Eating disorders are a serious problem among adolescents. It is estimated that approximately five percent have diagnosable eating disorders but many more have non-specific symptoms that signal problems with disordered eating. There are numerous negative consequences that can impact a teenager who suffers from disordered eating, both physical and emotional. Moreover, If left untreated, eating disorders can have tragic effects: they have the highest mortality rate of all psychiatric disorders.

Why Teenagers?

While there are genetic factors which contribute to the development of eating disorders, there are many variables related particularly to being an adolescent. Puberty and developmental changes during adolescence contribute to physical and psychological instability. At the same time, teenagers are very concerned with body image, a major risk factor in the development of disordered eating. Adolescents’ desire to fit in often leads to a hyper-focus on weight and overall appearance. Unfortunately, society has set unrealistic standards as far as acceptable body types. These impossible standards are further enhanced by social media. Apps like Instagram and Snapchat are highly image-focused and a significant part of a teen’s social network. The constant barrage of friend and celebrity images puts a lot of pressure on teenagers to live up to an idealized body image.

How Are Adolescents Affected?

Adolescents who exhibit disordered eating have an unhealthy preoccupation with food and their weight. In many ways, eating disorders are an issue of control. Teenagers may exhibit perfectionistic qualities or obsessive-compulsive behavior. They usually possess a distorted body image, sometimes reaching the level of Body Dysmorphic Disorder. Frequently, they will have a poor self-image and resulting mood issues. Physical problems may include dramatic weight loss, dental problems, and gastrointestinal complaints.

Interventions

Treatment for adolescents is often a multidisciplinary approach involving medical doctors, psychotherapists, nutritionists, and family members. Depending on the severity of the eating disorder, treatment may be performed in a residential/inpatient setting, day program, or outpatient basis. While many different forms of treatment are used to treat eating disorders, not all are supported by research. Surprisingly, the research into adolescent treatment for eating disorders remains sparse. The following are generally validated forms of treatment:

Family-Based Treatment (FBT)

Most commonly used with Anorexia and Bulimia Nervosa, this form of treatment is usually performed on an outpatient basis and involves the family as essential members of the treatment process. The focus is on returning the teenager to normal body weight. Family members help the teen learn healthy eating habits and offer needed support. This type of treatment is the most studied with the adolescent population and has consistently proven to be successful. This is not all that surprising due to the critical role family plays in the life of an adolescent.

Adolescent Focused Therapy (AFT)

AFT is an individual psychotherapy rooted in psychodynamic principles. Some of the goals of AFT are improving autonomy, individuation, assertiveness, and self-efficacy. The rationale of this approach comes from the idea that adolescents develop disordered eating because they feel out-of-control and their personal development may be stunted by over-involved parents. Treatment includes encouraging the youth to gain weight and to eat normally as a way to increase self-control and mastery. Parent meetings may also be included as a way to support individual treatment.

Enhanced Cognitive Behavioral Therapy (CBT-E)

Although CBT is commonly used with adults who display disordered eating, its use with teenagers is not as well-studied. The reasoning for the use of CBT is that people with eating disorders exhibit distorted thinking about bodyweight and put an overemphasis on the importance of being thin. CBT addresses these issues through regulating eating patterns, cognitive restructuring of distorted thoughts, and recording food intake. Nutritional education and parent involvement are also commonly employed.

Interpersonal Therapy

Interpersonal psychotherapy has been employed most specifically for the treatment of Bulimia Nervosa and Binge Eating Disorder. Its use is related to the theory that interpersonal problems are linked to the development of disordered eating. Its focus is on resolving the interpersonal areas of grief, role disputes, role transitions, and interpersonal deficits. It is believed that addressing these areas of interpersonal conflict will lead to symptom reduction.

Medication

Although adolescents are often prescribed psychotropic medication as part of a treatment protocol for eating disorders, there is little evidence to support its use. There have been a few studies of the effectiveness of medication in treating Anorexia Nervosa in teenagers but neither Selective Serotonin Reuptake Inhibitors (SSRIs) nor atypical antipsychotics (e.g., Olanzapine)  have yielded positive results.

Despite the prevalence and severity of eating disordered behavior in adolescence, it is an area that is not well-studied. While many different forms of treatment are employed, more research is needed to find support for treatments that are empirically effective. For now, it appears that family-based treatment and/or individual treatment that focuses on either psychodynamic principles, cognitive distortions, and interpersonal relationships holds the most promise. In any case, if you know someone who is suffering from disordered eating, it is important to seek the appropriate help.