Eating Disorders in Adolescents - Case Study Example

Eating Disorders in Adolescents Introduction Eating disorders among adolescents have become a disease and a serious health problem for families and society. The incidence of this psychiatric disorder can be found in children as young as elementary to high school and college ages in the United States (Grothaus, 1998). Adolescents with eating disorder have the sickness called anorexia nervosa or bulimia nervosa. It is a serious state of an individual as it may lead to medical complications, affecting the organs of the body and can have long-term and sometimes irreversible consequences. Epidemiological studies provided data on high mortality for anorexia nervosa after 10 years, with 6% to 7%, but after 20 to 30 years, mortality rises to 18% to 20%. It is 0 to 19% for bulimia nervosa. Others fall victim to suicide, which is about 2% (Clarkin-Watts, 1996 as cited in Grothaus, 1998). Etiology The etiology of eating disorders points to several factors, including biologic, psychological, and cultural factors. Biologic vulnerability relates to neuroendocrine dysfunction. Serotonin dysregulation is the neuroendocrine abnormality commonly referred to in many studies. People with anorexia nervosa are always anxious, depressed, and perfectionistic (Levine, 2002). There is a disagreement among professionals on the incidence of eating disorders, but there are those who state that one percent of teenage girls and college women have anorexia nervosa, while 5% to 8% have bulimia nervosa (Clarkin-Watts, 1996; Anderson & Holder, 1989 as cited in Grothaus, 1998). DSM-IV provides statistics of about 0.1% to 1% among late adolescents and early adult females who have anorexia nervosa, and 1-3% of adolescents and young adult females who have bulimia nervosa (APA, 1994 as cited in Grothaus, 1998). Studies on eating disorders Studies have shown that adolescents with anorexia nervosa are more likely to get well or get rid of the disease than adults (Fisher, 2003). There were studies conducted in the 1970s and 1980s on anorexia nervosa which reported a mortality rate of 2-8%, making this psychiatric disorder a lethal disease. But there were other studies conducted for 20 years or more which showed 15% mortality. There was one study which showed that the mortality rate for patients with anorexia nervosa was six times that of the general population. As treatment improved in the 1970s to the 1980s, the mortality rate decreased; yet those who could not overcome their eating disorder had a high percentage of dying of the disease. Causes of death ranged from complications of the illness (50% of cases), suicide (25%), and unrelated causes (25%) (Herzog et al., 1988 as cited in Fisher, 2003, p. 153). Epidemiological studies have found that eating disorders are common among young white females below 25 years old from middle- to upper-social classes in the Western world (Hsu, 1990 as cited in Grothaus, 1998). Eating disorders will most commonly appear during the ages 12 to 18 years. If eating disorder is not treated, it will continue up to adulthood. Causes of eating disorders are varied. Some point to social and cultural issues involving women in society (Chitty, 1996; McGoldrick, Anderson, & Walsh, 1989 as cited in Grothaus, 1998). There are other causes like dysfunctional interpersonal relationships with family members, traumatic experiences including sexual abuse (Root, Fallon, & Friedrich, 1986; Wooley, 1994 as cited in Grothaus, 1998), and difficulty in choosing one’s identity (Bruch; Yager, 1989 as cited in Grothaus, p. 147). But there are many female adolescent with eating disorders that do not meet full criteria for anorexia nervosa of bulimia nervosa, but can be classified in DSM-IV as “Eating Disorder Not Otherwise Specified” (Flament et al., 1995 as cited in Kotler & Walsh, 2000, p. I/109). Definition and diagnosis Anorexia nervosa is a disease with primary symptoms such as loss of weight or a denial to keep a minimum normal body weight, causing the person to emaciate (Kotler & Walsh, 2000). Other important features of the disease, as provided by DSM-IV, include “intense fear of weight gain, disturbance in body image characterized by feeling fat even when underweight, an undue influence of shape and weight on self-evaluation, and amenorrhea” (Kotler & Walsh, 2000, p. I/109). A teenager is believed to have amenorrhea if she losses at least three consecutive menstrual cycles. There are two types of anorexia nervosa: restricting type and binge-eating or purging type. In the restricting type, the person restricts food and does not resort to binge-eating. In the latter type, the person submits to episodes of bingeing and purging between episodes of restricting food (Grothaus, 1998). The purging type resorts to self-induced vomiting and/or abuse of laxatives or diuretics; and the non-purging type which is characterized by excessive exercise or fasting. In order to qualify for the DSM-IV criteria, the binge eating and other behaviors must occur on average, at least twice a week for a period of 3 months. Persons with bulimia nervosa tend to be concerned with their shape and weight and to accommodate their self esteem. Patients with bulimia nervosa may have normal weight or can also be overweight, while others have weight fluctuation (Kotler & Walsh, 2000, p. I/112). Bulimia nervosa is more common among adolescents and young adult females, and is characterized by periods of binge-eating wherein the individual consumes a large amount of food and experiences a sense of loss of control, with attempts to prevent weight gain. Bulimia is common for older teens with age peaks in late high school and college. But there are studies which state that 50-67% of adolescent females are on a diet because they are not satisfied with their weight and body and shape (Levine, 2000). Treatment and medication Screening for eating disorders should be done in communities and schools to provide prevention and early intervention. Adolescents must be evaluated by medicine physician, nutritionist, psychiatrist, and psychologist. Eating disorders are self-evident and can be detected easily; evaluation depends on complaints and presentation by the person concerned and the family of the patient. Anti-depressant medications have been applied on those with bulimia nervosa. Pharmacological treatments for this sickness remain doubtful, but the fact is this is a sickness that needs treatment. Other researchers suggest that it is for preventive measures. Although eating disorders are most prevalent during childhood and adolescence, most medication trials were conducted with adults, giving the conclusion that the results of the medication trials are not conclusive for children and adolescents. (Kotler & Walsh, 2000) Drugs found to be useful for anorexia nervosa are: antipsychotics, mood stabilizers, antidepressants, appetite enhancers, pro-kinetic agents, and nutritional supplements. Antipsychotic medications and lithium are also proposed for anorexia nervosa treatment. There are also medicines like chlorpromazine, pimozide, and sulpiride that can be useful for patients with anorexia nervosa. Chlorpromazine can make patients attain short-term weight gain, although only for short-term, but it has side effects like seizures and increased purging behavior. Some doctors experimented on placebo-controlled pimozide and sulpiride but only pimozide can provide weight gain. Appetite enhancers like cyproheptadine can be used to treat anorexia nervosa. Cyproheptadine is used in low doses but can be given in large doses to hospitalized patients. A drug that has been studied involving a large number of individuals is fluoxetine, which has already been approved by the US Food and Drug Administration (FDA) and found to be effective for bulimia nervosa in adults. A study involved participants’ responses on placebo, 20 milligram of fluoxetinem, and 60 milligram fluoxetine, with findings stating that the 60 milligram dose was superior or effective to the 20 milligram dose and placebo (Kotler & Walsh, 2000, p. I/113). A combination method of treatment composed of psychotherapy and antidepressant medication provided inconclusive results. Some methods include nutritional counseling, individual psychotherapy, and group psychotherapy. Reflection The literature on eating disorders is important to adolescents and young adults because this concerns their health and relationship with their families and friends. There should be early diagnosis and intervention if eating disorder is diagnosed and detected. Eating disorder has been found to be easily “cured” if it is detected early and the individual submits to treatment. References Fisher, M. (2003). The course and outcome of eating disorders in adults and in adolescents: A review. Adolescent Medicine, 14(1), 149-158. Grothaus, K. (1998). Eating disorders and adolescents: An overview of a maladaptive behavior. Journal of Child and Adolescent Psychiatric Nursing, 11(4), 146-156. Kotler, L. & Walsh, B. (2000). Eating disorders in children and adolescents: Pharmacological therapies. European Child & Adolescent Psychiatry, 9(1), I/108-I/116. Levine, R. (2002). Endocrine aspects of eating disorders in adolescents. Adolescent Medicine, 13(1), 129-142. Read More