Posted with permission by Jane M. Rees, PhD, RD, CD
Adolescent Nutrition and Eating Disorders
Chapter 2: Anorexia Nervosa in Adolescence
Anorexia Nervosa: Symptoms
The term anorexia nervosa is actually a misnomer. Affected adolescents ignore and even lose their hunger sensations. The motivation to be thin apparently keeps these adolescents from eating. Since an early description, (in 1689), a combination of symptoms has come to be regarded as characteristic of anorexia nervosa, although certain of these symptoms may be seen in other disorders. The unique combination of symptoms in anorexia nervosa has been defined by the American Psychiatric Association (APA). A description appears below, including considerations suggested by adolescent eating disorder specialists (in brackets and capital letters), making it applicable to most adolescents.
Refusal to maintain body weight at or above minimal normal weight for age and height
Loss or failure to gain weight with maintenance weight 15% below expected
Fear of gaining weight or becoming fat, although underweight
Disturbed experience or evaluation of body weight, size, or shape
Feeling fat although underweight
Absence of three consecutive menstrual* cycles not relying on estrogen in post-menarcheal females
* In all cases females are considered amenorrheic when menses do not occur unless induced by estrogen replacement.
"A relentless pursuit of thinness" and "a misuse of the eating function in efforts to solve or camouflage problems that otherwise would appear insolvable" underlies these symptoms as pointed out by Hilde Bruch in her classic description in 1973 (Eating Disorders, New York, Basic Books). In summary, the adolescent with a severe eating disorder suffers from arrested physical and psychological growth and development. (Because most patients are females, the feminine pronoun will be used in this discussion.
Anorexia Nervosa: Overall prevalence
Although recent precise figures are not available, as many as 1% of American teenaged females, 15 - 19 years of age, are said to suffer from anorexia nervosa. The majority of persons with anorexia nervosa are adolescents, although the disease affects young adults and other age groups. The disorder is supported by a cultural paradox: food is abundant and used lavishly for purposes other than survival and on the other hand slimness is highly valued. These cultural values are strong internal messages for many in the modern world. The impact is great on a young adolescent who has not developed autonomy.
Anorexia Nervosa: Prevalence in females
About 1% of average high school aged girls in the US and England are thought to be affected. It must be recognized, however, that accurate data are difficult to obtain because of the secretive nature of the disorder and the fact that many do not seek treatment.
Anorexia Nervosa: Prevalence in males
The disorder is not common among males, with only about 5% to 10% of diagnosed cases being males less than 14 years. Of cases diagnosed in older adolescents, 19% to 30% are in males. Males with anorexia nervosa seem to have the same sort of disorder as females. The traditional lack of value on extreme slimness in males adolescents probably puts them at a somewhat lower risk for the disorder. Celebrities with excessively thin and/or muscular bodies are beginning to influence the ideals of young males, however. Obsessive muscle building and exercise to the point of harming their bodies, may be the equivalent of anorexia nervosa in vulnerable males.
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