Eating Disorders in Adolescents

Kristen Anderson, LCSW, CEDS-S & Sara Desai, LCSW

Co-Founders

Chicago Center for Evidence Based Treatment

Objectives

• Participants will have a deeper understanding of the prevalence and seriousness of eating disorders in society.

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• Participants will be able to recognize the signs and symptoms of eating disorders.

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• Participants will learn skills for how to talk with their peers with eating disorders and provide support.

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• Participants will gain knowledge on current evidence based treatments for eating disorders.

What is an eating disorder?

• Eating disorders are serious mental and physical illnesses that can be life threatening
• People of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights can be affected
• In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or EDNOS (Wade, Keski-Rahkonen, & Hudson, 2011)

Eating Disorder Diagnoses

• Anorexia Nervosa (AN)
• Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health)
• Bulimia Nervosa (BN)
• A pattern of binge eating and purging/compensatory behavior
• Avoidant Restrictive Feeding & Eating Disorder (ARFID)
• Indifference to food, rigidity and refusal to eat food based on smell, taste, texture or appearance, concern about aversive consequences of eating (e.g. vomiting/choking). Results in persistent failure to meet growth and nutritional needs

Signs and Symptoms of ED

• Individuals with eating disorders may not be low in weight (very important to note we look at individual growth and development curves)

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• Malnutrition can be seen in patients of ANY weight

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• Individuals with eating disorders may not appear to be eating very little

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• Hypervigilance/anxiety/rigidity around food can signal early onset

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• Shape and weight concerns often intensify after weight loss

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Athletes

• The eating disorder may disguise itself as a way to increase performance in sport
• Female athletes may attribute loss of menses to activity levels and the female athlete triad
• Shape and weight concerns may present through perfectionism, esp as it relates to performance in athletics
• Males with eating disorders may be less likely to report shape and weight concerns

A Brief Update on the Research…

The Minnesota Starvation Experiment

During WWII, Ancel Keys studied starvation and sustenance diets using 32 conscientious objectors from Civilian Public Service as test subjects eventually producing his two-volume Biology of Human Starvation (1950).

Ancel Keys’ study of the effects of starvation on healthy young men showed that many psychological and behavioral symptoms of eating disorders were the result of the biology of starvation.

Biology of Human Starvation (Keys 1944):�Effect of starvation on young, healthy men�

• Strong preoccupations with food
• Emotional and personality changes
• Inflexible eating patterns
• Social withdrawal
• Decreased concentration, comprehension, and judgement
• Binge eating, followed by remorse
• Distrust of authority
• Depression

What does this tell us:

• The malnutrition may come first
• Weight and caloric intake MUST be returned to normal in the treatment process
• We do not need to just “change” the way individuals are thinking about food or their shape/weight, we need to target starvation/malnourishment as well

Suicidality and Eating Disorders

• Suicide is the second leading cause of death among individuals with AN
• Individuals with AN are 18 times more likely to die by suicide
• Ideation and attempts are elevated compared to the general population
• Approximately one-third of people with AN and BN have attempted suicide
• Eating disorders tend to co-occur with other disorders (i.e., mood disorders)

Data source: Smith et al., 2018

How to support a friend who has an eating disorder

• Talk to a trusted adult
• Parent, teacher, coach
• Ask direct questions…
• Are you doing anything to alter or change your weight?
• Are you thinking about food, calories, eating often?
• Are you able to go a day without exercise?
• When speaking with your friends, use clear fact driven statements…
• I am concerned that you are not eating enough
• I have noticed you seem more anxious/rigid, especially around food/eating/workouts, etc.
• I am worried about you and I am going to talk with your parents
• If a friend tells you they were diagnosed with an eating disorder…
• Share your support for them and patience during the process of fighting the ED
• Understand that circumstances may temporarily change (i.e. taking a break from sports, need for supervised eating, shift in social capacity)
• Avoid comments about weight/shape

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Treatment Updates

• Old ways of thinking
• Separate children from their families
• Parents are viewed as the problem
• Control/boundary issues result in eating disorders
• Insight can be gained mid-disease and is necessary for recovery
• Chronic, lifelong illness
• Treatment: residential
• New research, new ways of thinking
• There is no evidence that pointing towards a “dysfunctional family”
• Many eating disorders are the result of a biological/genetic vulnerability
• The family is the best resource for the patient
• Nutrition first, psychological progress unlikely until nutritional rehab has begun
• Outpatient treatment is the first line recommendation: Family Based Treatment (FBT) for An, Cognitive Behavioral Therapy- Enhanced for Eating Disorders (CBT-E) for BN and BED, Cognitive Behavioral Therapy For ARFID (CBT-AR) for ARFID

Treatment Recommendations

• First, visit the family’s pediatrician/PCP
• Outpatient evidence-based treatments as the first line option for adolescents

Evidence-Based Treatments

• Family Based Treatment (FBT) is recommended as a first line treatment for adolescents with AN
• Parents are viewed as the most useful resource in their child’s treatment
• Focus on the current ED symptoms NOT on underlying cause; agnostic to cause
• Appropriate for those who are medically stable for outpatient treatment
• Cognitive Behavioral Therapy- Enhanced for Eating Disorders (CBT-E) is recommended as a first line treatment for adolescents and adults with Bulimia Nervosa and Binge Eating Disorder
• Individual outpatient treatment
• Makes core assumption that overvaluation of shape/weight is central
• Cognitive Behavioral Therapy for ARFID (CBT-AR) is recommended as a first line treatment for adolescents and adults with ARFID
• Individual or family involved outpatient treatment
• Works on exposing patient to feared stimulus through thoughtful, planned exposure and response prevention both in and outside of session

Questions?

Thank You!

Feel free to reach out with any questions!

Kristen.anderson@ccebt.com

Sara.desai@ccebt.com

312-600-3936

www.ccebt.com