Every mental illness wreaks a devastating toll on the person who is suffering and his or her family. As a clinician working in a residential treatment program for teens and young adults, I see evidence of this daily. However, teen eating disorders are perhaps the most dangerous of all. Here's why.
Eating disorders are the deadliest mental illness.
Diagnoses of eating disorders, specifically anorexia nervosa, carry the highest death rate of all mental health disorders. This is due in part to the higher-than-average rate of suicide among those with eating disorders, and partly to the medical complications associated with eating disorders.
Adolescents are among those at the greatest risk, as the most common age of onset for eating disorders is between 12 and 25. For females between 15 and 24 years old who suffer from anorexia, the mortality rate associated with the illness is 12 times higher than the death rate of all other causes of death.
The medical issues that come with the disease can hinder mental health treatment.
Once an eating disorder is diagnosed, the biggest roadblocks in effectively addressing it with mental health treatment are often the medical components of the disease. Teens with anorexia or bulimia can require frequent medical intervention and hospital stays for conditions caused by malnutrition, such as low heart rate, potassium deficiency and dehydration.
That means that treatment for the disease itself gets put on the back burner, particularly as mental health interventions for eating disorders are often, by necessity, rigorous and immersive. Another complication: For underweight patients, it can be medically unsafe to prescribe medication for co-occurring depression or anxiety. (There is currently no medication specifically addressing eating disorders, though researchers are looking closely at the genetic and neurological factors associated with anorexia.)
Eating disorders are linked with substance abuse, suicide and depression.
Because eating disorders are symptoms of underlying causes, they are frequently linked with other teen mental health challenges. A National Institute of Mental Health study of 10,000 teenagers (ages 13 to 18) with eating disorders found that as many as 88 percent reported suffering from anxiety, depression or a behavioral disorder. Moreover, about a third of those with bulimia, 15 percent of those with binge eating and 8 percent of those with anorexia had attempted suicide.
In addition, teens with eating disorders are at greater risk for substance abuse. According to a report from the National Center on Addiction and Substance Abuse at Columbia University, as many as 50 percent of those with an eating disorder also abuse drugs. Looking at it from the other direction, just over one-third of individuals with substance abuse disorder also have an eating disorder.
Beyond the psychological understanding of this association, science may also shed light on this link: New research shows that the dopamine-linked reward systems in the brains of adolescent girls with anorexia remained altered even after weeks of treatment and significant weight gain.
It's easy to find support and encouragement online for eating-disordered behavior.
Online "pro-ana" (anorexia) or "pro-mia" (bulimia) sites encourage and even give instructions for disordered eating. In a study at Indiana University, researchers interviewed regular pro-ana bloggers and found that many of them felt that the websites essentially granted permission for them to continue with their eating disorder.
In addition to helping those with eating disorders maintain their unhealthy behaviors, these online communities may encourage teens who do not have full-fledged disorders to go further. Another study showed that these types of sites are visited by 13 percent of young female teens – and that number triples among female teens who exhibit problematic eating behaviors.
Family doctors are less likely to notice the warning signs.
Research shows that doctors are less likely to pinpoint eating disorders than they are to notice signs of other mental illnesses. In the NIH study mentioned above, researchers found that the majority of teens with eating disorders did have contact with mental health care, school services or general medical services, but less than a third had talked with a professional about their eating or weight problems.
The vast majority of the time, nutrition isn't discussed thoroughly in a typical doctor's visit, given both the time constraints and the discomfort associated with the topic. In addition, doctors (and parents) may tend to dismiss the possibility of an eating disorder if a teen doesn't exhibit obvious weight loss.
But there is good news, too.
Contrary to what is often assumed, eating disorders can be fully cured, according to scientists. The results of a long-term study done at Massachusetts General Hospital and published earlier this year challenged the notion that eating disorders are a life sentence, finding that around two-thirds of women with anorexia nervosa or bulimia nervosa will eventually recover from their eating disorders. But it takes time, particularly for anorexia: Nine years after entering the study, less than a third of participants with anorexia had recovered; 22 years later, almost 63 percent were considered recovered.
The key, researchers and mental health experts agree, is heading off eating disorders before they take root. A six-year study identified factors that parents, teachers and doctors should be aware of in both boys and girls, beginning as early as age 9, including body dissatisfaction and depressive symptoms. As with all mental health conditions, keen attention, early assessment and comprehensive treatment can save lives and end suffering for our children and teens.
