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Thursday, May 17, 2007

Healthy or orthorexic? The new battle for teenage girls

Western societies obsession with everything thin and beautiful is frequently questioned in regards to the long-term effect this has on body image, self-esteem and the prevalence of eating disorders, particularly in the teenage population.

Teenage girls, for a myriad of reasons are a group of the population at particularly high risk in the high-pressured world in which they spend their adolescent years. Television, popular magazines and “My space” websites, are filled with stunning images of twelve going on thirty year old girls, pouting and posing with their lithe body’s wrapped in minute pieces of material, showing of the stunning physiques that bless us all during these brief few years.

While most will emerge from this period, strong and unscathed, for the vulnerable few who collapse under the pressure of this time, clinical disorders including depression and eating disorders become increasing common, potentially ruining young lives before they have even begun. The classification for clinical disorders is clearly defined in the DSM IV- the official manual used by the American Psychological Society to classify psychological disorders but as for any scientific definitions, there are outliers, and this is the case with an increasingly commonly seen condition in teenage girls – orthorexia.

Orthorexia was first described by an American doctor in the late 1990’s, who was seeing an increasing number of female patients who were exhibiting a number of eating disorder related symptoms including eating only an extremely limited food variety, and maintaining an extremely low body weight without satisfying the criteria for a clinical eating disorder. These girls were obsessed with only consuming foods that were “pure” and “healthy”, and as a result tended to consume only extremely low calorie, unprocessed foods, which in turn kept their body weight extremely low.

Unlike sufferers of a clinical eating disorder, these girls were not malnourished, as their diets were packed full of nutritious food choices, but in many cases their mood state was low either a result of a low food intake or a result of other stressors in their lives such as school issues caused by a clinical depression.

Orthorexia has been referred to less in the Australian scientific literature, with brief mentions in the lay media only but clinically over the past twelve months I have seen four teenage girls who too have presented in private practice with such symptoms. All cases have been teenagers between the ages of fourteen to sixteen, from middle class family backgrounds attending good schools. All girls have been classified as “very intelligent” but struggle socially with the pressures only teenage girls experience from peers - the lure of boys, the pressure to achieve at school and to look good. A trigger, either family distress or negative interaction at school appears to be a common link with all cases, leading to depressed mood and the desire to be in control of as many other variables in their life as they can, such as their food intake and the way they feel about their body.

From a clinician’s perspective, this is a challenging situation. The girls are underweight but not “unhealthy” and their eating patterns are disturbed, without being clinically disordered. Blood biochemistry can be checked for signs of physiological distress but in most causes, return within normal ranges as food or supplement intake, although minimal keeps the girls within normal biochemical ranges.

Maintaining an optimal baseline nutrient intake by ensuring adequate intake of core food groups including dairy, meat, oily fish and nuts is a positive initial step with these cases to ensure that the key nutrients; calcium, iron, zinc, protein and unsaturated fat are adequate.

Secondly, exploring the underlying emotional triggers such as stressors at home or at school that may be directly or indirectly related to the depressed mood and rigid eating patterns of these girls is an important part of the process to help empower them to be able to manage the various scenarios that arise in their day to day lives. There are a number of simple techniques including diarising all personal interactions with both friends and family that may be causing distress or anxiety is one way to help the girls learn to identify and manage their emotions, rather than using food and exercise as an escape from them.

Perhaps the most important step of all with this vulnerable patient group is developing a strong rapport and therapeutic alliance to help guide them and their family through this challenging period of their lives. Mums and dads are terrified as they see their baby girl struggle both physically and emotionally and need clinician support to empower them to help their teen through this intense period of their adolescent years.

While adolescents’ can be an extremely challenging group to work with, they can also be an enormously rewarding group to work with. I have now seen two of these girls work through their eating distress and are now well on their way into their final years of school, significantly happier and healthier than when I first saw them.

Unfortunately, the powerful media images of health and beauty are unlikely to disappear entirely and hence the incidence of conditions such as orthorexia is likely to increase. The key for health professionals and families affected is to know how to mange it before it is too late.