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Medical Information Center

Teen Eating Disorders

Katherine Liebesny MSIII, Yingshan Shi, MD

The page started on 09/14/08, updated on 10/16/08

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What is an eating disorder?
Anorexia Nervosa (AN)– a disorder of self-starvation and excessive weight loss
Bulemia Nervosa (BN) – a disorder of binge eating and compensatory behaviors such as self-induced vomiting or laxative abuse
Binge eating disorder – recurrent binge eating without compensatory behaviors
The female athlete triad – a competitive athlete who’s stopped eating normally, has disrupted menstrual periods and reduced bone strength

Facts

Eating disorders are the 3 rd most common chronic disease of adolescence after obesity and asthma!
1% of adolescent girls suffer from AN and up to 10% of 16-25 year old teens have subclinical AN.
3-10% of adolescent/college women in US suffer from BN
Adolescents are more likely to have some symptoms of AN or BN.
Early adolescents more often have AN and later teens may have either AN or BN.
The ration of males to females (M:F) before puberty is 1:1, in early adolescents 1:10 , and in early adulthood 1:20 .

Who is at Risk?

Anorexia Nervosa - AN
C aucasion, African American, Asian and Hispanic
M iddle-upper class
P ersonality features: high achievers, driven, very involved, perfectionists, internalizing coping styles, obsessive behaviors
P articipation in activities valuing thinness
F amily history of eating disorder
F amily features: conflict avoidance, overwhelming attachment to parent, rigid/overprotective parenting

Bulemia Nervosa - BN
U nsuccessful weight loss
History of childhood sexual abuse
History of psychoactive substance abuse/dependence
Family history of alcoholism or depression

High risk-easily missed groups:
Diabetics: Up to 1/3 of women with IDDM have disordered eating. This includes binge eating, omission or under-dosing of insulin to promote weight loss, purging and use of laxatives.
Female Athletes may not meet criteria for AN or BN.
Typically do not have disturbed body image.
Do exhibit behaviors and complications similar to AN and BN.
Female athlete triad = disordered eating, amenorrhea and osteoporosis.
Risks: Appearance/endurance focused sports such as ballet, gymnastics, and long distance running and over-controlling parents or coaches.
Male risks: Gay or bisexual, premorbid obesity, jobs with pressure to be thin, and sports where specific weight range must be maintained (e.g. crew, wrestling, boxing).

Signs of eating disorders

AN
Parental, friend or teacher concern about weight loss
Skipping meals, reducing portions, vomiting, significant increase in exercise frequency or exercising right after meals
Social isolation
Cessation of menstrual periods
Lightheadedness
Exercise intolerance
Poor school performance
Dry brittle hair/ fine baby-like hair
Cold intolerance

BN
Binge/purge at least 2 times per week for 3 months
Use of laxatives, diuretics or diet pills to control weight
Weight fluctuations without necessarily being underweight
Menses present but possibly more irregularity
Secretive about eating.
Swelling of the cheeks
Enamel erosions/dental caries
Calluses on knuckles
Complaints of epigastric pain/constipation

Complications of eating disorders

AN
Cardiovascular: bradycardia, hypotension, mitral valve prolapse, s udden death due to Long QT, peripheral edema, refeeding syndrome
Dermatologic: dry skin, carotenodermia, lanugo, starvation associated pruritis
Gastrointestinal: constipation, refeeding pancreatitis, acute gastric dilatation due to refeeding
Endocrine: amenorrhea, infertility, osteoporosis, thyroid dysfunction, hypercholesterolemia, hypoglycemia, n eurogenic diabetes insipidus, fluid/electrolyte disturbances
Hematologic: starvation pancytopenia, d ecreased ESR

BN
Cardiovascular: arrhythmias, diet pill toxicity (palpitations, hypertension), emitene cardiomyopathy, mitral valve prolapse
Gastrointestinal: dental erosion, parotid gland swelling, esophageal rupture, GE reflux, acute gastric dilatation, post-binge pancreatitis, constipation due to laxative abuse, cathartic colon
Endocrine: irregular menses, hypoglycemia, mineralcorticoid excess, electrolyte disturbances, dehydration, nephropathy
Pulmonary: aspiration pneumonitis, pneumomediastinum, pneumothorax/ rib fractures

Treatment options
Outpatient team approach involving the pediatrician, a nutritionist and a mental health specialist.
Behavior modification, psychotherapy, and medications
Day program include meals, therapy groups and activities 4-5 days a week from about 9am-5pm.
“Intensive outpatient programs” may add afternoon/evening sessions 2-4 days/week.
Inpatient programs are reserved for the management of serious complications or restoration of weight when outpatient therapy fails and can include intravenous feeding and rehydration.

Local resources for treatment

Organization	Phone #	Address
University of Chicago Eating Disorder Clinic http://psychiatry.uchicago.edu/clinical/clinics/edp/	(773) 702-3858	5841 S. Maryland Ave. Chicago , IL
Northwestern Weight and Eating Disorder Program http://www.eatingdisorders.northwestern.edu/index.htm	(312) 695-2269	303 E Chicago Ave. Chicago, IL
Lakeview Eating Disorder Treatment Program http://www.lakeviewtherapy.com/eatinghome.html	(773) 525-3313	3322 N Ashland Chicago , IL
Eating Disorders Program at Rush University Medical Center http://www.rush.edu/rumc/page-1099918800224.html	(312) 942-6656	1653 W Congress Pkwy Chicago , IL
Center for Eating Disorders at NorthShore University HealthSystem http://www.northshore.org/clinicalservices/eating/	Info: (847) 480-2617 Appt: (847) 570-2500	Highland Park Hospital 777 Park Avenue W Highland Park IL
UIC Eating Disorders Clinic http://www.psych.uic.edu/clinical/eating.htm	(312) 355-1312
Linden Oaks Hospital at Edwards Eating Disorders Program http://www.edward.org/body.cfm?id=641&oTopID=336	(630) 305-5500	Arabella House 806 Edgewater Naperville, IL
DePaul University Community Mental Health Center *fees on a sliding scale base don income and family size, no one is turned away	(773) 325-7780 (773) 477-5581 (312) 654-0450	2219 N Kenmore, Byrne Hall room 300 Chicago, IL 2156 W Wellington 206 W Division
Anorexia Nervosa and Associated Disorders list of therapists and support groups in Illinois Therapists: http://www.anad.org/22301/348500.html Support: http://www.anad.org/22322/460944.html
National Eating Disorders Association list of therapists in IL http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=730

What can I expect for recovery?

AN
40-45% recover completely
30% improve
25% chronic problems maintain weight
10-15% mortality (highest of any psychiatric disorder)
Causes of death: starvation, suicide, medical complications
Indications of poor prognosis: lower initial weight, disturbed family relationships, male, vomiting, longer duration of illness, failure to respond to early treatment

BN
50% recover – of this group 25% continue to have some abnormal eating habits
30% maintain status of “eating disorder not otherwise specified”
Indications of poor prognosis: premorbid and paternal obesity

Online Information

For Teens and Parents

Resources NEDA
Eating disorders NMHIC
nlm.nih.gov
lpch.orgl anorexia
lpch.orgbulimia
Eating disorders mayo
Resources anred
Eating disorders wiki

Survival Guide NEDA
Eating disorders KH
My friend may has fd
Eating disorders aacap
Binge eating KH
Screening quiz PC

Coaches and Teachers

for coaches
Information for school

For Physicians

National Guideline NGC
Eating Disorders NLM

Helpful resources and websites
Resources for patients/family
http://www.nationaleatingdisorders.org/information-resources/parent-toolkit.php resources
http://www.nlm.nih.gov/medlineplus/eatingdisorders.html
http://mentalhealth.samhsa.gov/publications/allpubs/ken98-0047/default.asp National Mental Health Information Center
http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/adolescent/anorexia.html anorexia
http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/growth/bulimia.html bulimia
http://www.mayoclinic.com/health/eating-disorders/DS00294 Eating disorders mayo
http://www.anred.com/toc.html Resources anred
http://en.wikipedia.org/wiki/Eating_disorder wiki
http://www.nationaleatingdisorders.org/uploads/file/information-resources/Eating%20Disorders%20Survival%20Guide%20revised%209_2008.pdf Eating Disorders Survival Guide
http://kidshealth.org/parent/nutrition_fit/nutrition/eating_disorders.html Eating disorders
http://kidshealth.org/PageManager.jsp?dn=familydoctor&lic=44&article_set=20286 Eating disorder
http://familydoctor.org/online/famdocen/home/children/teens/eating/277.html eating disorders Facts for teens
http://kidshealth.org/teen/food_fitness/problems/binge_eating.html Binge eating
http://psychcentral.com/eatingquiz.htm screening quiz

Teachers/coaches
http://www.nationaleatingdisorders.org/information-resources/educators-and-coaches.php
http://www.nationaleatingdisorders.org/information-resources/educator-toolkit.php

Resources for physicians:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3589&nbr=2815 NGC: Guideline for screening, assessment and diagnosis
http://www.nlm.nih.gov/medlineplus/eatingdisorders.html eating disorders
http://www.nationaleatingdisorders.org/index.php

News articles
Eating disorders and healthcare benefitshttp://www.marketwatch.com/news/story/illinois-only-17th-state-provide/story.aspx?guid=%7BB33AB078-8AFE-41D8-A10E-E2FEB012B670%7D&dist=hppr
http://www.pediatricnews.com/article/S0031-398X(04)70026-0/fulltext
http://www.pediatricnews.com/article/S0031-398X(04)70502-0/fulltext
http://www.nlm.nih.gov/medlineplus/news/fullstory_69858.html