




































Special Edition: Junior Clinical Research (2022), Vol. 2 No. S2 
 https://doi.org/10.47488/dhrp.v2iS2.69 

 

 
 

 
DHR Proceedings ǀ http://dhrproceedings.org 93 2022, Vol. 2 No. S2 93--99 

 

COMMENTARY 

Eating Disorders in Adolescence 

 

Anevaeh Escamilla 1,2, Francis Herrera 1,2, Nevaeh Areli Serna 1,2,  Yeikol Chapa 1,3,  

Jasmin Perez 1,3,  Monseratt Ramos 1,3, Angela Anguiano 1,4, Issac Banda 1,4, Arleen Garcia 1,4 

 

 

12nd Annual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health 

Institute for Research & Development 
2Hebbronville High School, Hebbronville, TX 
3J.W. Nixon High School, Laredo, TX 
4Progreso Early College High School, Progreso, TX 

All correspondence should be addressed to Program Director, 2nd Annual Junior Clinical Research Internship Program, DHR 

Health Institute for Research & Development, 5323 S McColl Road, Edinburg, Texas, 78539 

Received 08/04/2022 

Accepted for publication 08/15/2022 

Published 08/15/2022

 
  

Introduction 

Adolescent eating disorders are on the rise, 

and this silent pandemic could be particularly 

alarming. Eating disorders are severe, potentially fatal 

illnesses that affect people of all ages, particularly 

affecting adolescents' physical and psychological 

development (1). Eating disorders affect people of all 

genders and racial and ethnic backgrounds and are 

recognized to have the highest mortality risk of all 

mental health illnesses. Estimates indicate that 

approximately 30 million people in the United States 

suffer from an eating disorder. About 95 percent of the 

patients suffering from an eating disorder are between 

the ages of 12 to 25 (2). 

Genetics, social, and psychological factors 

contribute to the risk of developing an eating disorder. 

Some examples include the role of social media, 

inheritable conditions, and/or other mental illnesses. 

However, it's essential to realize that eating disorders 

involve more than just food and weight. Eating 

disorders are characterized by secrecy and denial (3), 

so patients frequently conceal or falsely describe their 

symptoms out of shame or guilt. Because mental 

health care is one of the most crucial components of  

 

rehabilitation, it is vital to understand eating disorders. 

If untreated, eating disorders can have serious adverse 

health effects such as organ failure or death. 

 Types of Eating Disorders 

Eating disorders are different types of 

psychological illnesses that affect eating habits in 

adolescents that are severely harmful (4). There are 

various conditions in eating disorders, but only a few 

are most common in adolescents, such as Anorexia 

Nervosa, Bulimia Nervosa, Binge eating disorder, 

Rumination disorder, and lastly, Avoidant/Restrictive 

food intake disorder. 

         Anorexia Nervosa carries one of the highest 

mortality rates in adolescent psychiatric illnesses (5). 

Anorexia is a condition that causes restricted oral 

intake and consequent low body weight. With this 

illness, people tend to see themselves as overweight 

despite being severely underweight. This illness can 

also cause individuals to restrict their calorie intake 

and hyper-fixate their weight. 

Bulimia Nervosa is an illness that causes 

binge eating for a period of time that will apply gut 



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discomfort. Individuals with Bulimia disorder often 

force themselves to throw up after excessive food 

intake (6). 

Binge eating disorder is commonly found in 

adolescents. This disorder causes an individual to eat 

excessively, but unlike bulimia, they do not purge (7). 

Individuals with this eating disorder do not take note 

of their calorie intake and continue to eat food when 

they are uncomfortably full. Purging can cause a 

feeling of lack of control and guilt.   

Rumination disorder is one of the newest 

discovered food disorders that cause individuals to 

regurgitate food they have previously chewed and 

swallowed, re-chew it, and then re-swallow it or spit it 

out. This illness can cause regurgitation shortly after 

meal ingestion (8). Rumination disorder occurs most 

commonly in adolescents. 

Avoidant/Restrictive food disorder is most 

commonly found in young adolescents that causes 

individuals to refuse to intake nutritional foods leading 

to low weight and dependence on supplemental 

feedings (9). Individuals with this disorder are 

disturbed by foods due to a lack of interest in eating or 

a distaste for specific smells, tastes, colors, and more.  

Prevalence in Adolescents 

Eating disorders can begin at any age; 

however, if left untreated, eating disorders may last for 

many years. Eating disorders in the United States are 

prevalent because of environmental factors, which 

include events and influences in an individual's life, 

such as diet, culture, media, trauma, and social 

influences (10). Approximately 2.7% of adolescents 

are affected by an eating disorder in the United States 

(11).  

Females are more commonly diagnosed 

compared to males to have a diagnosis of anorexia 

nervosa or bulimia nervosa and being underweight. 

Binge eating is more common in males than females, 

and they are more likely to get diagnosed. Females are 

more likely to report weight dissatisfaction, dieting for 

weight control, and use of purging but are either as 

likely as males to report binge eating or excessive 

exercise for weight control (12). Caucasians have a 

higher lifelong prevalence of eating disorders, 

particularly anorexia nervosa, bulimia nervosa, and 

binge eating disorder, compared to other ethnic groups 

(13). Hispanics have elevated rates of any binge eating 

disorder but low prevalence of anorexia nervosa and 

bulimia nervosa (14). 

Eating disorders are more common in lower 

socioeconomic status groups as they report having 

higher rates of disordered eating behavior, including 

vomiting, use of diet pills, diuretics, or laxatives as a 

means to lose weight (15). 

 Epidemiology and Risk Factors 

Factors that contribute to eating disorders can 

be genetic, social, or psychological. Eating disorders, 

especially non-specific ones, are common during 

childhood and adolescence. Such diseases were 

attributed mainly to the family environment and 

exposure to the media (16). Social and family 

environments are the most critical risk factors for 

eating disorders (16). Family environments and meal 

times appeared to be fundamental in shaping eating 

behaviors and the development of diseases. The media 

and social environment have been related to the 

worship of thinness. Additionally, eating disorders can 

be associated with nutritional problems, including 

malnourishment and disfigurement (16).   

Genetic Factors 

   Genetics can be a family history, and chemical 

imbalance narrates starvation and temperament traits. 

Genetics are 40-50% of the risks of developing an 

eating disorder (17). For example, a child born to a 

mother with anorexia nervosa is 12% more likely to 

develop this eating disorder (17). 

Health Risks 

 Patients with anorexia have related cardiac 

issues that result in one-third of deaths (18). Cardiac 

complications that occur among people with anorexia 

include bradycardia and hypotension. Anorexia and 

bulimia are at greater risk for heart failure. The 

heartbeat of an individual with this disorder can be 

slower or faster than the regular heartbeat. 

    Up to 50% of people with a Binge eating 

disorder (BED) have obesity (18). Obesity increases 

the risks of heart disease, stroke, type 2 diabetes, and 

cancer. Studies have found that people with BED have 

an even greater risk of developing health problems like 

sleep problems, chronic pain conditions, asthma, and 

irritable bowel syndrome (18). 



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Effects on the Body 

Anorexia Nervosa 

Many women have many complications, but 

there is a history of eating disorders when trying to get 

pregnant later in the future. They will likely bleed 

during pregnancy, have a miscarriage, preterm birth, 

or induced abortion. It was proven with evidence that 

women with eating disorders or a history of eating 

disorders are more commonly known to have used 

hormonal birth control and to be moderate heavy 

smokers. These effects become severe for any woman 

trying to get pregnant after having problems with any 

associated eating disorder (19). Another complication 

with anorexia nervosa is alterations of the gut 

microbiome. Medical complications in the human 

body due to anorexia nervosa usually occur due to 

starvation and malnutrition, for example, sodium 

depletion, hypovolemia, hypophosphatemia, and 

hypomagnesemia (20). These disorders can also result 

in gastrointestinal complications, including gastric 

dilations and severe liver dysfunction. They are also at 

high risk of various arrhythmias. Underweight patients 

are at risk of osteoporosis (21). Anorexia also affects 

the body in four cardiovascular domains: structural, 

repolarization, conduction, hemodynamic, and 

peripheral vascular (22). 

Bulimia Nervosa 

Bulimia nervosa causes the patient to overeat, and 

when binge eating, you can get diseases because your 

body can't handle the amount of food. These diseases 

include diabetes. Diabetic patients are at high risk for 

hyperglycemia, ketoacidosis, and premature 

microvascular complications. Patients with Bulimia 

Nervosa who vomit daily cause electrolyte aberrations 

from this. Bulimia Nervosa also increases the risk of 

cardiovascular diseases, including ischemic heart 

disease and death in females. Effects that come to the 

patient from vomiting are trauma to the oral mucosa 

and pharynx and dental erosions. The parotid glands 

are also affected, and they develop sialadenosis. While 

the patient is vomiting increases intrathoracic and 

intra-alveolar pressures, leading to 

pneumomediastinum. Excessive purging exposes the 

esophagus to gastric acid and damages the opening to 

the stomach. (23). 

Binge Eating 

The clinical importance of BED is related to 

its comorbidity with obesity and complications of 

being overweight. BED also comes with psychiatric 

symptoms like depression and anxiety, with concerns 

about one's image and weight. BED patients show 

relevant alexithymia and are deficient in emotional 

identification. Eating impulsiveness has been related 

to more significant physical discomfort and worse 

quality of life. Overeating can also lead to many health 

disorders such as diabetes, obesity, high blood 

pressure, high cholesterol, and heart problems (24). 

Rumination Disorder 

Rumination can cause mental and physical 

distress to the patient causing problems with how they 

view life. This disorder also results in significant 

weight loss, especially in adolescents. More in-depth 

electrolyte disturbances and dental damages occur. 

These problems have been commonly found in 

patients diagnosed with rumination disorder. Another 

common thing that develops with this disorder is 

anxiety, depression, and somatization (25). 

 Avoidant/Restrictive food disorder 

Most patients with this eating disorder have 

neurological or gastroenterological disorders. They 

diagnose this when a child fails to meet their 

nutritional needs leading to significant weight loss. 

The comorbidities of restrictive food disorder are 

autism spectrum disorder, cognitive impairment, and 

intellectual disability (26). 

Mental Health 

Body Dysmorphia 

People with BDD have some compulsive 

behaviors, such as combing their hair in a specific 

way. These behaviors are typically hard to control or 

resist. Patients with BDD are also associated with 

feelings and guilt and shame, causing them to have 

high rates of suicidal ideation and suicidal attempts 

(27). 

Many patients don't acknowledge that there's 

help for them, such as effective treatment and therapy. 

They will hide and/or misrepresent their symptoms out 

of guilt or embarrassment. Unfortunately, patients 

often have difficulty with intimate relationships and 

social functions, but it's not only that they also have 

academic or occupational problems. BDD is 

associated with biological, psychological, and 

environmental factors. Usually, BDD develops with 

past traumas such as abuse and violence; patients are 

more likely to have flashbacks that make them recall 

their pain very clearly. BDD patients took a survey, 



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and 68% suffer from emotional neglect, 56% suffer 

from emotional abuse, 33.3% suffer from physical 

neglect, 34.7% suffer from physical abuse, and 28% 

from sexual abuse. These results show the 

understanding that BDD patients have been associated 

with a low-quality life and an increase in suicidality 

(27). 

 Social Media Effect on Eating Disorders 

EDs have one of the highest medical 

complication rates among disorders and put 

adolescents at increased risk for many physical 

problems. EDs often happen when you're an 

adolescent; intervening is crucial to the outcome, 

especially during youth development. By age 6, girls 

are exposing concerns about their shape and weight. 

However, teens are unlikely to seek treatment and ask 

for help with their EDs for countless reasons but 

mainly fearing what their parents might say when they 

disclose their symptoms or not being ready for 

personal treatment. Only about 20% of adolescents 

seek professional help putting those who haven't at 

more risk of progressing illnesses and poorer 

outcomes (28). 

Research shows teens engaging with social 

media idealize thinness and are more likely to suffer 

from eating disorders or body image concerns; social 

media plays a crucial role in these concerns. 97% of 

adolescent’s report using at least one social media 

such as YouTube, Instagram, Snapchat, FaceBook, 

Twitter, Tumblr, or Reddit. In addition, 95% of 

adolescents own or have access to a smartphone daily 

(28). 

One study found that about 52% of girls and 

45% of boys often skip meals, do heavy exercises, and 

other behaviors associated with eating disorders. Of all 

participants, 75% of girls and 70% of boys were found 

to have at least one social media account, with 

Instagram being the most common. (29) 

Suicidality 

Suicidal attempts and death caused by suicide are 

common in EDs. An estimate of suicide attempts 

ranges broadly from 3.0% to 40%. Data from an 

epidemiologic survey shows that higher prevalence of 

lifetime suicide attempts, especially in people with 

anorexia nervosa binge eating, followed by 31.4% for 

bulimia, 22.9% for binge eating disorder, and 15.7% 

for AN restricting type (30). 

The national US epidemiologic survey states between 

17% - 45% reported a suicide attempt before the onset 

of their EDs. Some possible co-occurrences are 

disorders such as depression, bipolar disorder, 

substance abuse, psychological and personality traits, 

self-image, early cognitive schema, interceptive 

deficits, alexithymia, and impulsivity (30). 

Obsessive Compulsive Disorder 

Research shows that 14-30% of patients with 

eating disorders tie in with obsessive-compulsive traits 

and obsessive-compulsive personality disorder. OCD 

is frequently comorbid with EDs, with 20-60% of 

patients with EDs having a lifetime history of having 

OCD; OCD can also predict future development with 

anorexia. OCD rates are higher for females with 7-

18% and 0%-5% for male patients; the patients 

included in those percentages have or had an ED (31). 

 Treatment 

Eating disorder treatment depends on your 

disorder and symptoms. It combines psychological 

therapy, medical monitoring, nutrition education, self-

help, partial hospital, intensive outpatient, and 

medication therapy (32). 

 Medications  

The most common medications used to treat 

eating disorders are Antidepressants. Antidepressants 

may be beneficial if you have bulimia or a binge eating 

disorder. It can also help reduce symptoms of anxiety 

or depression, which are seen in those with eating 

disorders. You could need to take medication for 

physical health problems caused by the eating disorder 

(32). 

Behavioral Therapy 

Eating disorder treatments also involve 

addressing other health problems caused by an eating 

disorder which can be consequential or even life-

threatening if they go untreated for too long. Suppose 

an eating disorder doesn't improve with quality 

treatment or causes health problems. In that case, you 

may need hospitalization, an inpatient program, and 

organized eating disorder treatment to maintain your 

physical and mental health and return to a healthy 

weight (33). 

Whether you start by seeing your primary 

care practitioner or some type of mental health 



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professional, you'll likely benefit from a referral to a 

team of professionals who concentrate on eating 

disorder treatment. Members of your treatment team 

may include A mental health professional, A 

registered dietitian, a medical or dental specialist, your 

partner, your parents, or other family members (34). 

Managing an eating disorder can be a long-

term challenge. You would perhaps need to regularly 

see members of your treatment team, even if you’re 

eating disorder and related health problems are under 

control (34).       

Prognosis 

An eating disorder, Anorexia Nervosa, can be 

a deadly disease during adolescence and is and has the 

highest fatality rate of all psychiatric conditions (5). 

Treatment for adolescents can be complex and has 

limited treatment options. Doctors' training in caring 

for people with eating disorders and their practical 

experience with underweight adolescents varies. The 

earlier the treatment, the higher the chances of 

recovery (1). By the end of treatment, most patients 

are within the normal weight range. An overview of 

the presentation and treatment of anorexia nervosa in 

adolescents is provided in this study, with a focus on 

the evaluation and management of physical health 

hazards, such as refeeding syndrome. Some 

researchers have found that approximately 70% of 

adolescents recover better than adults (35). However, 

recovery is a life-long process, and therapy should 

remain an ongoing recovery due to the fact that some 

habits may resurface again, like perfectionism. It has 

been estimated that 50% of patients have a full 

recovery, 30% improve, and 20% remain chronically 

ill (5). 

 Conclusion 

  It is crucial that people do not underestimate 

eating disorders and their impacts as a result. Eating 

disorders, ED, are extremely serious, even fatal, 

diseases. Each person who is impacted by an ED 

experiences it differently, and each person's recovery 

is unique. Furthermore, it is not uncommon for people 

to go through extensive periods of therapy due to 

setbacks or a relapse. Adolescents are more likely to 

recover than adults that have been dealing with an ED 

for years.  Although it is never too late to get help, 

getting help as soon as you are diagnosed is best for 

your physical and mental health. There is so much that 

can be done for these individuals who suffer. One such 

action we can take to prevent eating disorders is to 

educate parents and those who are around adolescents.  

Acknowledgments 

 

Dr. Monica Betancourt-Garcia, MD, Scientific 

Director; Melissa Eddie, MS, Program Manager; 

Xochitl Lopez, BS, Program Coordinator 

 

Funding 

Funded by DHR Health Institute for Research & 

Development; DHR Health; Region One ESC 

GEARUP College Ready, Career Set!; Region One 

ESC GEARUP College Now, Career Connected and 

Region One ESC PATHS 

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