Eating disorders are fairly common during the adolescent stage of development.  Concerns with body image and weight control may lead to the development of disorders like anorexia nervosa and bulimia.  This is due to the determination not to become obese.


  • Obesity (excess body fat) itself is not considered a mental disorder (DSM-5) as a range of genetic, physiological, behavioural and environmental factors contribute towards its development.

  • People are considered obese if they weigh 20% more than normal weight-for-height or weight for age.

  • Obesity is about three times more common in adolescence than childhood.

  • Medical Research Council of SA reports SA as one of highest of obesity in world (40% population).

  • Factors that influence increase in weight in the adolescent are genetic factors, metabolic disturbances, hormonal imbalances and variations in the number of fat cells in the underlying tissue.

  • Some adolescents are overweight due to their physique.  Lack of exercise and poor nutrition are also contributing factors. Slow basal metabolism is another reason for weight gain in the adolescent.  During this stage, the basal metabolism declines by 15%. This means that adolescents are more susceptible to putting on weight if they do not exercise or control their food intake.

  • Although in some cultures obesity is considered a status symbol or prosperity, in Western cultures attractiveness is often equated with slimness.  Being slim as a sign of beauty is promoted by the media.  Therefore, obese adolescents will may themselves as unattractive and socially less acceptable than thinner peers.

  • Psychological reasons can be attributed to many factors. Overfeeding by parents is often due to love but also resentment.  The adolescent may overeat to avoid pressures of social interaction, participation in sports or heterosexual relationships to which they feel unequal.  They may experience ‘empty feelings’ or be compensating for feelings of inferiority. Sometimes they overeat to punish themselves out of a sense of guilt.  They will often experience a lack of control and lack of individuality.  Food is often eaten when it is available and not necessarily when it is needed.

  • Being obese negatively affects the formation of the adolescents’ self-concept.  This may cause them to experience problems socially, preventing them from forming healthy relationships.

  • It is a misconception that fat people are supposed to be “jolly” because many fat people spend time and money on supposedly “miracle” diets.  If these diets do not produce rapid results, the adolescent may become disheartened by their sense of failure and start overeating again.  The result is a vicious cycle.

  • The importance of a healthy lifestyle must be highlighted which include following a nutritional diet with plenty of exercise.

  • Sometimes a determination not to become overweight can result in more severe problems than overweight itself, including other serious eating disorders such as anorexia nervosa and bulimia nervosa.

Anorexia Nervosa

  • Anorexia Nervosa is a potentially life-threatening emotional disorder characterised by an obsession with food and weight.

  • It entails a drastic decrease in food intake relative to requirements, leading to a significantly low body weight for age, sex, development and physical health.

  • It usually starts with an intense fear of gaining weight.  The desire to lose a few kilograms may end up in dieting obsessively once the goal has been achieved.

  • Anorexia nervosa is more common in girls than boys because girls seem to be more dissatisfied with their bodies during adolescence.

  • Secondary symptoms are the irregularity or cessation of menstruation, thick, soft hair covers entire body, abnormally slow heartbeat, vomiting (may be self-induced) social withdrawal, shivering, loss of head hair, brittle nails, extreme sensitivity to cold, difficulty urinating, constipation, bulimia nervosa and often loss of appetite in the later stages.

  • When seriously underweight, many individuals may have depressive signs and symptoms such as depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex.

  • Anorexia patients are often preoccupied with food. They may enjoy preparing food but often only eat a little themselves.  They may be withdrawn or depressed and experience feelings of loneliness and helplessness.  A distorted body image leads to the perceptions that they appear overweight even if they are thin.  The relentless pursuit of trying to get thin to the point of self-starvation and even death.

  • Causes: There are various viewpoints as to what causes anorexia nervosa.  Society’s emphasis on being slim may lead to the individual’s excessive concern about their weight.  They may also feel uncertain about demands made by sexual maturation and experience anxiety about sexuality and the onset of menstruation. A need to have more control over their lives and their body may be another factor influencing anorexia.  Sufferers are usually good students from families where perfectionism and performance are considered important.  Another possible explanation is a physical disorder caused by disfunctioning of hypothalamus or chemical disturbance.  A combination of physical, emotional and social factors seems to be the accepted explanation.

  • Treatment:  Anorexia nervosa is difficult to treat because the victims often deny they have a problem, therefore they will resist any help. Possible psychotherapy, group therapy and counselling for family members may be an option. It is important for sufferers and parents to understand the symptoms and the possible consequences.  The victim must ‘focus on their abilities and resources for independent thinking and express their feelings and needs’.  In some cases hospitalisation may be necessary, and in advance cases force feeding.

Bulimia Nervosa

  • Bulimia nervosa is characterized by the following:

    • Recurrent episodes of binge eating (often high calorie, easy digested food is consumed in a discrete period of time) with a sense of lack of control over eating during the episode

    • Tries to get rid of the food by recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; rigorous dieting or excessive exercise.

    • The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.

  • Individuals with bulimia nervosa are typically ashamed of their eating problems and attempt to conceal their symptoms. Binge eating usually occurs in secrecy.

  • An excessive emphasis is placed on body shape or weight in their self-evaluation, and are extremely important in determining self-esteem.

  • It closely resembles anorexia nervosa in fear of gaining weight, the desire to lose weight, and the level of dissatisfaction with their bodies, but is not always easy to identify.  This is because the sufferer does not lose weight initially.

  • It is more common in girls than boys.

  • Symptoms include severe tooth decay, stomach and intestinal irritation and hair loss; menstrual irregularity often occurs among females; the fluid and electrolyte disturbances resulting from the purging behaviour are sometimes sufficiently severe to constitute medically serious problems including esophageal tears, gastric rupture, cardiac arrhythmias and rectal prolapse.

  • Causes: Bulimia viewpoints seem to be electro-physiological disturbances of brain and depressive disorders. The psychoanalytical explanation is the use of food to satisfy need for love and attention not received from parents. Most bulimics experience cognitive disturbances related to food, weight loss expectations, eating and dieting.  Bulimics do not have information about a balanced diet and have distorted expectations about food and weight. Bulimics are often perfectionists and have feelings of worthlessness and an exaggerated fear of failure.  They believe that loss of weight will lead to acceptance and that people will love them more.  They also seem to have problems expressing their emotions.

  • Treatment for bulimia sufferers follow the cognitive-behavioural therapeutic approaches or individual psychotherapy, dietary and family therapy and counselling.  They are helped control binges and find alternate activities. These include relaxation, sport, and spending time with friends. In some cases, antidepressant drugs may be prescribed.

Both anorexia nervosa and bulimic adolescents suffer from depression, shyness, self-contempt, failure, shame and have suicidal tendencies. Both disorders are as a result of distorted body image and may lead to severe psychological problems.

Written by Debbie Jameson – Clinical Psychologist at FEMINA HEALTH

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