Wednesday, 16 July 2014

"EATING DISORDERS IN ADOLESCENTS: POSITION PAPER OF THE SOCIETY FOR ADOLESCENT MEDICINE"

"Eating Disorders in Adolescents: Position Paper of the Society for Adolescent Medicine"
Journal of Adolescent Health 2003;33:496-503
Society for Adolescent Medicine, 2003
Published by Elsevier Inc., 360 Park Avenue South, New York, NY, 10010

p.496

Eating disorders are complex illnesses that are affecting adolescents with increasing frequency [1]. They rank as the third most common chronic illness in adolescent females, with an incidence of up to 5% [1-3]. 

Three restrictive subgroups are recognised: anorexia, bulimia, ednos (eating disorder otherwise not specified).

Diagnosis:

Many adolescents, because of their stage of cognitive development, lack the physiological capacity to express abstract concepts such as self-awareness, motivation to lose weight, or feelings of depression. In addition, clinical features such as pubertal delay, growth retardation, or the impairment of bone mineral acquisition may occur at sub-clinical levels of eating disorders -5,[9-14]. 

It is essential to diagnose eating disorders in the context of the multiple and varied aspects of normal pubertal growth, adolescent development, and the eventual attainment of a healthy adulthood, rather than merely applying formalised criteria.
- Too many variables to consider at this age as the body is still naturally developing. 
- Kids can be hard to diagnose due to changes in eating habits whilst growing up.

Medical Complications:

No organ system is spared the effects of eating disorders [1,19-22]. 

The physical signs and symptoms occurring in adolescents with an eating disorder are primarily related to weight-control behaviours and the effects of malnutrition. Most of the medical complications in adolescents with an eating disorder improve with nutritional rehabilitation and recovery from the eating disorder, but some are potentially irreversible. 

p.497

Psychosocial and Mental Health Disturbances:

Eating disorders that occur during adolescence interfere with adjustment to pubertal development [42] and mastery of developmental tasks necessary to becoming a healthy, functioning adult. Social isolation and family conflicts arise at a time when families and peers are needed to support development [43,44].

Studies emphasise a frequent association between eating disorders and other psychiatric conditions. Important findings include a lifetime of incidence of affective disorders (especially depression) of 50% - 80% for both anorexia nervosa and bulimia nervosa; a 3-%-65% lifetime incidence of anxiety disorders for anorexia nervosa and bulimia nervosa; a 12%21% rate of substance abuse for anorexia nervosa; and a 9%-55% rate for bulimia nervosa. Estimates of comorbid personality disorders among patients with eating disorders range from 20% to 80% [49,50]. 

p.498

Treatment Guidelines:

Mental health evaluation and treatment is crucial for all adolescents with eating disorders. The treatment may need to continue for several years [63].

Antidepressants have been shown to reduce binge eating and purging by 50% to 75% [5,71,72].

The optimum treatment of the osteopenia associated with anorexia nervosa remains unresolved. 

p.449

The Internet and Pro-Ana Sites:

Approximately 49% of teenagers worldwide, have access to the Internet [82]. 

Such websites include "pro-anorexia" and "pro-bulimia" websites which are devoted to the maintenance, promotion, and support of an eating disorder. 

These websites often promote anorexia and bulimia as a lifestyle choice and not as a disease.





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