Why do eating disorders so commonly emerge during the teenage years?
Adolescence is a time of transformation and growth physically, mentally and biologically. This is a time when children move towards adulthood and begin to discover who they are. They become more independent, establish friendships, and their bodies develop. This development is obvious physically but there is also a large amount of change happening internally, especially in the context of hormone levels. All these changes can set the tone for a difficult relationship between mind, body, and food.
For many, entering into puberty can be a very emotional, stressful, confusing, and frightening time. Some may unintentionally develop disordered eating or an eating disorder as they attempt to gain a sense of control or to help regulate anxiety, sadness, anger, and other difficult emotions. It can become a way to cope with difficult challenges they may be facing at home, school, extracurriculars or within themselves. Personality traits like perfectionism, rigidity, persistence, obsessive thoughts, harm avoidance, or impulsivity may also put a teen at risk. It is natural for teens to gain a significant amount of weight during this period of time but unfortunately, our culture doesn’t normalize this, creating unrealistic body expectations and body shame.
In addition to the physical and hormonal changes, there are social mechanisms at work. Studies show that when a child hits puberty, their brain’s socio-emotional system changes, increasing their concern in being socially accepted. In ecological terms, this is a natural progression into sexual maturity and the social responsibilities that go hand in hand with getting older. As a result, the teenage brain seeks reward from being popular among peers and behavior is often focused on activities and ways to be more socially accepted. Teens may engage in dieting in the hopes of fitting in, but it can develop into an eating disorder.
Next are environmental factors such as the pressure to look thin and to engage in dieting behaviors with peers and family. There are other stressors that arise in the teenage years like the pressure to perform well in school, get good grades and test scores so they can attend a good college and ‘be successful’. For some, stress like this can be enough to make them unintentionally lose weight or intentionally diet to get their mind off the stress. Weight loss, increased attention, and receiving compliments on their appearance can also contribute to the development of an eating disorder.
Adolescence is a time of rapid growth. A large weight gain is necessary to fuel the growth and changes required for a body to go through puberty. Some adolescents don’t eat enough to keep up with growth and this energy imbalance may trigger an eating disorder in those who are genetically predisposed. In addition, middle school is a time when adolescents get involved in a higher level of competitive sports. Some adolescents may unintentionally fail to keep energy intake up with the high level of energy expended in sports. This too can cause an energy imbalance that may trigger an eating disorder. Remember, not all people who develop eating disorders start off wanting to lose weight on purpose. It is now understood that a variety of factors may spark an eating disorder in a person who is biologically predisposed.
There are also theories that the hormonal changes in puberty initiate the activation of genes that predispose individuals to eating disorders. For example, some studies suggest there is a greater prevalence of eating disorders in teen girls with a higher level of the sex hormone estradiol. Researchers point to the influence of ovarian hormones as a potential area for explorative research into the biological factors behind the development of eating disorders. Ovarian changes are also known to affect body weight and food intake when they occur in puberty.
These hormonal explanations help explain why more women than men develop eating disorders and why adolescence is such a critical time for the onset of eating disorders. Generally, people assume more women are afflicted because they feel a greater social pressure to be thin but it could also be due to hormonal differences. Studies have shown that genes and gonadal hormones are influential in the timing and pattern of changes in the structure of the brain and the way the brain functions while a teenager is experiencing puberty.
Early Detection & Treatment
Middle and high schools are in an excellent position to aid in the early identification of eating disorders in adolescents. Teachers, coaches, and school counselors should be made aware of the signs to look for. If eating disorders are detected and treated early, the chances of full recovery are greater.
If your child or someone you know is struggling with an eating disorder, developing a treatment team of providers who specialize in eating disorders is recommended: medical doctor, licensed therapist, and registered dietitian. Family therapy or involving caregivers in treatment is also recommended.
Helping Teens with Eating Disorders Get Treatment
Information on treating eating disorders
Getting your child with an eating disorder to eat
Family-based treatment for adolescent anorexia nervosa
Binge Eating Disorder in Children
Buchanan C, Eccles J, Becker J. Are adolescents the victims of raging hormones?: Evidence for activational effects of hormones on moods and behavior at adolescence. Psychological Bulletin
Sisk C, Foster D. The neural basis of puberty and adolescence. Nature Neuroscience.
A Social Neuroscience Perspective on Adolescent Risk-Taking. Laurence Steinberg
Updated by Molly Bahr – 12/2019
Written by: Colleen Thompson