Anorexia Nervosa in Teens

How does anorexia nervosa happen?

This is a question that we at the Columbia Center for Eating Disorders have been pondering (and studying) for decades. It’s a question asked by our patients, and by their very concerned family members.

We know that anorexia nervosa is a serious, complex eating disorder characterized by extreme weight loss (or in some teens, a failure to make expected weight gains) and a fear of gaining weight and/or fat.

But, as you might have guessed, we don’t exactly know the answer to how anorexia nervosa happens.  The answer likely to be as complex as the disorder itself, with no one variable offering a full explanation.

What we know a little bit more about (though still not as much as we’d like!) are risk factors for the development of an eating disorder. One of those risk factors – a risk factor that we all experience on our journey from childhood to adulthood – is the developmental stage of adolescence. The peak age of the first presentation of anorexia nervosa is between 14 and 18 years old.

Why is adolescence a critical period for the development of the disorder?

We can find our answers in biology or the environment and, most likely, in a perfect storm between the two. Adolescence is a time when the body changes. It changes physically in response to hormonal changes. Weight (and fat) gain are essential for proper growth. Adolescence is also a stage marked by a transition from a family-focused existence to a peer-focused universe.

Some adolescents may alter their eating behaviors either in an attempt to address their rapidly changing weight or shape or to fit in with friends who may be spending a lot of time thinking or talking about diet, appearance, or exercise. Some teens lose weight without any particular intent, and in the setting of weight loss, their behavior starts to change. A cycle of restriction and weight loss takes hold.

[Read here for more on signs of disordered eating in children and teens, and here for some tips on how to call it like you see it with your teen if you are concerned.]

With so many questions, we continue to look for answers.

When it comes to adolescents and anorexia nervosa, “parents are always trying to understand what happened,” explains Joanna Steinglass, MD.

So are we.

The National Institute of Mental Health (NIMH) has given us $2.5 million to answer this question.  With the help of NIMH, we have launched a new research study, Longitudinal Assessment of Teens with Anorexia Nervosa, to better understand the development of anorexia nervosa. We are looking at the changes that take place in the brain over time in adolescents with and without anorexia nervosa. By comparing these two groups of teens, we will be able to identify changes in the brain that are specific to the course of anorexia nervosa.

“These are critical questions in the field and will help us understand more about how anorexia nervosa develops,” elaborates Dr. Steinglass, one of two principal investigators of this study. Dr. Steinglass is partnering with, Dr. Jonathan Posner, child and adolescent psychiatrist and co-Principal Investigator. Dr. Posner’s expertise in brain imaging in adolescents will guide this research to address critical questions about the brain activity of adolescents with and without anorexia nervosa as they make decisions about food.

What does participation involve?

Participants in this study complete questionnaires and interviews related to heath, eating, and mood in addition to undergoing an imaging technique called functional Magnetic Resonance Imaging (fMRI for short).  The fMRI is a donut shaped magnet that is used to create a picture of the brain, and to indicate neural activity patterns by measuring a marker of blood flow. One of the advantages of fMRI is that it lets us see what is going on in the brain without using any radiation.  During the scanning, participants are asked to answer questions about food.  Following the brain scan, study participants eat a dinner with us.

To capture changes over time, this study has a longitudinal design. This means that participants complete the procedures three times – at baseline, and then one and two years from the original date of testing.

Why participate?

• For adolescents interested in and eligible for research participation, we are able to provide a variety of treatment options, including but not limited to inpatient treatment, day treatment, and outpatient treatment.
• Research participants – those with eating disorders and those without – also make an incredible contribution to science. Our hope is that if we are able to recognize the brain activity and changes related to anorexia nervosa, this information could lead us closer to understanding the cause of the disorder and help us advance in its treatment. We cannot do our work without you.
• Monetary compensation is available for all participants’ time and scientific contribution.

If you are interested in learning more, please call (646) 774-8066 or email us at edru@nyspi.columbia.edu.

Please note: For this study, we are also enrolling healthy female teens between the ages of 14-18 years old [Learn more about being a control participant here.].

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