He grows a size in a month; he is moody, aloof and sarcastic; he wears strange clothes; he hangs out with an annoying gang... so you may ask: "where is the kid I used to know?" - Well, the answer is just one word: adolescence... This is a very important stage in our life, still, people usually do not have enough information on it. I am often asked by parents "what should I do with my teenage kid?", and it usually turns out that these parents have no clue about the physical and mental changes and challenges their children are facing during these years. Having two adolescent sons, I wish to give an insight into this transitional period with this series.

I heard a piece of news recently on the radio: following the same tendency started in France, Germany bans advertisements featuring extremely slim models. These advertisements have a scientifically proven negative effect on women's body image and self-esteem (and adolescents are the most vulnerable). In the first and second parts of this series I was dealing with the characteristics of healthy adolescents, but I think it is worthwhile to have a look at the other side of the coin, so the following few episodes will deal with some major behavioural problems parents can meet.

Let's start with eating disorders (bulimia, anorexia, and obesity) as a leading problem-group of today's teenagers. Unfortunately, there are still a lot of parents who consider these disorders as a strange eating habit or as an annoying characteristics of their kid, but these symptoms always mask very serious underlying issues, so we cannot neglect them.

What are the common characteristics of eating disorders?

Eating disorders though very different in their appearance, they carry some common characteristics:

• they all originate from early childhood
• they all involve self-destructive tendencies (it is most obvious in anorexia)
• the symptom of these disorders keeps in check very strong emotions (these emotions are suppressed from early childhood).
• there is usually a pathological or at least problematic parent-child relationship and/or interactions in the background
• persons suffering from these disorders usually have high levels of stress and anxiety - and the symptoms are intended to reduce this

Obesity

Obesity is usually defined by the body mass index (BMI), therefore we consider those adolescents obese whose BMI is in the top 5% for their age and gender.

A chart reflecting these percentiles based on WHO data can be found here for girls and here for boys.
Unfortunately, the number obese adolescents have doubled in the past 3-4 decades. twice as common among adolescents as it was 30 years ago.

We usually suspect two root causes at the background of obesity:

• If the mother is not good at understanding the behavioral clues of her baby, it might happen that the child later cannot learn to identify his/her needs. In many cases mothers react with food to all sorts of discomforts of the baby, therefore the child learns that eating is the solution to all of his emotional problems, fears, anxieties, excitements etc.
• Nervous, neurotic and uncertain mothers will look at eating as the major function: this is how they can justify that they are good mothers (often these mothers cannot relate to their child emotionally, they cannot express warm feelings towards them, so they try to compensate this with overfeeding). Here the child learns that everything is about the food, so if he wants to achieve something, this is how he can get the attention. (For example, if he does not eat, then he will receive attention and care.) Here the fight between the mother and the child will go for the emotional control.

Obese children partly lose their gender signs, their sexual drives become blunt or they slow down. Overfeeding mothers subconsciously want their kids to remain babies, they grow a big and fat baby body to pretend that they are still infants.

In a Hungarian experiment researchers (Geiger and Berghammer, 1982) asked obese children to identify certain emotions in pictures. They found that despite the serious emotional difficulties they had, they could identify emotions perfectly on others. They probably grow up in families where emotions are blocked, so they need to be sensitive and detect even the slightest change that they experience to try to figure out what comes next.

Classic obesity usually starts in early childhood (usually in early kindergarten years), so if a child starts to be obese later, then there is probably some sort of a trauma in the background. Obesity then works as a physical and psychological protection, it is a barrier that keeps other away.

Anorexia nervosa

Many researchers agree that - partly due to the idealistic body image the media is suggesting - a major proportion of adolescent girls have a tendency for this eating disorder.

It is characterized by limiting the intake of food because of an increased desire to be thin (and/or an intense fear of gaining weight). People having this disorder have a distorted view of their body image, they consider themselves fat, even if they are absolutely skinny. They reject food or keep a strict diet by counting calories and they also do heavy exercising.

The problem usually is that they evaluate themselves based on their weight and appearance, so their self-confidence and self-worth is depending on how they look.

The disorder is characterized by a rapid or excessive weight loss (losing 20-30% of the total body weight is quite typical, but in severe cases weight loss can reach 70%). This dramatic change has very serious consequences on the entire physiology of the person. There are a lot of additional symptoms indicating the severe imbalance anorexia causes:

• In females, absence of menstrual cycles (if there is no other cause)
• Lack of energy, tiredness, fatigue
• Cold hands and legs, due to bad circulation
• Excessive facial and body hair

These girls usually have a low self-esteem which makes them perfectionistic and very critical towards themselves. They can be characterized by a rigid personality and a high level of tension. (The eating disorder is an attempt to decrease this anxiety by strictly controlling their lives.)

Seemingly everything is fine in the families of these adolescents. Buti if we have a closer look, we will see that there is a problem with boundaries, there are permeable boundaries. Children often play an adult role in these families. They cook, clean the house, do the shopping and live according to a very strict and controlled schedule. Emotions are kept under strict control, too. Everything looks perfect, but the entire system is rigid and demanding. Mothers of adolescents with anorexia often (subconsciously) look at their daughters as competitors, though when they are asked, they tell that everything is fine and they have an excellent relationship. They are perfect mothers, so they want a perfect daughter, and really, the girl is smart and performs well in every situation. The mother is controlling everything and the child learns that she has to do everything for the approval of the mother.

When we are talking about anorexia, we usually mention only girls (because there are more girls with this disorder), but it is important to note that boys can also have it. The major difference here is that they are usually not slim, on the contrary, they build large muscles due to very excessive training.

Bulimia nervosa

Bulimia nervosa is an eating disorder which is characterized by uncontrolled episodes of overeating (bingeing) followed by a feeling of guilt and self-induced vomiting, excessive use of laxatives as well as doing too much exercise in order to control weight. (Persons with this disorder also tend to believe that they are fat, though they usually have normal or skin body shape.)

Bingeing means really a lot, the person eats way too much compared to his/her usual portion. It might happen that during the day she eats only a yogurt, then at night she secretly eats up everything from the fridge. In a severe case, stomach rupture can happen, because the person cannot stop eating.

Families of these adolescents are often chaotic, similarly to the mothers of obese children, the mother here also reacts to all emotional problems with eating. The child is often nervous and have an aching belly already in early infancy.

Treating these disorders

As I have mentioned above all these disorders are deeply rooted in the pathological or problematic parent-child relationship, therefore successful treatment cannot be done without involving the family.

The emotional development of these teenagers is slowed down or broken, therefore it is essential to establish meaningful emotional connections with their family. Providing stability as well as giving encouragement, reinforcement, kindness, and caring are also very important, they have to learn that love is more important than approval. (Many of them lacked these things earlier, they have to experience them in order to have a normal emotional life.)

They have to learn ways to express their emotions, get in touch with their own emotions, as these are usually kept under strict control. They have to learn to embrace their good qualities and values without making (negative) judgments about themselves. We should help them to understand their fears and face them.

Patience is of the utmost importance, it took so many years until this disorder is formed, we have to understand that we cannot change everything in the blink of an eye, but giving acceptance and unconditioned love helps a lot in the process.

Literature used

• Parrot, L.(2012): Parenting Your Teenager, Right Now Media

• Pickhardt, Carl (2013): Surviving Your Child's Adolescence, Wiley

• Geiger Ágota - Berghammer Rita (1982): Külső kontroll, érzelmek felismerése és kifejezése kövér gyermekeknél, Magyar Pszichológiai Szemle, 39. köt. 3. sz.

• Daniel Le Grange and James Lock (2011): Eating Disorders in Children and Adolescents: A Clinical Handbook, The Guilford Press

Sources of pictures

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