This web site was
partially supported by the Health Resources and Services Administration,
Maternal and Child Health Bureau through grant number 6T76-MC00011
Disorders during Adolescence: Nutritional Problems and Interventions
Jane Mitchell Rees, PhD, RD, CD
Departments of Health Services and Pediatrics
Maternal Child Health and Adolescent Medicine
University of Washington, Seattle, WA 98195
Chapter 3 Onset of Anorexia Nervosa during Adolescence
[Table of Contents]
The physical manifestation of anorexia nervosa may be sudden, although
unrecognized underlying characteristics may have been present prior to
manifestation of an identifiable disorder. Intervention strategies
should simultaneously address the psychological and physical issues of
Onset: Progressive development
From the family's point of view, the teenager with anorexia nervosa has
traditionally been a "model child". She fits into the family and
meets her parents' high expectations, working extremely hard at school
and being satisfied only with excellent grades. Suddenly she displays
a compulsive attitude about her weight and food consumption. The
family erupts in crisis as response to her extreme eating behavior.
Onset: Psychological characteristics
The teenager with anorexia nervosa is troubled about her life. She finds
it difficult to mature psycho-socially and clings to the rigid patterns
of childhood. She is unable to sustain peer friendships and isolates herself.
Life appears to be out of her control. She is conflicted about living as
her parents direct, is hurt by their critical comments and begins to realize
that she must assert herself but finds that difficult. She feels too fat
and thinks she has to be slim to be a worthy person. She takes an uncompromising
stand about her eating and exercise habits. Increasingly preoccupied
and angry when her family interferes, she denies her illness.
Onset: Distorted perceptions
A range of distorted perceptions has been noted, often related to body
size and shape, hunger, satiety, physical endurance and the need for rest.
Distorted perceptions characteristic of anorexia nervosa may be exacerbated
during episodes of crisis level starvation and will vary from time to time
as well as adolescent to adolescent. Anorexia nervosa should not
be ruled out on the basis of lack of specific distortions if other symptoms
The adolescent with anorexia nervosa has been described as wishing to stave
off adulthood. The question is whether she tries to avoid maturation
or whether maturation eludes her.
Onset: Family characteristics
Many families of adolescents with anorexia nervosa list no problems until
the manifestation of the disorder. They need assistance from family
specialists on the health care team to deal with the unexpected crisis
of an eating disorder. As treatment progresses they require guidance
while developing a family system to support their adolescent as she learns
to regain her health.
This Web Site is a reference for health care professionals, students and
educators; it is not intended to provide advice or treatment to people with
eating disorders. If you have an eating disorder or disturbed eating
patterns, consult a qualified physician who specializes in eating disorders.