Tuesday, December 4, 2012

Anorexia: More Than a Body Image Distortion for Young Adolescents

Teens with eating disorders, such as anorexia, often have a distorted image of their body and they have difficulty maintaining an average body weight. Young people who are struggling with anorexia typically believe they have multiple physical abnormalities, which they try to change through various means, whether it is starvation, vomiting, or extreme exercise. The continued aspiration to “fix” something about their physical body, however, most often serves as a mask for underlying feelings of insecurity and worthlessness, which they are fiercely striving to hide.

A primary factor to understanding anorexia in adolescents is the recognition that the body is serving as the vehicle through which these young people are attempting to express something about their inner world. In other words, when dealing with eating disorders in teens, it is important to focus on exploring issues of self-esteem, value, and self worth. Many adolescents presenting with symptoms of anorexia feel out of control or unable to manage their emotions. That feeling of insecurity is then expressed by an intense need to take charge of something they think they can control – their physical body. What is important for parents and other caregivers to remember is that adolescents with eating disorders can feel stuck and they need patience, support, and a caring environment in which to develop a healthy sense of self, where they feel confident, unique, and comfortable on the inside and, thus outside.

The following behaviors have been found in young people with eating disorders and may serve as cues that an adolescent has not yet developed a strong, positive sense of self. 
  • Extreme levels of involvement or over-involvement in activities or other achievements: This is especially important if young people express that their achievements are performed/completed for others and not for themselves.
  • Frequent comparison to or excessive competition with other students, peers, and friends: Young people may express feeling like they are not as “good” as other, feel left out despite trying to be part of a peer group, or describe their relationships with others as superficial and not genuine.
  • Difficulty separating oneself from parent or caregiver: This may be manifested in constant demands for attention and reassurance and experiencing great anxiety or hyper-alertness when separated from family. Some young people also have few boundaries and share too much intimate information with family when they should be starting to individuate.
  • Compliant and overtly conforming behavior: This may be expressed by always doing what is expected (e.g., doing things that friends and family want and not expressing an opinion, etc.), not out of desire or a sense of responsibility but in hopes of earning attention, praise, or connection.
Creatingboundaries and modeling the importance of setting limits in a warm, sensitive environment is one way of helping develop a positive sense of self in these young adolescents. While this may seem difficult because of the potential for a negative response, limit setting serves an important function. It allows young people to trust their caregiver to create a safe space that supports the expression of emotions. Helping adolescents express their inner feelings and take responsibility for themselves and their actions increases one’s sense of self esteem and can reduce the temptation to feel in control of oneself by managing one's physical body. Of course, this should be done without taking over the young person's life but by balancing support and involvement. Finally, helping young people to recognize their inner uniqueness builds positive self regard and makes external influences less powerful. These strategies all serve to help struggling adolescents let go of the need to externally control themselves (e.g., via weight and looks) and start to control their inner feelings. That, in turn, will allow them to create a much richer meaning to their life “fed” by much more than lack of food.  

Posted by: Asya Brodsky, MSW, LSW

Barth, D. (2003). Separate but not alone: Separation-individuation issues in college students with eating disorders. Clinical Social Work Journal, 31(2), 139-153.

Pharis, M. & Penn, M. (1984). A Model for outpatient Treatment of young adolescents with anorexia nervosa. Child and Adolescent Social Work Journal, 1(1), 34-48.