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COMMENTARY 

The Effects of Anorexia on Adolescents  
 

Melanie Acosta1,3, Adalyn Coronado1,4, Isabela Elizondo1,2, Mahaa Gondi1,5, Miguel Hernandez1,2, 

Annalisa Martinez1,4, Jaiden Mendoza1,2, Brianna Moreno1,3, Alejandro Reyes1,2, Aliyah 

Rodriguez1,4, Annabella L. Ruiz1,2, Miranda Sifuentes1,3, Vanessa Villegas1,3 

 
1 3rdAnnual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health  

   Institute for Research and Development 
2 McAllen Memorial High School, McAllen, TX 
3 Mission High School, Mission, TX 
4 Rio Hondo High School, Rio Hondo, TX 
5 South Texas ISD Health Professions, Mercedes, TX   

 

Received: August 3, 2023 

Accepted for publication: November 6, 2023 

Published: November 16, 2023

 
 
Introduction 

 
According to Missouri Baptist University 

researchers, in the United States, 95% of the people 

that have an eating disorder are from ages 12 through 

25.1 Eating disorders are a heavily misunderstood 

subject throughout the world. Commonly, many 

people deny the prominence of eating disorders, 

leading to a major effect on adolescents. Due to this, 

many adolescents suffer from this disorder alone and 

without help. In a national statistic reported by the 

National Library of Medicine, it was found that 3-20% 

of all eating disorders lead to death.2 The recognition 

of the causes and effects of eating disorders is 

imperative because the more society understands, 

there will be a greater sense of awareness to help 

prevent the increase of fatal eating disorders. 

 

What is Anorexia?   

 
Anorexia nervosa, or anorexia is typically 

defined as the neurotic loss of appetite.3 Anorexia, in 

other words, is a mental disorder that leads an 

individual to constantly think about their weight and 

body shape from a negative perception created through 

the patient’s brain.4 Anorexia, in some cases, is known 

to stem from small habits and evolves into a larger 

issue, eventually leading to several risk factors which 

affect a patient’s quality of life. In critical cases, 

anorexia nervosa may lead to hospitalization, a variety 

of health issues, and even death. Anorexia is  

 

acknowledged to have the highest death rate compared 

to other mental disorders.5 Anorexia is also commonly 

known for permanently affecting a patient’s brain 

negatively, in most cases, for the rest of their lives. 

Anorexia is not usually spoken about socially, as 

patients with anorexia will not speak about their 

illness, especially if they are aware of the issue.  

 

Diagnosis 

 
 Currently, the most reliable method of 

diagnosis for anorexia patients is The Diagnostic and 

Statistical Manual of Mental Health Disorders, 5th 

edition (DSM-5TR). The DSM-5TR is the most recent 

and relevant publication for diagnosis which covers 

anorexia symptoms in detail and variety, as anorexia 

symptoms vary from person to person. A patient must 

fit the three main criteria according to the DSM-5-TR 

for anorexia to be diagnosed: Restriction, Fear, and 

Lack of Recognition.6 Restriction is shown through a 

patient’s habit of restricting calorie intake, based on 

the individual’s body mass index (BMI). Fear is 

presented in an individual’s mental perception of body 

weight. Lack of Recognition is exhibited through the 

development of body dysmorphia, leading to a warped 

perception of the severity of their circumstances.7  

 

Symptoms 
 

Anorexia is an illness that begins 

psychologically and progresses to various physical 



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components. Common physical and psychological 

symptoms of anorexia include but are not limited to, 

frequent headaches, dizziness, anemia, loss of muscle 

mass, irritability, excessive hair loss, loss of a 

woman’s menstrual cycle, constipation, fatigue, 

nausea, and lanugo.8 

 

Medical Complications  
  

Anorexia is commonly conceptualized as 

being connected to other mental and physical 

disorders, many of which come as a future result of 

malnutrition and a consequence of insufficient vitamin 

and mineral intake. Anorexia is known to affect 

adolescence the most in the long term, as several 

organs in the body are affected through future growth 

and development.9 With time, anorexia is known for 

causing other medical problems such as anemia, 

muscle weakness, infertility, osteoporosis, damage to 

the heart, damage to the brain, and multi-organ 

failure.10 Since the human body develops the most 

during adolescence, anorexia is known for delaying 

puberty. In females, anorexia permanently affects 

fertility, as hormones and nutrients necessary for 

growth and development are not available. Other 

minor medical complications that may arise from 

long-term anorexia in adolescence are carotenoderma, 

hyperpigmentation, excessive acne, dermatitis, 

paronychia, and striae distensae.11 Psychologically, 

many comorbid disorders arise as a result of anorexia. 

Mood disorders are the most common comorbid 

disorders of anorexia nervosa at 60.4%. Many mood 

disorders which arise from anorexia include 

depression, general anxiety, personality disorders, and 

many phobias which correlate to eating or weight 

gain.12  

 

Prevalence 

 
Due to social and psychological factors, 2.7% 

of adolescents are diagnosed with anorexia nervosa 

with lifetime prevalence of 0.3%.13,14 According to 

Newport Academy, anorexia is most prevalent in 

teenagers than adults and children. Adolescence is a 

common time for the onset of anorexia nervosa. 

Though social media was created to be a place for 

joyful communication and memories, many teens from 

the ages of 13-18 have admitted to being socially 

influenced.15 As a result, media influence has 

increased low self-esteem, stress, and anxiety, making 

it the largest risk range for those who have anorexia. 

The widespread use of social media, such as Tumblr 

or Instagram, can give adolescents an unrealistic view 

of their bodies and lead to eating disorders such as 

anorexia to fit that view. With women and teen girls 

being more commonly diagnosed with anorexia, it is 

crucial to remember that females are not the only ones. 

According to Newport Academy, 10% of teenage 

males are diagnosed with anorexia.16 Factors like 

shame, denial, or a lack of knowledge about the 

severity of their problem, have many adolescents 

going untreated or choosing not to seek treatment. 

 

Neurobiological Aspects of Anorexia  

 

Cognitive and Physiological Background 
 

Anorexia nervosa alters the way one discerns 

food. For instance, a study using magnetic resonance 

imaging on female patients with acute anorexia 

alongside patients without anorexia found that when 

patients were shown photos of high-caloric drinks, the 

hippocampus and the left amygdala of the brain 

exhibited signs of activity.17 Other studies show 

increased activation of both the left and right 

amygdala.18 The left amygdala is associated with 

sustained and verbal emotions, while the right 

amygdala is associated with dynamic and visual 

emotions, and the hippocampus plays a vital role in 

memory and learning. The response displayed by the 

patients with anorexia was the same as that of 

individuals who had an aversion to a phobia, in 

contrast to patients who were healthy and expressed 

delight or neutrality.19 Many functional magnetic 

resonance imaging studies found that because of a lack 

of nutrition, patients with anorexia also had decreased 

gray and white brain matter.20 These fMRI studies also 

show that the disorder alters the brain activity in the 

cingulate cortex which is responsible for linking 

reward and punishment information.  

 

Limbic and cognitive pathways have been 

highlighted in research for structural and functional 

differences in someone who has anorexia inclusive of 

neurochemical changes. According to other studies, 

there have been abnormalities in the orbitofrontal 

cortex. Its function is to signal when to stop eating, 

while the dorsal striatum controls habitual behaviors. 

The altering of the right insula controls and alters your 

perception of taste.21 Utilizing neuroimaging, 

researchers and scientists have found that there is a 

change in gray matter volume and cortical thickness 

within the brain. These results show us that restricting 

food intake does affect brain structure and function.22  

 

The Brain’s Reward Systems and How They 

Come into Play in Neurochemistry 
 

According to the National Association of 

Anorexia Nervosa and Associated Disorders, when 



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dopamine is released from the dorsal striatum of an 

anorexic person, it causes anxiety instead of 

satisfaction or pleasure.23 For example, an individual 

without anorexia may eat a serving of cake and will be 

motivated by dopamine to have a second serving. 

However, in the mind of someone with anorexia 

nervosa, the motivation given by dopamine forgoes its 

function. In the mind of an individual with anorexia, 

the process of eating is broken down, making it 

difficult to understand the reward processing and how 

to learn from the rewards.24 Due to this, patients 

become highly sensitive to punishment.  

 

 A study done based on animal models 

showed that there are projections from the 

hypothalamus to the nucleus accumbens (NAc).25 The 

NAc indicates reward in conducting natural behaviors 

such as sex, exercise, and in particular, feeding. As 

shown in Fig. 1, there are neural pathways specific to 

eating disorders. NAc is involved in mediating 

emotion and motivation. The mesolimbic system 

transports dopamine to the NAc and is involved in 

pleasurable sensations. It is also a location for 

endogenous opioids to module dopamine (DA) release 

and orosensory—relating to oral innervation—reward 

process.26 Serotonin (5-HT) also plays a big role in 

feeding behavior, being related to your satiety. In 

conclusion, behavioral neuroscience suggests that 

there is dysregulation of the reward systems in your 

neurotransmitters shown by studies utilizing people 

who have eating disorders such as anorexia nervosa.27 

 

 

Dopamine (blue), serotonin (green), acetylcholine 

(red) and opioids (orange) have each been indicated 

in disordered eating. This schematic illustrates 

some of the neuronal projections that research 

indicates are of particular interest in the 

regulation.28 

 

 

 

Cultural Influences  

 

Western Culture  
Western culture tends to glorify small and 

slim bodies. The prevalence of obesity and being 

overweight, despite affecting a majority of the 

population, remains stigmatized. The origin of this 

unknown bias has caused many adolescents to develop 

problems such as body dysmorphia and internalized 

societal expectations. Especially within social media, 

the unrealistic bodies depicted cause many to engage 

in dieting and weight loss to conform to societal 

expectations.29 Western culture tends to associate 

slimness with power and self-discipline, compared to 

other cultures like the Samoan culture which 

emphasizes the importance of nutrition and eating a 

variety of foods.  

 

Asian Culture   
 

Asian culture is collectivistic, meaning that 

group autonomy is underscored while individual 

autonomy is not the community’s main priority. For 

this reason, pressure is set on individuals to fit into 

cultural and societal norms. Another idea that Asian 

culture emphasizes is the idea of 'filial piety’, which is 

having an immense amount of respect for elders, 

which may create pressure on individuals to conform 

to societal norms, including body image standards. For 

example, in Thailand, various stores for plus-sized 

individuals are called “Moo Moo” and “Love 

Calories”, in an effort to degrade them.30 

 

Diet Culture  
 

Diet culture is a way of life that groups 

unhealthy foods with fatness and healthy foods with 

thinness. Individuals who follow diet culture tend to 

comment on others' weight loss and thinness, while 

also bashing those who eat unhealthy or maybe are 

overweight. Many who follow diet culture are fearful 

of weight gain and look down on gaining weight. Diet 

culture is not just that, diet culture also instills fear in 

others of weight gain, one of the diagnostic criteria for 

anorexia.31  

 

Diet Culture: An Early Beginning 
 

During the 19th century, also known as the 

Victorian Era, diet culture began to take a prominent 

role in society. This era saw rises in many young 

women's restrictive patterns mostly due to the 

emergence of many obsessions with achieving an 

hourglass silhouette.32 During this era, many ate small 

portions of bland food while avoiding more indulgent 



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dishes. Corsets also reinforced eating smaller portions 

and having a perfect body. There was immense 

pressure, mentally and physically, to conform to 

societal standards, which in turn caused these 

individuals to suffer from malnutrition and eating 

disorders. 

 

Diet Culture: 20th Century  
 

The 20th century marked a turning point in 

the history of diet culture. With the rise of mass media, 

beauty standards became heavily influenced by 

Hollywood films and advertisements. Slim figures 

were idealized and equated with success and 

desirability. This led to the emergence of countless 

diet products, programs, and fads promising quick 

weight loss and a perfect silhouette.33  

 

Diet Culture: 21st Century 
 

The 21st century has undergone immense 

industrialization and many other changes. One of the 

main factors contributing to the rise of dieting and 

eating disorders today is the availability of information 

via technology.34 Adolescents today have easy access 

and are exposed to a wealth of online resources that 

claim to provide advice on weight loss and "perfect" 

body ideals. Many times, this information is 

misleading, contributing to distorted body image 

perceptions and promoting unhealthy habits. 

 

Social Influences 

 
Many individuals on the social media app 

called “TikTok” have gone out of their way to create 

pro-anorexia accounts, where information about 

weight loss and weight loss methods are shared and 

encouraged. These accounts, often called “pro-ana” or 

“Mia” accounts, can be dangerous. They can be 

viewed or interacted with, whereby the app's algorithm 

will continue to advertise these videos to adolescents. 

This may influence adolescents to engage in 

disordered eating or develop body image issues. For 

this reason, about 81% of 10-year-olds are afraid of 

being fat.35 Predisposing adolescents to this sort of 

behavior could later manifest into a greater fear of 

gaining weight, and exposing them to disordered 

eating.  

 

Via their TV show “Keeping Up with the 

Kardashians” and social media apps such as 

Instagram, the Kardashian family has been able to 

influence others into striving to look like them, despite 

their family having undergone a variety of surgical 

procedures. Their social media platforms and reality 

TV shows showcase their glamorous lifestyles, which 

often include a consistent emphasis on their body sizes 

and appearances. Adolescents, who are in a vulnerable 

period of self-discovery, tend to be heavily influenced 

by these unrealistic beauty standards promoted by 

Kardashian influencers. One element that the 

Kardashian family has gone under scrutiny for is 

photoshopping on Instagram. On several occasions the 

family has been caught using FaceTune to shrink their 

waists, make their lips bigger, widen their hips, and 

then lying about editing their photos, causing their 

viewers to want to reach an unrealistic body image. 

Along with their photo editing, the family has denied 

their use of Botox and other procedures which further 

make their viewers believe that their bodies are 

somehow achievable through natural remedies. Other 

influencers like Gigi and Bella Hadid are idolized for 

their slender physique, further glorifying the concept 

of being skinny.  Designers like Karl Lagerfeld and 

fashion magazines like Vogue have indirectly 

contributed to this culture by showcasing 

predominantly slim figures. This can be detrimental 

especially since 69% of girls in 5th-12th grade 

reported that magazine pictures influenced their idea 

of a perfect body shape”.36 The fashion industry has 

long been known for promoting thinness as the ideal 

body type, using underweight models in runway 

shows and advertising campaigns. Playboy magazine, 

a very influential magazine, has also been known to 

hire underweight models. According to the National 

Institute of Health, 75% of these women were less than 

85% of their ideal body weight.37 These social 

influences may be a cause and the reason why 

adolescents engage in risky behavior to reach an 

unrealistic body standard.  
 

Management and Treatments  
 

Patients with anorexia only recognize the 

disorder when the mental illness is dangerous or life-

threatening, therefore it is strongly emphasized that 

the illness should be caught in the early stages. 

Management and treatments for anorexia range from 

physiological therapy to hospitalization.38   

 

Typical treatments for eating disorders such 

as anorexia consist of different types of therapy, 

education on the disorder, and medication. Some of 

the different types of therapies include cognitive 

behavioral therapy, family-based therapy, and 

psychotherapy.39 These different types of therapies 

focus on the patient's mental as well as physical well-

being. For instance, cognitive behavioral therapy is a 

type of psychotherapy focusing on the mental health 

of the patient. It focuses on the patient's behaviors, 



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thoughts, and feelings related to their eating disorder.40 

After helping the patient change their eating habits, 

cognitive behavioral therapy helps the patient 

acknowledge and adjust the twisted thoughts that 

originally led to developing anorexia.41 Education and 

awareness are also important elements to help address 

anorexia. One way the patient or a family member 

could educate themselves is to research different ways 

to manage it. A few techniques they could implement 

to help manage anorexia involve nutritional 

management, terminating purging behaviors, and 

seeking professional help from dietitians.42 With the 

help of professional dietitians, the patient can work on 

both nutritional management and putting a stop to 

purging behaviors.43 Professional dietitians help by 

providing counsel to help patients with their eating 

behaviors. They accomplish this by providing 

individualized meal plans and suggestions on different 

meals that the patient could start with, as they begin 

their “healing” and improvement journey.  

 

Even though there are no notable medications 

that could “fix’’ anorexia, there are a variety of 

therapies that can help treat as well as manage those 

who are diagnosed with anorexia. For instance, in 

older generations, doctors used a variety of different 

methods/therapies that they claimed would help their 

patients. Unfortunately, most of these methods ended 

up affecting the patients even more, and would 

sometimes even lead to their deaths. Some of the 

therapies that specialists used to use include 

parentectomy, lobotomies, shock therapy, and 

neuromodulation. Parentectomy is the removal of the 

parents from the teen's life in order to check for any 

improvement in their physical and mental health. By 

withdrawing the parents from the teen’s life the 

specialists hoped that the patients would improve 

mentally and begin eating more. Lobotomy 

therapy/Lobotomy is a procedure in which specialists 

split the white fibers of the frontal lobes to stop 

illnesses and make them go away.44 Lobotomies have 

caused many controversies throughout the years and 

have been widely considered to be one of the craziest 

procedures one could get back then to try to fix their 

mental illnesses. It is well known that anorexia was 

sometimes dealt with by lobotomies. However, it is 

also known that lobotomies didn’t have the best 

effects. Most of the time, lobotomies didn’t work and 

would have serious consequences on the individual's 

intellect and personality.45  

 

Shock therapy was also a common way to 

deal with mental and physical illnesses such as 

anorexia. Shock therapy is the use of 

electroconvulsive therapy to improve severe mental 

issues and their symptoms.46 Shock therapy was well 

known for providing rapid relief and improvements of 

some serious and severe mental conditions.47 It was 

also known that, although not typically used to treat 

anorexia, in some cases it helped “fix’’ it. Finally, 

unlike the previous methods and therapies, 

neuromodulation was one of the least common 

practices used to treat anorexia and it was typically 

only used in hard-to-treat cases.48 Neuromodulation is 

a procedure done by altering nerve activity through 

targeted stimuli such as shock stimulation or by the use 

of chemical agents.49 Although sometimes not 

successful, it would typically alter the brain in a way 

that the patient's depressive and anxiety symptoms 

were long gone. After the procedures, it was also 

observed that with time, the patient's weight was 

restored up to 20%. 

 

The treatments used today are family-based 

therapy and Psychotherapy. Family-based therapy is 

when family members help the patient learn healthy 

eating habits until the patient can get to a healthy state 

in their weight and get rid of the unhealthy habits.50 

The parents also help the child by controlling the 

patient's diet and what they need to eat and help them 

listen to their body and get them the nutrients they 

need. Psychotherapy is a form of therapy that helps the 

patient recognize the problem and helps control the 

patient's emotions and feelings.51 This therapy helps 

anorexic patients learn about themselves and 

understand why it happens. They do this to help 

overcome challenges in the patient's daily life. This 

helps people become more confident in themselves 

and can help the patient get better.52 

 

Conclusion 
 

The causes and effects of anorexia have a 

significant on society, specifically among adolescents. 

It is crucial to spread awareness of this disorder across 

America to prevent more adolescents from falling into 

the trap of a false reality that will cause horrible 

consequences. Fortunately, in recent years, there has 

been an emergence of new uses for existing 

medications such as olanzapine, traditionally used to 

manage schizophrenia. This research has 

demonstrated a potential to help manage symptoms of 

anorexia including an association with BMI increase 

and better sleep quality.15 This new research has 

caused promising results in the treatment of anorexia 

which can be a big breakthrough in the management 

of this disorder. 

 

 

 

 



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Acknowledgements 

 
Monica Betancourt-Garcia, MD, Program Director; 

Melissa Eddy, MS, Program Manager  

 

 

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; 

Region One ESC PATHS; Region One ESC Upward   

Bound Math & Science; Benavides ISD; and Jubilee 

Academy-Brownsville 

 

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