Position paper
Eating disorders in adolescents: position paper of the Society for Adolescent Medicine

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Diagnosis

Diagnostic criteria for eating disorders such as those found in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) [7] are not entirely applicable to adolescents [8]. The wide variability in the rate, timing and magnitude of both height and weight gain during normal puberty, the absence of menstrual periods in early puberty along with the unpredictability of menses soon after menarche, limit the application of those formal diagnostic criteria to adolescents. Many

Nutritional disturbances

Nutritional disturbances are a hallmark of eating disorders and are related to the severity, duration, and timing of dysfunctional dietary habits. Significant dietary deficiencies of calcium, vitamin D, folate, vitamin B12 and other minerals are found 18, 36, 37. Inadequate intake of energy (calories), protein, calcium and vitamin D are especially important to identify, since these elements are crucial to growth and attainment of peak bone mass [38]. Moreover, there is evidence that adolescents

Psychosocial and mental health disturbances

Eating disorders that occur during adolescence interfere with adjustment to pubertal development [42] and mastery of developmental tasks necessary to becoming a healthy, functioning adult. Social isolation and family conflicts arise at a time when families and peers are needed to support development 43, 44. Issues related to self-concept, self-esteem, autonomy, and capacity for intimacy should be addressed in a developmentally appropriate and sensitive way 45, 46. Given that adolescents with

Treatment guidelines

Eating disorders are associated with complex biopsychosocial issues that, under ideal circumstances, are best addressed by an interdisciplinary team of medical, nutritional, mental health and nursing professionals who are experienced in the evaluation and treatment of eating disorders and who have expertise in adolescent health [1].

Various levels of care should be available to adolescents with eating disorders (outpatient, intensive outpatient, partial hospitalization, inpatient hospitalization

Barriers to care

Interdisciplinary treatment of established eating disorders can be time-consuming, relatively prolonged and extremely costly. Lack of care or insufficient treatment can result in chronicity with major medical complications, social or psychiatric morbidity and even death. Barriers to care include lack of insurance, coverage with inadequate scope of benefits, low reimbursement rates, and limited access to health care specialists and appropriate interdisciplinary teams with expertise in eating

The Internet and “pro-ana sites”

Approximately 49% of teenagers worldwide, have access to the Internet [82]. Therefore, many teenagers are able to access health information and other resources on the Internet. In addition to accessing reputable sites, adolescents also have access to websites that provide young people with harmful content. Such websites include pro-anorexia (“pro-ana”) and pro-bulimia (“pro-mia”) websites which are devoted to the maintenance, promotion, and support of an eating disorder. The proliferation of

Future research

Several issues deserve further study. Examples include: (a) identification of psychosocial, psychiatric and biological risk factors that are associated with eating disorders in young people; (b) the prevention of eating disorders for adolescents who are at high risk; (c) creation and validation of brief, developmentally-appropriate screening tools for use by primary care providers; (d) new therapeutic modalities for the treatment of osteopenia and osteoporosis in anorexia nervosa (type and

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