Teens with Eating Disorders Complex to Treat

Children and teens with eating disorders have a challenging path to recovery, say experts, and there is not a lot of research into what treatments actually work for younger people.

"Disorders that start when you're young, in adolescence, no matter what the disorder, are always harder to treat and harder to recover from," says Dr. David Schlager, at Texas A&M Health Science Center.

This applies to a wide range of problems, he says, from eating disorders such as bulimia and anorexia, to addictions and mental illness.

Anorexia, a form of self-starvation, is an eating disorder characterized by low body weight, a distorted body image, amenorrhea (absence of at least three consecutive menstrual cycles), and an intense fear of gaining weight.

Bulimia is defined as uncontrolled episodes of overeating (bingeing) and usually followed by purging (self-induced vomiting); misuse of laxatives, enemas, or medications that cause increased production of urine; fasting; or excessive exercise to control weight.

Pressure in the Teen Years

The teen years can be hard enough even without complications such anorexia or bulimia.

"There are so many crucial things going on, so much pressure to establish yourself in various ways," explains Dr. Schlager. Maintaining mental health can be easier for adults, he reasons, because "if you've made it to 30 you've carved out a little groove for yourself, most people will give you a little latitude."

Anorexia typically starts between the ages of 14 and 17.

"In anorexia, when someone is severely underweight, their brain and their body tend to react differently," says Andrea Vazzana, Ph.D., at New York University Child Study Center. "Someone who is severely underweight is likely to have difficulty concentrating, making good judgments.

“Reasoning becomes more difficult and their mood is affected,” notes Dr. Vazzana. “They're more irritable and depressed and anxious."

People with bulimia suffer from a similar problem.

"They're bingeing and purging and their body is affected,” she says. “They have the same preoccupation with weight [as anorexics] and, to a lesser extent than with anorexia, their judgment is impacted," explains Dr. Vazzana.

Getting the Help They Need

There are good treatments that work for bulimia in adults but no one knows if they apply to children, though they do seem to have some effect, she says.

These include cognitive behavioral therapy and interpersonal therapy.

"It depends on the condition, says Dr. Schlager. “If it's one of the conditions that only have behavioral treatments and no medication, then it's hard first of all to get them [children] to participate in behavioral treatment.”

And, according to Dr. Vazzana, there is no evidence yet that 12-step programs work for eating disorders, especially in younger people, because they require people to acknowledge their illness.

Dr. Schlager says, "Like most young people, they pretend it's not happening."

None of this means that parents should give up hope. Treating eating disorders, addictions, and other mental health issues in younger people can be difficult, but it is not impossible, says Dr. Schlager.

Parents, teachers, coaches, or instructors may be able to identify the child or adolescent with anorexia, although many persons with the disorder initially keep their illness very private and hidden.

However, a child psychiatrist or a qualified mental health professional usually makes the diagnosis of anorexia in children and adolescents.

A detailed history of the adolescent's behavior from parents and teachers, clinical observations of the adolescent's behavior, and, sometimes, psychological testing contribute to the diagnosis.

Parents who note symptoms of anorexia in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Always consult your child's physician or other healthcare provider for more information.