Slow heart rate and low blood pressure means
that the heart muscle is changing. The risk for heart failure rises as the heart rate and
blood pressure levels sink lower and lower.
With bulimia, vomiting and lack of nutrients can cause constant stomach pain,
damage to the stomach and kidneys, tooth decay (from exposure to stomach acids)
Anorexia and bulimia among adolescent girls 7
(Caldwell, 2005). "Chipmunk cheeks," happen when the salivary glands permanently
expand from throwing up so often and loss of potassium. Electrolyte imbalance is
caused by dehydration and loss of potassium, sodium and chloride from the body as a
result of purging behaviors. Electrolyte imbalances that can lead to irregular heartbeats
and possibly heart failure and death. Cardiac complications are found in 80% of patients
with an eating disorder and studies have demonstrated that approximately 30% of
deaths in patients with AN are due to cardiac complications (Stiles-Shields, 2011).
Treatments and Solutions
Psychotherapy
Psychotherapy is an essential part of any treatment plan for eating disorders. It is
the most effective and longest lasting treatment. Individual, group, and family therapy
sessions focus on different aspects of these complicated conditions. Psychotherapy,
coupled with attention to medical and nutritional needs, should be tailored to the specific
individual depending on the severity of the disorder. Psychological counseling should
focus on both the disordered eating symptoms and the underlying issues that
contributed to the disorder. Simply changing patients’ thoughts and behaviors is not
enough, however. To ensure lasting improvement, patients and psychologists must
work together to explore the psychological issues underlying the eating disorder.
Psychotherapy may need to focus on improving patients’ personal relationships.
Antidepressants, to improve mood and reduce obsessiveness, may be prescribed for
those with eating disorders (Stiles-Shields, 2011).
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) is an active type of counseling and is known
to be an effective treatment for eating disorders. Sessions usually are held once a week
for as long as you need to master new skills. Individual sessions typically last one hour,
and group sessions may be longer. During cognitive-behavioral therapy for anorexia,
patients will learn about the illness, its symptoms, and how to predict when symptoms
will most likely recur. They are encouraged to keep a diary of eating episodes, binge
eating, purging, and the events that may have triggered these episodes. They learn to
eat more regularly, with meals or snacks spaced no more than 3 or 4 hours apart.
Patients learn how to change the way they think about their symptoms, reducing the
power the symptoms have over them. Cognitive-behavioral therapy is used to treat the
mental and emotional elements of an eating disorder. This type of therapy is done to
change how one thinks and feels about food, eating, and body image. It is also done to
help correct poor eating habits and prevent relapse (Fairburn, 2003).
Many people turn to 30-day inpatient treatment after finding little success with
outpatient psychotherapy. When a person is "inpatient" it means that they will be living
at the facility for a certain period of time. This can range from a couple of weeks to
several months. The facility usually has medical doctors, registered nurses, therapists,
dietitians and volunteers on staff to work with the people in recovery on a daily basis. It
is intended to provide a safe environment in which to recovery from an eating disorder.
Depending on the facility, the routine can vary, but it may include the following: group
sessions, one-on-one therapy, medical evaluations, weigh-ins, nutritional counseling, art
Anorexia and bulimia among adolescent girls 8
therapy, medication administration, spiritual exploration and prayer, meal times, and
social or leisure activities.
Integrative Medicine
Integrative medicine can be defined as a healing-oriented discipline that takes
into account the whole person — body, mind and spirit — including all aspects of
lifestyle. It emphasizes the therapeutic relationship and makes use of both conventional
and alternative therapies. Complementary and alternative therapies used in integrative
medicine can include acupuncture, chiropractic, herbal medicine, dietary supplements
and others that give the clinician a wide array of treatments for difficult conditions. This
is particularly true in the integrative medicine approach to eating disorders. The
cornerstones of an integrative medicine model for eating disorders includes some
components that are found in every approach to the treatment of eating disorders, but
may be used in a unique manner.
Prevention
Prevention is always the best option when it comes to eating disorders. There
are many ways to help prevent a child from developing and eating disorder. Parents can
set healthy examples by eating right and exercising. Parents need to lead by example
when it comes to self-image. If the general public would accept the basis of eating
disorders and remove the surrounding stigma, then affected individuals will feel more
comfortable seeking help within the medical community and among close friends and
family rather than anonymous and potentially detrimental websites. There also needs to
be more support for families of girls struggling with an eating disorder. It would be highly
beneficial to have some kind of program, possibly through the schools, that educates
and supports parents and students. There are several options when it comes to
treatment of anorexia and bulimia. Sadly, the number of girls not receiving treatment
greatly outnumbers the girls that are in treatment. Eating disorders are not easy to
recognize, even by those who need help and asking for help is even more difficult.
Conclusion
It is important that people in the lives of young girls with anorexia or bulimia know
how to recognize the signs and symptoms. Eating disorders are more than just a
problem with food. Food is used to feel in control of other feelings that may seem
overwhelming. Parents can help prevent kids from developing an eating disorder by
building their self-esteem and encouraging healthy attitudes about nutrition and
appearance. Living a healthy lifestyle where kids are taught that they don’t have to be
thin to be happy and beautiful can do a great deal to prevent an eating disorder. They
need to be able to get these girls the treatment they need in order to live a healthy life.
It's important to remember that eating disorders can easily get out of hand and create
habits that are difficult to break. Eating disorders are serious clinical problems that
require professional treatment by doctors, therapists, and nutritionists. Parents and
family members need to pay attention to this research because eating disorders, such
Anorexia and bulimia among adolescent girls 9
as anorexia and bulimia, are most prevalent in adolescent girls and it seems that they
will not be going away anytime soon.
Anorexia and bulimia among adolescent girls 10
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed., text rev.). Washington, DC: Author.
Caldwell, P. & Kirkpatrick, J. (2004). Eating disorders: Everything you need to know.
Buffalo, NY. Firefly Books.
Derenne, J. M.D., Beresin, E. M.D.; (2006). Body Image, Media, and Eating Disorders.
Academic Psychiatry. May, 30(3), 257-261.
Ebneter, D.S., Latner, J.D., O’Brien,K.S., (2011) Just world beliefs, causal beliefs, and
acquaintance: Associations with stigma toward eating disorders and obesity.
Personality and Individual Differences, 51(5), 618-622. Retreived from
(http://www.sciencedirect.com/science/article/pii/S0191886911002595)
Fairburn, C., Cooper, Z. Shafran, R.. (2003). Cognitive behaviour therapy for eating
disorders: a “transdiagnostic” theory and treatment. Behaviour Research and
Therapy, 41(5), 509-528. Retrieved from
(http://www.sciencedirect.com/science/article/pii/S0005796702000888)
Lock, James. (2011). Family treatment for eating disorders in youth and adolescents.
Psychiatric annals. 41(11), 547-551. Retrieved from
http://illiad.csumb.edu/illiad/illiad.dll?Action=10&Form=75&Value=46661
Soyka, L., Grinspoon, S., Levitsky, L., Herzog, D., & Klibansky, A. (1999). The effects of
anorexia nervosa on bone metabolism in female adolescents. The Journal of
Clinical Teens Health. Retrieved from
http://kidshealth.org/teen/food_fitness/problems/eat_disorder.html
Stiles-Shields, C., Smyth, A., Glunz, C., Hoste, R. Boepple, L., & Le Grange, D. (2011).
A Review of the Role of Psychiatrists and Pediatricians in Outpatient Treatment
of Adolescents with Anorexia and Bulimia Nervosa. Current Psychiatry Reviews,
7, 177-188
Watson, H. J., Raykos, B. C., Street, H., Fursland, A. and Nathan, P. R. (2011).
Mediators between perfectionism and eating disorder psychopathology: Shape
and weight overvaluation and conditional goal-setting. International Journal of
Eating Disorders, 44, 142–149. doi: 10.1002/eat.20788
Anorexia and bulimia among adolescent girls 11
Appendix
Anorexia and bulimia among adolescent girls 12
Note: These criteria were accessed from the American Psychiatric Association. Diagnostic and statistical
manual of mental disorders, 4th ed. Washington, D.C.: American Psychiatric Association, 1994:427-9.
Copyright 1994.