Pathways to Eating Disorders among Teens

Many unhealthy weight loss and eating behaviors do not fit the criteria for an eating disorder as defined by the DSM-IV, but may eventually lead to anorexia nervosa or bulimia nervosa. Annie Aimé, PhD and researchers at the University of Quebec, York University, and Queen’s University, all in Canada, recently designed a study to examine the paths or eating trajectories among a group of 739 students in the 9th, 10th, and 11th grades (Int J Eat Disord 2008;41:686).

Problems with eating were measured by 13 items selected from the Eating Attitudes Test (EAT-26). Students reported on how often they had such problems as “I stuff myself with food,” and the results were scored on a six-point Likert scale. Fifty-nine items from the Youth Self Report behavioral scale were also used—this questionnaire identifies internalizing and externalizing behaviors. Internalizing behaviors are emotional disorders characterized by inhibition and over-control, while externalizing indicates the presence of attention, oppositional, antisocial, and aggressive problems. Drug and alcohol use were also evaluated.

Five Trajectories Were Identified

Dr. Aimé and her colleagues identified five eating trajectories among the students: no eating problems, some eating problems, increasing eating problems, eating problems that spike, then decrease, and chronic eating problems. Boys were more likely than girls to report having no eating problems, whereas a significantly higher proportion of girls than boys were in the some, high-decreasing, and chronic eating problems groups. In the high-risk groups, the authors reported a ratio of about 1 teen male for 10 female teens, which matches the usual ratio seen in adult patients with full eating disorders.

Most adolescents did not develop eating problems between the ages of 13 and 18, and no link was seen between alcohol intake and eating problems in both boys and girls. There also was no relationship between the frequency of drug use and eating problems among the girls. Disordered eating in males but not in females was associated with victimization in middle adolescence (around 16 years of age), but not later.

According to the authors, their study results underscore the importance of not taking for granted that partial eating disorders among teens are transient and will vanish without any intervention. In fact, in most teens low levels of eating problems are very unlikely to develop into more serious disordered eating (Int J Eat Disord 2005; 37:119; J Youth Adolesc 2005; 34:521). Also, when eating problems are present, clinicians should assess and investigate other co-occurring risk factors as well as their impact on the adolescent’s functioning. The authors note that the results show that eating problems are not transient and can have serious consequences. In fact, when eating problems are present, they tend to follow a stable course or to worsen from middle to late adolescence and to be associated with other psychological conditions.