Posted with permission by Jane M. Rees, PhD, RD, CD
Adolescent Nutrition and Eating Disorders
Chapter 3: Onset of Anorexia Nervosa During Adolescence
The physical manifestation of anorexia nervosa may be sudden, although unrecognized underlying characteristics may have been present prior to manifestation of an identifiable disorder. Intervention strategies should simultaneously address the psychological and physical issues of the adolescent.
Onset: Progressive development
From the family's point of view, the teenager with anorexia nervosa has traditionally been a "model child". She fits into the family and meets her parents' high expectations, working extremely hard at school and being satisfied only with excellent grades. Suddenly she displays a compulsive attitude about her weight and food consumption. The family erupts in crisis as response to her extreme eating behavior.
Onset: Psychological characteristics
The teenager with anorexia nervosa is troubled about her life. She finds it difficult to mature psycho-socially and clings to the rigid patterns of childhood. She is unable to sustain peer friendships and isolates herself. Life appears to be out of her control. She is conflicted about living as her parents direct, is hurt by their critical comments and begins to realize that she must assert herself but finds that difficult. She feels too fat and thinks she has to be slim to be a worthy person. She takes an uncompromising stand about her eating and exercise habits. Increasingly preoccupied and angry when her family interferes, she denies her illness.
Onset: Distorted perceptions
A range of distorted perceptions has been noted, often related to body size and shape, hunger, satiety, physical endurance and the need for rest. Distorted perceptions characteristic of anorexia nervosa may be exacerbated during episodes of crisis level starvation and will vary from time to time as well as adolescent to adolescent. Anorexia nervosa should not be ruled out on the basis of lack of specific distortions if other symptoms are present.
Onset: Motivation
The adolescent with anorexia nervosa has been described as wishing to stave off adulthood. The question is whether she tries to avoid maturation or whether maturation eludes her.
Onset: Family characteristics
Many families of adolescents with anorexia nervosa list no problems until the manifestation of the disorder. They need assistance from family specialists on the health care team to deal with the unexpected crisis of an eating disorder. As treatment progresses they require guidance while developing a family system to support their adolescent as she learns to regain her health.
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