Focus Area 8: Mental Health Basics
4. Mental Health Disorders Prevalent Among Youth
Eating Disorders
Eating disorders are generally assumed to be an affliction of white upper class teenage females. That assumption is being continuously challenged as more and more women of all ages, races, ethnic backgrounds, and economic means struggle with disordered eating. The number of teen males dissatisfied with their body image has tripled in the last 25 years, from 15% in 1991 to 45% in 2016.
Eating disorders often co-occur with other mental health disorders such as anxiety, depression, and substance abuse. Effective treatment usually involves a team of professionals. The team typically includes a primary care physician, therapist, nutritionist, and psychiatrist working in partnership with the youth and their family.
These are the primary types of eating disorders:
Anorexia Nervosa - Characterized by self-starvation & excessive weight loss. May exercise to the point of exhaustion in an effort to eliminate calories.
Bulimia Nervosa - Characterized by feeling out of control eating large amounts of food in a short period of time--more than most people would eat in one sitting, and then getting rid of the food through vomiting, laxative abuse, or over-exercise.
Binge Eating Disorder – Characterized by eating an amount of food over the course of two hours that is much larger than what most people would eat in a similar period of time, under similar circumstances. Binge Eating Disorder is similar to Bulimia but differs in that the person does not attempt to purge or exercise excessively after a binge.
Avoidant/Restrictive Food Intake Disorder – Characterized by persistent failure to meet appropriate nutritional or energy needs; extreme picky eating, significant weight loss and marked interference with psychosocial functioning.
RISK FACTORS FOR EATING DISORDERS
There is a range of biological, psychological, and sociocultural issues that may contribute to the development of an eating disorder.
Highlighting some of the risk factors you may observe in your work with youth:
- Perfectionism, especially when it involves setting unrealistically high expectations for oneself
- History of an anxiety disorder including social phobia and obsessive-compulsive disorder
- High level of body image dissatisfaction
- Behavioral inflexibility that shows up as always following the rules and believing there is just one ‘right’ way to do things
- Being teased or bullied about weight
- Identifying as LGBTQ
- Few friends, little social activities, smaller social network that lead to loneliness and isolation
SYMPTOMS OF EATING DISORDERS
Eating disorders are notoriously difficult to treat and become more so the longer the delay in getting treatment. Recognizing the symptoms early on is important since the physical toll of an eating disorder can be fatal.
Watch out for:
- Dramatic weight gain or loss
- Frequently talking about food, weight, and shape
- Rapid or persistent decline or increase in food intake
- Excessive or compulsive exercise patterns
- Purging, restricting, binge eating, or compulsive eating
- Abuse of diet pills, laxatives, diuretics, or emetics (to induce vomitting)
- Denial of food and eating problems, despite the concerns of others
- Eating in secret, hiding food, disrupting meals, feeling out of control with food
Other signs are the medical complications that result from eating disorders. They include menstrual irregularity, dizziness, fainting, bruising, dry skin, leg cramps, hair loss, brittle hair, osteoporosis, diarrhea, constipation, dental problems, morbid obesity, diabetes, chest pain, heart disease, heartburn, shortness of breath, organ failure, as well as other symptoms.
WARNING SIGNS OF EATING DISORDERS
When potential signs of an eating disorder are seen in an adolescent, timely intervention is vital. Adolescence is a period of crucial physical development. An untreated eating disorder creates the risk of irreversible medical effects including delayed growth, structural changes in the brain, delayed or arrested puberty, and impaired acquisition of peak bone mass.
Some general clues to a possible eating disorder include:
- Eliminating entire food groups
- Skipping meals, “I’m not hungry” or “I already ate.”
- Lots of diet soda, gum, water, mints, etc.
- Isolation from friends, activities
- Eating erratically, lots of rules around eating
- Constant talk of food/weight/calories
- Eating in isolation (hiding their eating)
- Going to the bathroom or showering after eating
ACTIONS FOR A YOUTH WORKER
The treatment of an eating disorder should be handled by professionals and specialists as soon as possible. But don’t just watch and wait! Full and lasting recovery can be achieved if the eating disorder is treated within five years of onset. You can be a critical part of early intervention by being aware of the warning signs and symptoms of eating disorders and taking appropriate action.
Recognize that it is partially a societal problem: Eating disorders have their roots in unreasonable societal expectations of physical appearance and are linked to gender roles. These harmful ideas and expectations when combined with depressive or anxiety symptoms in a youth can be disastrous. Most youth, with or without disordered eating symptoms, could benefit from an open and honest conversation about how we are all impacted by images, expectations, and the role food plays in our culture.
Be conscious of communication: Be aware of how images, gendered physical expectations or ideas about food are unintentionally or unconsciously reinforced. How food is discussed, how jokes are made about body images or gender norms, or about how much or how little food someone is eating can be a tipping point for a young person struggling with their appearance or mental health.
Understand and reinforce healthy eating: You need to be aware of and call out harmful gendered comments such as, “You’re having a salad...what are you - a girl?” or “You’re eating as much as a football player.” Stand against unhelpful physical expectations. It will make a positive difference.
Consult with supervisors and involve family: If symptoms of an eating disorder seem to be worsening or there is a clear indication of an active eating disorder, involve the parents or caregivers in collaboration with the youth and encourage them to seek treatment as soon as possible. In general, eating disorders are very difficult and complicated to treat and the earlier treatment is sought, the better the chances of preventing physical harm.
What do you do?
- Build trust and rapport with the young person as well as their family
- Avoid psychologically loaded terms such as “fat” or “weight gain”
- Avoid giving your opinion of the youth’s weight or physical appearance.
There is a tool called the SCOFF Questionnaire which can be helpful. A score of 2 or more indicates a possible risk for eating disorder and warrants further assessment by a professional:
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone (15 lbs) in a 3-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
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