What is the role of age in the etiology of anorexia nervosa?

Updated: Jun 10, 2019
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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Answer

Precipitating factors relate most often to developmental tasks that cause intense intrapsychic conflict and unconscious feelings of anxiety, which in turn interact with physiologic and biologic ones.

In individuals aged 10-14 years, such precipitating factors are related to sexual development and menarche, which are associated with a spurt in weight gain. Societal influences, such as a peer group that comments in a rejecting fashion, intensify the fear of becoming "fat." Affected individuals often diet and receive peer acceptance for weight loss; this emotional reinforcement, combined with the physiologic response of the body to the sudden loss of weight (when >5 lb), increases the likelihood of continued weight loss.

Sudden weight loss with loss of fat causes a decrease in body temperature, which physiologically causes a subjective feeling of chills; this discomfort is relieved by increased physical activity, which causes further weight loss. The continuous downward spiraling of weight loss then causes secondary amenorrhea and loss of secondary sexual characteristics, further worsening weight loss.

In adolescents aged 15-16 years, precipitating factors stem from struggles with independence and autonomy. Individuals in this age group with anorexia nervosa typically feel ambivalent about growing up and will transition from dependence to interdependence rather than to independence.

In individuals aged 17-18 years, identity conflicts are more common. These patients do not make healthy transitions from leaving home to going to college or getting married.


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