Understanding how can Anorexia develop in adolescents?
As we go through our early years, we encounter situations and problems, some positive and some negative. However, how we deal with and react to each experience can influence how we deal with the situation the next time it repeats.
For example, when an adolescent transitions from Primary School to Secondary School in Ireland. The change in friendships, structure, environment and expectations from Parents and Teachers will naturally cause some anxiety or stress. This is normal and expected from any adolescents or adult going through similar changes.
Some adolescents can feel uncomfortable and deal with these difficult stages by discussing them with friends or family. Others may role play conversations to develop talking strategies to prepare them for the next situation.
At this stressful and anxious time, some adolescents may not feel hungry due to anxiety and “butterflies in their tummy”. This could result in them skipping lunch while in School. Further to this, when a group of adolescents are also skipping meals/ snacks in school, this can create a culture of skipping lunch and an adolescent may feel uncomfortable going against the social norm despite their desire to have lunch.
This may not be an uncommon experience in school for some, however, the challenge presents when this negative behaviour receives positive reinforcement.
When the behaviours lead to some changes in body shape or new found body or appearance confidence, a friend or family member may say something encouraging or positive about the body changes but this can reinforce the negative coping strategies.
An example of positive reinforcement may be comments such as “you’re looking well”, “I wish I had your willpower” “have you any tips?” etc. The complication of this is it can reinforce to the person with the eating disorder that the negative coping strategies leads to approval from others and by repeating the action it can lead to acceptance by others.
Using these examples, it can be seen how restricting food could equal social success and acceptance by others. The challenge in treatment of this presentation is that the restriction being combined with social success or acknowledgement from others and that letting go or recovering from anorexia equally means also letting go of behaviours that brought social acceptance from others.
An experienced multidisciplinary team (MDT) can recognise when an adolescent has made connections with anorexia and social success, acknowledgment or validation. This presents a challenge as the anorexia gains traction over other elements of the thoughts and behaviours and to be without the anorexia thoughts can be frightening. Some describe this as feeling as out of control of situations.
An example of this might be “if I were no longer to be in a “smaller body” would people accept me since they only accepted me when I was restricting my food and becoming smaller”.
This can show how anorexic thoughts and behaviours can give the impression of social inclusion and success and that moving away from this could cause a fear of social rejection or failure to retain the approval of others. Protection of these negative coping strategies increases the more they are used and can lead to the development of rules and rituals.
An example of this may be how the behaviours and thoughts develop into a fear of gaining weight.
Not that gaining will mean the person will now be unsuccessful or socially unaccepted, but because losing weight leads to the person becoming successful or feeling involved in their friendship networks, and to gain weight puts these benefits at risk, the person may be frightened to let go of these.
If the behaviours initially worked but now are not offering the same benefit, some people will move to different approaches, but some will push further with the behaviours.
As with anything in life, the laws of diminishing return apply; i.e., the first time you do a behaviour, it will equal a reward, but the second time the reward might be slightly less, and so on the third and fourth times, etc.
With anorexia, the first time the behaviours are carried out, the positive rewards can be achieved easier, and combined with an influx of dopamine from the sense of achievement, naturally the person wants to repeat a behaviour that worked, but it may not give 100% of the sense of achievement or dopamine reward.
This now presents a problem to the person; they could try a different approach or increase the anorexic behaviours in the hope of gaining a sense of control or validation. Combing this with diminishing returns, the behaviours and rules need to increase to gain the wanted goals; this can be similar in addictions. This may be rules developed around portion control, meal times, food groups and leaving a certain amount of each meal etc.
Focusing on all aspects of the adult or adolescent and where the behaviours originated can be required to understand where to focus their treatment and prevent relapse in the future.
Treatment of anorexia
Understanding how can Anorexia develop in adolescents and treatments
There are lots of material written about treatment of anorexia in adolescents and adults but little in understanding why each case of anorexia develops. If you were to think about anorexia as the symptoms of the problem, we can then understand if we don’t treat the cause of anorexia, we may only be putting a bandage over the wound. An example of this could be trying to dry out clothes in the rain, no matter the amount of heaters or hot air flow it won’t solve the fact that the clothes are still getting wet.
Therefore, only approaching anorexia with food-based solution is unlikely to solve the causing factors that lead to its development. Also, by only offering psychological treatment can lead to not treating the fact that malnutrition can lead of a chemical imbalance in the person’s brain and this has been shown to increase likelihood of anxiety or intensifying of anxiety, depression and other mood disorders. Approaching anorexia treatment from an experienced multi-disciplinary team (MDT) is required for long term recovery.
Other precipitation factors need to be considered in treatment, the personality traits of a person and how they process information and how long it takes for such processing to be happen. An example of this is logical versus emotional thought patterns.
A logical person will require a rationale to an action, i.e. it needs to make sense to them before they will consider it the correct action, they will also need time to prepare for this action. A common indicator of this could describe a person who does not like change but more structure and order.
An emotional thought pattern is different, the action could be correct or incorrect but if others perceive it to be correct, then it must be the best choice, this could be described as following how others think- i.e. approval.
As shown above in these two examples no two cases will present identically, when you consider how many variables will be involved such as friends, family, environment and schools etc.
Rather than defining what anorexia nervosa is, looking at where it could have originated from can be beneficial. Noting that no two cases will present the same way and each one will require individualised care from an experienced multi-disciplinary team to understand how development of anorexia in an adolescent or adult. Recognising the contributing factors the person may be guarding related to the illness and understanding the thought process of the person is necessary when providing care in treatment of the person with anorexia.
Where can I get help for adolescents and adults with anorexia?
The National Eating Disorders Recovery Centre (NEDRC) based in Dublin 4, Ireland. Offers treatment for adolescents and adults with anorexia nervosa and other eating disorders. Our multidisciplinary team lead by our Consultant Psychiatrist, regulated by the Mental Health Commission of Ireland as an Approved Centre for 8 residential beds (adults). NEDRC Day Programme for adults and our Adolescent Day Programme. Our outpatient services can also help adolescents and adults with our specialist Psychologists and Dietitians. NEDRC programmes are covered by VHI, Irish Life, Garda Medical Aid and the HSE provides funding in certain cases.
Further information on NEDRC’S adolescent treatment program: Click here
If you would like to discuss the concerns you have about a love one, contact NEDRC in confidence. We are happy to listen and guide you through.
NEDRC can help you and your loved one take that vital step to regain a happy, healthy life. Please use the contact details below to find out about our eating disorder treatment options available to you and your loved one. Contact NEDRC
Telephone: 01 564 4450 or Mobile: 087 7755996 / Email enquiries@nedrc.ie
For referrals from Healthcare/ Therapeutic professionals please contact via : referrals@nedrc.ie or healthlink@nedrc.ie or online via Healthlink
Healthmail users can send referrals to healthmail@nedrc.ie
