Body image affects all our teens to varying degrees and it begins with their quest for popularity, to fit in, or to simply be accepted, especially at school. The changes their hormones inflict upon their bodies only adds to the frustration they already feel regarding the afore-mentioned desires. Everyone wants, at the very least, to be accepted and fit in, but kids can be brutal in their acceptance or rejection of their peers and unfortunately it is based primarily on a person's physical appearance as opposed to any inner qualities. As body image is so closely related to self esteem, any rejection or criticism made against how your teen looks is more often than not taken to heart and ultimately results in a poor body image and low self esteem. It is at this point when your teen becomes susceptible to more worrying psychological issues such as, depression, suicide and eating disorders. In some cases one can inevitably lead to another, for example: Poor Body Image = Low Self Esteem, which can then lead to depression, which can then lead to an eating disorder, and finally suicidal behaviour. The latter usually only occurs if the previous conditions go unnoticed and untreated.
Another area in their life where your teen's body image may be threatened is in some sports, such as gymnastics, ballet or swimming, where a certain weight is required in order to compete at certain levels. Your once confident teenager may feel very dejected at being told that she needs to lose a few kilo's, or the perception could be worsened in an already unhappy child. Many sports stars, especially those who compete in the Olympics etc, are governed by weight ranges, and many of them in turn develop an eating disorder in an attempt to keep their place. It is no different for your impressionable young teen.
So, what is Body Image?
Body image refers to the perception an individual has of their physical appearance – the “image” they get in their minds when they envision how they look on the outside. Our teens are not only critical of their peers, but they are also very critical of themselves, and it is because of this self-critical element that their perceptions are not always entirely accurate - but you won't always be able to tell them that.
Society's Body Image Ideal
When our teens form an opinion of their body image, it is ultimately influenced by outside sources. It can be through family or friends, who to a certain degree offer a more realistic opinion, but the most powerful influence in your teen's life is the media and the various industries like fashion, beauty and film. Although they are but mediums through which society “markets” it's ideal, your teen, nevertheless, will identify more with these forms of influence than anything you could tell them.
As is has been through most of recorded history, society's unrealistic, and sometimes unjust, ideals are aimed at the female population, and body image is no exception. It holds to the belief that all women should look, young, slim and attractive, without thought or mention of the role genetics play in our body's make up.
To add even more pressure to our teens and to females in general, society has also devised a very sexist success scale, which is used to measure personal success. Now, let me ask you, how would you like to have your success measured? By the accomplishments you make and/or your financial standing? Well, if you're male this is exactly what it takes to be deemed successful, however, if you're female, this is all irrelevant. Society states that if you are female, you need to live up to it's body image ideal – having a high desirability factor – before you are considered successful. The Media, the Fashion Industry, the Beauty/Cosmetic Industry and the Film Industry all promote this ideal as well.
What This Means For Your Teen
Pressure! Pressure! And more Pressure! Everywhere they look they see the “perfect body image” projected to them from television commercials, magazine advertisements, movies etc. Couple that with radical new diets, exercise equipment and everything else that promises your teen miracle results; and your teen believes that it is expected of them to be that “perfect female”. The problem is, and your teen may or may not realise or accept this, is that a miracle is exactly what it is, because not everyone's genetic make up allows for them to achieve those results. We are all different, which is how one of us is distinguished from the other, much like a zebra and their stripes. However, blinded as they are, this is when your teen may turn to a more drastic means of achieving what they want. In a study conducted on female teens, 68% said that they felt they were less beautiful than the average girl, and 25% of those said they wanted to change everything about themselves.
What Are Eating Disorders?
Eating disorders are when a change in normal eating patterns occurs which can vary from insufficient intake of food to excessive, and which impact negatively on the body both mentally and physically. There are a variety of eating disorders which your teen may develop, each of which are explained in detail below.
Due to the complexity of eating disorders there is no specific cause of it, however, there are a number of factors which have been identified as contributors. These include:
• Psychological factors – self-seen personality flaws or low self esteem.
• Socio/Cultural factors – thinness ideal, cultural ideals, eg: small feet, long elegant neck, tiny waist.
• Family factors – attitudes, beliefs, communication.
• Biological factors – genetic inclination
• Situational factors – unemployment, death, relationship breakdown, abuse and other stressful life events.
There are a number of eating disorders that your teen may develop. Below is an outline of each and the signs you can look for. Be cautious when confronting your teen with your suspicions as sometimes it can make it worse. It is recommended you seek medical advice from your doctor if you suspect your teen is suffering from an eating disorder as they will either be able to advise you on the best way to deal with the problem, or refer you to someone who can.
At the end of this article we have included The Eating Test (EAT-26) which can help determine the presence of an eating disorder.
1. Binge-Eating Disorder
Binge-eating is the consumption of unusually large amounts of food (that which is outside the normal range for the individual) over a very short period of time (most commonly 2 hours or less). Although most people binge-eat on occasion, the difference between them and those who suffer from this particular disorder is the frequency with which they do it and the fact that they do not purge afterwards. Between 10-30% of obese people have been diagnosed with having this disorder.
A person suffering from binge-eating disorder will usually succumb up to twice a week for at least 6 months or more, whereas the normal person may only do it once a month. The frequency of binges coupled with the person having a BMI higher than 17.5 is what distinguishes someone with binge-eating disorder from any other eating disorder. Although it is relatively unknown what compels a person to binge-eat, it has been linked to emotional crisis and the previous engagement of strict dieting. It is also believed that a low level of the brain chemical serotonin can cause compulsive eating.
People who suffer from binge-eating disorder are often embarrassed by their condition and will wait until they are alone before indulging themselves. This disorder comes with 2 different sets of symptoms, the behavioural and the emotional.
Behavioural Symptoms
• inability to stop or control the amount which is being consumed
• eating large amounts of food at a rapid pace
• hiding or creating a stockpile of food to consume once alone
• can maintain normal eating habits when around others, but gorges oneself when alone
• no routine to when meals are consumed, generally eats all day whenever they feel like it.
Emotional Symptoms
• tension only relieved by eating
• embarrassment over amount of food being consumed
• a feeling of numbness toward what they are doing - eating on auto-pilot
• no satisfaction regardless of how much food is consumed
• depressed, guilty or disgusted for overeating
• desperation to control weight and eating habits
As most binge-eaters do so under emotional distress, the only way for them to overcome their disorder is to learn new ways of coping with stress and reprogramming their way of thinking so that they eat for nutritional needs and not emotional ones. There are many therapies and medications which can help sufferers to overcome binge-eating disorder, but for most it is very difficult for them to overcome their embarrassment and seek professional help in the first place. Binge-eating affects males and females equally with approximately 4% of teens developing the disorder in Australia.
2. Anorexia Nervosa
Anorexia Nervosa is thought to be the most powerful and seductive of all the eating disorders, however, it is also a dangerous one in that it damages the person both physically and psychologically – which is common with all eating disorders. It is an obsession with avoiding weight gain and although the word Anorexia means “loss of appetite”, it is not entirely true. Most anorexics are almost always hungry, but they suppress that hunger and feel proud and empowered by their ability to do so, regardless of the discomfort it may cause them.
Anorexia affects females 15 times more so than men and usually develops during adolescence or in early adulthood. It has been found that approximately 2-3% of young females aged 15-24 are affected by this particular eating disorder in Australia alone.
People with anorexia nervosa tend to look at certain parts of their body rather than their body as a whole and pick on the parts they believe appear heavy or bulgy and that they would rather see thin or flat. The abdomen and thighs are commonly targeted, and although they know that they are of a healthy or normal weight, anorexia nervosa sufferers maintain the perception that these parts are bigger or heavier. Even someone who has become emaciated will still see these parts as bigger than the rest of them. Bottom line is they know they are thin, but they feel fat.
Due to their constant suppression of hunger pangs and their refusal to eat certain foods such as, red meat, specific dairy foods like cheese and butter, or anything containing fat or oil, anorexics become obsessed with food. They don't eat it themselves but they find tremendous enjoyment in the purchasing, planning and preparation of food. They buy cookbooks, food magazines etc, all in an attempt to satisfy their obsession, without actually yielding to it and indulging themselves. Some anorexia nervosa sufferers have been known to become possessive of the kitchen, considering it their own private domain in which trespassers are not allowed. Instead they prefer to decide upon and prepare something for each person to eat. Many anorexics become vegetarians, and it is this group of people who research has determined are more likely to have tried laxatives, vomiting or have made suicide attempts.
It has also been established that some anorexia nervosa sufferers occasionally lose their self-control and binge-eat, hence the introduction of the 2 sub-types. Sub-type A are those who restrict their food consumption and don't tend to vomit or abuse laxatives, they are classed as the Restricting sub-type. The second is the one introduced to distinguish not only from the first sub-type, but also from bulimia nervosa. It is called the Binge-Eating/Purging sub-type. Those in this group go on a merry-go-round ride of bingeing and purging followed by a return to sub-type A, then another episode of bingeing and purging, and so it continues on. They use vomiting, laxatives and even excessive exercise as a way of compensating for their bingeing behaviour.
Some anorexics become obsessive-compulsive. They develop certain rituals that may appear odd if observed by an outsider, but are a very real function to the sufferer. They will do such things as; chew every bite of food a certain amount of times before allowing themselves to swallow it, touch a particular household item every time they leave the house, performing x-amount of sit ups for every bite of food consumed, and the list goes on. They do this to distract themselves from the discomfort of their hunger pangs, or block out the other thoughts that bombard a person with an eating disorder. Any interference with these rituals will be met with a rigidness that is completely out of character.
Sufferers of anorexia will isolate themselves and suddenly have zero tolerance for people and things they once enjoyed. In their self-centered state they tend to unintentionally alienate those around them, refuse to take phone calls, attend certain social gatherings/functions, and sometimes reach the point of refusing to go out at all. Refusing to go to work or school is also a common progression for a sufferer to make, preferring to spend their days in baggy clothes or pj's. Hygeine also takes a dive as the all-consuming fear of seeing or touching their naked bodies overwhelms them.
After an extreme drop in weight, there is a change in the chemicals of the brain which distorts a person's perception causing them to see fat where their isn't any, which is what happens to anorexics and why some end up emaciated. Anorexics have a tendency of not looking at their body as a whole and only pick on certain parts of their bodies which they feel are fat or heavier than the rest of them. No matter what weight they achieve, or how thin they become those body parts remain unchanged in their eyes and they continue on with their debilitating behaviour.
The symptoms below fall into 4 different categories. The first, the Physical Symptoms are those which can be felt by the sufferer, or seen by an outsider. The second, Medical Symptoms, are still physical, but will only be discovered by medical testing. The third is behavioural which show patterns and changes in actions, attitude etc. The forth is the psychological which is more in their mind, but can still be recognised by those close to them.
Physical Symptoms
• Dry/chapped lips
• Dry skin
• Pins and Needles and/or the extremities turning purple caused by poor circulation
• Headaches
• Brittle Fingernails
• Easily bruises
• Lack of libido; impotence in males
• Amenorrhoea – endocrine disorder leading to suspension in periods for girls
• Oedema – fluid retension which causes a puffy or bloated appearance.
• Height and growth in general is stunted
• Fainting spells
• Thinning of hair
• Lanugo – a fine layer of hair which appears all over the body to promote warmth
• Constant feeling of cold
• Pallid complexion
• Sunken eyes
• Constipation/Diarrhoea
• Tooth Decay
• Appearance of frailty
• Hypothermia
• Abdominal Pain
Medical Symptoms
• Reduced metabolism
• Abnormally slow heart rate
• Low blood pressure
• Hypotension
• Anaemia (iron deficiency)
• Abnormal electrolyte and mineral levels
• Zinc deficiency
• Reduction in white blood cell count
• Reduced Immune system
• Osteoporosis – dry and brittle bones caused by reduced bone density
Behavioural Symptoms
• Participation in excessive exercise
• Excessive food restriction
• Over-sensitive to references to weight or appearance
• Secretive in regards to their eating and exercise habits
• Won't eat in the presence of others
• Becomes aggressive when they are forced to eat foods that they feel are “forbidden foods”
• Self Harm
• Substance abuse
• Suicide attempts
Psychological Symptoms
• Distorted body image/ Low self esteem
• Weight & appearance is the main focus of self-evaluation
• Preoccupation and/or obsessive thoughts about food and weight
• Denial that weight is of a dangerously low level
• Mood swings
• Depression
• Anti-social behaviour such as withdrawing from interpersonal relationships
The average duration of anorexia nervosa is approximately 5 years and if left untreated approximately 40% of those sufferers will end up with Bulimia Nervosa. In many instances, because of the person's denial they have a problem it is up to a family member or someone close to them to identify the illness and seek advice from a medical professional. If left untreated anorexia nervosa can cause a myriad of other health issues. Like all eating disorders, anorexia can be treated. It will be a long and arduous journey for them as they undergo intense therapy to help them change the way they see and feel about food and themselves.
3. Bulimia Nervosa
A s opposed to anorexia nervosa where the sufferer's obsession is not to eat, bulimia nervosa is an obsession to eat, but in a most unhealthy, uncontrollable and dangerous way. Bulimics have an uncontrollable desire to binge-eat and then purge themselves of everything – solid and fluid – they have just consumed during that bingeing session. Bulimia literally means ox-like hunger and the pattern which this “hunger” leads to can become an addiction; binge-purge. The person feels like they have no control over either action. This out-of-control behaviour can be terrifying and painful, but the sufferer feels unable to prevent it from happening.
The binge-purge habit is caused by an overwhelming desire to eat, coupled with an equally overwhelming desire not to gain weight as a result. Once the habit or addiction is formed many bulimia sufferers will re-arrange their life and routine to accommodate it. They will go to extreme measures to ensure they have the food required - like stealing - and also the privacy in which to indulge their obsession.
A bulimic binge can vary in length and frequency and is open to interpretation by the sufferer as to what constitutes a binge. To some it's the consumption of copious amounts of food within a 2 hour or less time frame. To others it can be the simple consumption of a certain kind of food – something they consider forbidden like fatty or starchy foods – and this can sometimes be something as insignificant as a bite or mouthful. The bingeing episodes are inevitably followed by a feeling of self-loathing and fear of weight gain, hence the purging behaviour.
Many people with bulimia nervosa reach a point where they no longer taste the the food they are eating, yet they continue to eat anyway because the urge is too great. Nor are they able to distinguish between a feeling of fullness or hunger as they have entered what is called a “bulimic zone”, which is like a trance. It is not until they break from the trance or are interrupted that they feel the physical discomfort and, as is within habit, resort to purging.
You will find many of the symptoms below very similar to those of anorexia nervosa. The main difference between the 2 is in the weight fluctuations and the bingeing episodes.
Physical Signs
• Missing food
• Swollen glands which give a chipmunk effect
• Broken blood vessels around the eyes
• Fatigue
• Muscle weakness
• Tooth decay
• Hoarse voice
• Sore throat
• Puffiness around the face
• Fainting
• Easily bruised
• Heartburn
• Abdominal pain
• Reduced concentration, memory and thinking ability
• Change or loss in bowel function – cramping, constipation, diarrhoea
• Hair, skin and nails become brittle and dry
• Insomnia
• Height and growth stunting
• Severe sensitivity to extreme temperatures, especially the cold
• Calluses on backs of fingers (usually with a vomiter)
• Weight fluctuations
Medical Signs
• Dehydration
• Oedema
• Hypoglycemia
• Irregular hear beat and pulse rate
• Electrolyte imbalance
• Hyperfunctional voice disorder
• A rupture in the bowel or stomach
• Reduced metabolism
• Kidney dysfunction
• Fertility problems
• Male impotence
• Osteoporosis
• High blood pressure
• Menstrual disturbance/Amenorrhoea
Behavioural Signs
• Going to the toilet soon after eating
• Avoids restaurants, social gatherings where food is to be consumed
• Secretive behaviour – usually regarding food
• Fasting
• Suicide attempts
• Vigorous or excessive exercise
Psychological Signs
• Mood swings
• Depression
• Severe self-criticism
• Weight determines self-worth
• Fear of not being able to stop eating
• Following eating they have self-deprecating thoughts
• Persistent over-concern with body weight
Bulimia nervosa can continue on for years in secret. Because of the weight fluctuations it is not an easy disorder to diagnose for someone who is unexperienced, but a combination of any of the above signs should give an indication.
4. Eating Disorder Not Otherwise Specified (EDNOS)
Many people develop an eating disorder that does not fall into any of the above categories. They may have some but not all of the diagnostic criteria which is used to determine the eating disorder suffered from. The DSM ( Diagnostic & Statistical manual) lists characteristics of each eating disorder which is specific to a certain type which helps doctors to diagnose correctly. You will find the diagnostic criteria for each disorder at the end of the article. Below you will find some examples of EDNOS that your doctor may or may not be familiar with. They are relatively new and are still in the developmental stage of research and treatment, but can nevertheless be used as a guide.
• Purging Disorder – The person purges themselves by the same methods used by the other eating disorders, but this occurs after normal eating, not after a binge. Individuals are not underweight so it is not diagnosed as Anorexia Nervosa, and they do not binge-eat before they purge, so it is not considered Bulimia Nervosa.
• Body Dysmorphic Disorder (BDD) – A preoccupation with a flaw in their physical appearance whether it be facial or a particular part of the body like the thighs or hips. The person becomes distressed with important areas of functioning including social and occuptional. When the obsession turns to body weight or a fear of becoming fat, this can then lead to either Anorexia or Bulimia.
• Muscle Dysmorphia – Sufferer's believe they are unpleasantly small or underweight when in fact the opposite is true. This particular disorder affects males more so than females and most especially those that attend the gym avidly or are body builders. The disorder reaches dangerous proportions when the person begins taking excessive amounts of steroids or muscle-enhancing drugs in order to increase body size and muscle capacity.
• Pica – This condition is more commonly found in pregnant women, children and those whose diets are considerably lacking in certain minerals. They crave and eat non-food items such as; dirt/clay, chips of paint, plaster, chalk, laundry starch, cornstarch, baking powder, rust, coffee grounds and even cigarette ashes or burnt match heads.
• Anorexia Athletica – An exercise addiction characterised by the obsession with exercising for an exact period of time or doing so at an intensity that is not considered normal or healthy. Often they have a poor body image and they exercise to gain temporary control or self-respect. They evaluate their self-worth based upon athletic performance although they are rarely satisfied with that performance. Truant behaviour from work or school in order to maintain their exercise goals is a common indicator – a missed exercise session results in an intense feeling of guilt - and they repeatedly exercise beyond the range of safety.
• Nocturnal Sleep-Related Eating Disorder (NSRED) – Although still under investigation, NSRED is not considered an eating disorder at present because the person is not conscious of their eating habits. They are asleep and the only evidence that they have consumed anything is in the crumbs, wrappers etc around them when they wake up.
• Orthorexia Nervosa – A person with this condition is not obsessed with thinness as those suffering from Anorexia nervosa are, instead, they are obsessed with eating foods that they consider pure, healthy and/or beneficial. They do tend to spend in unusual amount of time planning and preparing their food and tend to become somewhat of a recluse, but don't tend to suffer physical dangers as such.
Treatment
Treatment varies for each disorder. Usually a team of experts are prescribed in order to treat all the various factors which are involved in any disorder which affects a person both mentally and physically. It will normally comprise your doctor, a therapist and a nutritionist. Their aims are mainly to restore a healthy body weight, alter perceptions of food and body image, teach them how to eat properly and even to treat any underlying problems. It can be difficult, and your teen will need as much love and support as you can possibly give.
Diagnostic Criteria
Binge-Eating Disorder
• repeated episodes of binge-eating minus the purging method adapted by bulimia nervosa sufferers.
Anorexia Nervosa
• An intense fear of gaining weight or becoming fat even though underweight
• Refusal to maintain body weight within healthy range, but is not due to any physical or mental disorder.
• BMI is equal to or less than 17.5
• Perception of body weight, shape and size is distorted
• Refuses to accept the dangers involved with current low body weight
• Has had amenorrhoea (no period) for 3 months consecutively
Bulimia Nervosa
• Rapidly consumes copious amounts of food in a short period of time
• Feels a lack of self-control over eating during the binge
• Regularly engages in measures to prevent gaining weight; self-induced vomiting, laxatives, diuretics, strict dieting/fasting, excessive exercise.
• Binges a minimum of twice a week (including the weight gain prevention measures) and has done so for at least 3 months
• Persistently over-concerned about body shape and weight
• The eating disturbance does not occur exclusively in association with anorexia nervosa.
EDNOS
• For females: all the criteria for anorexia nervosa are present except that she still has her periods.
• All criteria for anorexia nervosa are met except the current weight is within normal range despite significant weight loss.
• All criteria for bulimia nervosa are met except binge-eating and purging occur less than twice a week and has been present for less than 3 months
• Purging behaviour after the consumption of small amounts of food, eg. 2 biscuits to a small meal
• Constantly chewing and spitting out food but never swallowing
The Eating Attitudes Test (EAT 26)
Choose one honest response for each statement.
Always – Usually – Often – Sometimes – Rarely – Never
1. Am terrified about being overweight.
2. Avoid eating when I am hungry.
3. Find myself preoccupied with food.
4. Have gone on eating binges where I feel I may not be able to stop.
5. Cut my food into small pieces.
6. Aware of the calorie content of foods I eat.
7. Particularly avoid food with a high carbohydrate content.
8. Feel that others would prefer I ate more.
9. Feel extremely guilty after eating.
10. Vomit after I have eaten.
11. Am preoccupied with the desire to be thinner.
12. Think about burning up calories when I exercise
13. Other people think I am too thin.
14. Am preoccupied with the thought of having fat on my body.
15. Take longer to eat meals than others.
16. Avoid foods with sugar in them.
17. Eat diet foods.
18. Feel that food controls my life.
19. Display self-control around food.
20. Feel that others pressure me to eat.
21. Give too much time and thought to food.
22. Feel uncomfortable after eating sweets.
23. Engage in dieting behaviour.
24. Like my stomach to be empty.
25. Enjoy trying new rich foods.
26. Have the impulse to vomit after meals.
Scoring:
For all items except #25:
Always = 3, Usually = 2, Often = 1, Sometimes = 0, Rarely = 0, Never = 0
For item #25 only:
Always = 0, Usually = 0, Often = 0, Sometimes = 1, Rarely = 2, Never = 3
A score of more than 20 on the EAT-26 indicates excessive concerns that may indicate the presence of an eating disorder.
For Further Information
Books
• Help Your Teenager Beat An Eating Disorder, James Locke MD, PhD & Daniel Le Grange, PhD
• A Parent's Guide To Eating Disorders, Marcia Heron & Nancy Matsumoto
Websites:
• Eating Disorders – Victoria http://www.eatingdisorders.org.au/
• Eating Disorders Foundation Inc. http://www.edf.org.au/
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