Eating disorders like anorexia nervosa and bulimia nervosa are common challenges, especially for adolescents. These conditions are complex, involving intense feelings and behaviors related to weight and food. However, with early recognition and the right support, it’s possible to prevent serious health consequences and guide those affected toward recovery.
What are Anorexia and Bulimia?
Anorexia Nervosa is an eating disorder characterized by an intense fear of gaining weight, which leads to severe food restriction and dangerous weight loss.
Adolescents with anorexia have a distorted body image and often deny the seriousness of their low body weight. They may exhibit obsessive behaviors around food and exercise, constantly weighing themselves, using laxatives or severely restricting their calorie intake.
Bulimia Nervosa involves cycles of binge eating followed by purging to avoid weight gain. During binges (defined as more than what the average person would eat during the same period of time), people consume large amounts of food in a short period and then engage in behaviors like vomiting, excessive use of laxatives or strenuous exercise to prevent weight gain.
Adolescents with either anorexia or bulimia can maintain a normal weight, making the disorders less visible to others. In fact, only about 6 percent of those diagnosed with an eating disorder of any kind are considered medically underweight.
*Patients with atypical anorexia have all the psychological symptoms of anorexia but have a normal weight, so being underweight is not always a sign of anorexia and the diagnosis is often missed by parents, and sometimes providers, due to the patients being a normal weight.
Prevalence of Anorexia and Bulimia in Adolescents
Eating disorders most commonly affect teens and young adults, although they can affect people of all ages, including both women and men.
More than 90 percent of people with an eating disorder are female. Teenagers, especially girls, face challenges like societal pressures, emotional changes and the effects of puberty on their bodies, which can make them more vulnerable to eating disorders. As kids go through the physical changes of puberty, they may become more aware of how their bodies are changing. When this happens – especially when coupled with exposure to social media and experiences like bullying – it can make some teens feel insecure about their appearance. Over time, these feelings can lead to body image issues and even symptoms of eating disorders.
The overall lifetime prevalence of eating disorders is estimated to be 8.6 percent among females and 4 percent among males in the United States.
Symptoms and Signs of Anorexia vs. Bulimia in Adolescents
The symptoms of these eating disorders can vary widely but typically include a preoccupation with food, weight and body shape.
Anorexia signs include:
- Extreme weight loss and thin appearance
- Intense fear of gaining weight, even when underweight
- Distorted body image, such as seeing oneself as overweight despite being dangerously thin
- Lying about how much food has been eaten
- Denial of hunger or making excuses to avoid meals
Bulimia symptoms are often harder to notice but can include:
- Frequent episodes of eating abnormally large amounts of food with a loss of control
- Extreme concern with body weight and shape
- Regular use of inappropriate compensatory behaviors such as fasting, excessive exercise or purging
- Frequently using supplements or herbal products, including laxatives, for weight loss
- Preferring to eat alone and avoiding eating in front of others
When to See a Specialist for Help
A person showing signs of an eating disorder should be evaluated by a specialist as early as possible. Early, effective intervention significantly improves the likelihood of recovery.
Signs of a potential eating disorder that warrant professional attention include:
- Drastic and sudden weight fluctuations.
- Preoccupation with weight and behaviors aimed at significantly altering appearance through drastic means, such as extreme dieting and exercise
- Depression, anxiety and withdrawal from social situations
- Regularly complaining of an upset stomach or lack of appetite
- Eating until uncomfortably full and eating in a rushed, frantic manner
- Eating alone or in secret to avoid embarrassment
- Feeling distressed, ashamed or guilty after eating
Treatment Options
Treatment for anorexia and bulimia in adolescents typically involves a combination of:
- Medical treatments to address any health issues resulting from the eating disorder, such as malnutrition or electrolyte imbalances.
- Nutritional counseling with help from dietitians who can help to establish normal eating routines and behaviors.
- Individual therapy, family therapy and sometimes group therapy, often involving Cognitive-Behavioral Therapy (CBT), which can be particularly effective for managing both anorexia and bulimia.
- Medications that are sometimes used to treat accompanying anxiety or depression.
Stony Brook Children’s Adolescent Medicine division offers specialized care for adolescents dealing with anorexia, bulimia and other eating disorders. Dr. Marianne Tateosian provides services for both the Adult and Child Psychiatry departments. She and her team address the emotional, behavioral and developmental needs of their patients.
