Anorexia nervosa in adolescence

An eating disorder is a dangerous mental health condition where those affected experience extreme disturbances within their eating behaviors. These disturbances can manifest in ones emotions, thoughts, and physical eating habits. Someone diagnosed with an eating disorder may ruminate over the thought of food, body-image, and exercise to the point where it gravely interferes with their daily life. Eating disorders are often paired with other mental illnesses such as anxiety and panic disorders, obsessive compulsive disorder, and drug and alcohol addiction. There are also many different types of eating disorders that each have their own symptomatic classifications with the DSM-5. Anorexia nervosa, a disorder characterized by low weight and food restriction, holds the highest mortality rate of any mental disorder. Symptoms of anorexia nervosa include restricted eating, extreme thinness, intense fear of gaining weight, and a distorted body image. Later on, without intervention, life-threatening symptoms can begin to develop such as thinning of the bones, anemia, low blood pressure, loss of period (for women), and multiorgan failure. Anorexia nervosa most commonly begins in adolescence, and without early intervention, it can be very difficult to feel motivated to seek treatment and fully recover. With the right data source to survey the widespread public and collect ata, anorexia nervosa and other eating disorders can be at last be monitored so that doctors and researchers within the field can find the best way to treat eating disorders as well as methods of stopping them in their tracks.

According to “Prevalence and Correlates of Eating Disorders in Adolescents,” a study conducted by Sonja A. Swanson, Dr. Scott J. Crow, Dr. Daniel Le Grange, Dr. Joel Swendsen, and Dr. Kathleen R. Merikangas, amongst a sample of adolescents aged thirteen to eighteen years old there was a 0.3% lifetime prevalence of Anorexia Nervosa (Swanson et al., 2011). This percentage may seem small but this statistic is based off of those adolescents who fit the entire DSM-IV criteria. Swanson et al. (2011) writes, “community studies that used dimensional measures in youths have also yielded far greater prevalences of disorder eating behaviors (ie, 14%-22%) than those found in studies that applied strict DSM-IV diagnostic criteria.” These findings exemplify that disordered eating is a huge issue amongst adolescents and indicates that eating disorders such as anorexia nervosa do potentially have “major public health implications (Swanson et al., 2011).” Swanson et al. (2011) states the median age of onset of Anorexia Nervosa to fall at 12.3 years old and also describes 55.2% of those adolescents diagnosed with anorexia nervosa endorsing 1 or more comorbid psychiatric disorders across their lifetime. 31.4% of those adolescents with anorexia nervosa experiences suicidal ideations within their lifetime and 8.2% had attempted suicide (Swanson et al., 2011). Research by Hamilton and Elenback (2018) reports the overall mortality rate amongst adolescents with anorexia nervosa is 12 times that of those who do not have anorexia nervosa.

Statistically, it is clear that anorexia nervosa is dangerously prevalent amongst adolescents. With an average onset of about twelve-years-olds, a high comorbidity rate, and a risk of suicide, the mental illness has the potential to permanently damage the lives of young women and men. There are an enormous amount of serious physical health problems that can result from anorexia nervosa including kidney failure, osteoporosis, and heart attack. Anorexia not only affects the emotional mind but the physical body, and is potentially life-threatening with the highest mortality rate of any mental disorder. Anorexia nervosa has yet to be acknowledged as a major public health issue because eating disorders are very publically stigmatized. There is widely spread false belief that eating disorders are just a “bad lifestyle choice,” which invalidates the disorder as a serious illness and makes it out to be a choice. This stigmatization and invalidation can lead those who are suffering to miss the symptoms , resist seeking the treatment that they need, and to a lack of support from loved ones. Without acknowledging the severity of eating disorders, we are taking away those affected from their potential for full recovery. The earlier the intervention, the higher change that one will fully recover from anorexia nervosa. The longer we wait to address anorexia nervosa as the enormous public health crisis that it is, the less likely individuals will seek treatment in order to recover and get the chance to live the full and healthy life that they deserve.

Once anorexia nervosa is taken into consideration as a public health crisis, public health surveillance on the condition could begin. Public health surveillance would allow researchers to identify treatment and preventative methods that work by monitoring the condition over time. A common data source that is used to the survey the nation is the “Center for Disease Control National Surveillance System.” The CDC uses this system to conduct many surveys with the goal of determining the prevalence of different conditions over time. In 2015, eating disorder surveillance questions were voted off the survey system. There were several questions, that would no longer be included yet were previously used to track eating disorder symptoms on the “Youth Risk Behavior Surveillance System” that was conducted every couple of years in many states across the nation. This left researchers with outdated information and no large scale way to survey eating disorder prevalence. The misconception was that eating disorders are not a public health issue, once again perpetuating the idea that they are a choice and minimizing how dangerous they are. The stereotype had bled into the CDC and was risking the livelihood of both adolescents and adults alike.

Returning the eating disorder surveillance questions to the “Youth Risk Behavior Surveillance System” would be a great data source in obtaining information on and monitoring prevalence of anorexia nervosa. Adolescents in schools nationwide would be surveyed every couple of years and researchers would be obtaining updated information from a wide-spread sample. Researchers would also be monitoring communities nationwide to detect what prevention efforts are working, where they are working, and who they are working for (age, gender, nationality, etc.) Tracking eating disorders through a school-wide survey could also help researchers detect the reason for onset. Researchers could also begin to push for eating disorder education in schools using the argument that in a number of years, they can come up with tangible data showing it decreases prevalence.

Although there are many positive attributes, there are also some negative attributes to the “Youth Risk Behavior Surveillance Systems,” eating disorder surveillance questions. Without eating disorder education, a lot of adolescents lack the knowledge and understanding of what is right and wrong when it comes to eating behaviors. When asked a series of questions, students could misunderstand and data can be skewed. Students could also feel as though they are taking a “test” and the pressure could make it so that they answer untruthfully in the attempt to answer in a way they think is “accurate.” Adolescents could also be afraid to be honest about symptoms could being not answering questions to the full truth- in fear of others finding out and in fear of embarrassment. With just a few questions on a questionnaire researches will only be able to identify those that match the DSM-5 diagnostic, and will be missing a lot of cases of anorexia nervosa and eating disorders that may not perfectly fall into the systematic definitions.

Once the “Youth Risk Behavior Surveillance System” includes eating disorder surveillance questions, there are many ways in which the survey can be improved. The system must make sure to include questions that reference many different eating disorder symptoms in many different ways. If the system fails to reference many different symptoms in many different forms, they can miss a lot of cases of eating disorders due to misinterpretation of data and those adolescents being surveyed misinterpretation of the question. Adolescents also tend to lose focus, so the questionnaire must stay accessible. Students should be told in advance how long the survey will take and have breaks to rejuvenate their energy and focus so that their answers may remain accurate. Students should also be educated on the diseases that they will be asked about beforehand- in this case, eating disorders. Education will help children reach an understanding of what anorexia nervosa and other eating disorders are, so that when they take the survey they know how to answer the questions truthfully.

Anorexia nervosa most commonly begins in adolescents and those with the illness are twelve times more likely to die as a teenager than those not suffering from the illness. Without proper public health surveillance, researchers and doctors within the field are stuck relying on outdated data to try and create treatment programs and interventions that work. By adding eating disorder surveillance questions to the CDC “Youth Risk Behavior Surveillance System”, we are giving researchers the opportunity to have dated and accurate information in order to help those with anorexia nervosa, and giving those with anorexia nervosa a second chance.