Despite your best efforts to persuade your child to accept professional attention, it’s possible that she’ll continue to resist. At this point, you’ll want to ask your pediatrician to help you formulate a plan for motivating her to enter therapy. Another option is to seek guidance from a therapist. Bring your partner but not your child to the consult. After helping you devise an individualized strategy aimed at encouraging her to accept treatment, the therapist will then follow up with you regarding her condition and whether she’s becoming more willing to see a doctor.

If your treatment-reluctant child is physically weakened or unstable, if she’s very depressed, or if her food restriction is extreme, you’ll need to get help despite her objections. Even if she is not in medical crisis, you may need to insist that she give therapy a try. Under such circumstances, you should remind yourself that your child’s recalcitrance is neither her fault nor yours, but rather part of an illness. Your role in getting her the help she so desperately needs is an admirable step, even though it may feel extremely difficult in the face of her opposition. Although she may not be able to understand your intentions now, you can take solace in knowing that your initiative in getting her help will be pivotal in affording her the opportunity for better health in the long run.

Now that we’ve addressed the challenges of encouraging your child to accept help, you’re likely wondering what professional care for eating disorders is all about, a topic we’ll introduce in the next section.

Adolescence is a time of life where young people are encountering many types of changes in their lives. Besides physical maturation, adolescents are also pushing the limits of independence and leaving elementary school for middle school, where increased expectations and responsibilities often results in new stress.

Eating disorders, though possible at any age or stage in life, often begin during adolescence. The physical and mental transition to adulthood can be tumultuous, and while there is a mix of biological and environmental components to eating disorders, adolescents seem to be at a prime time in life for developing disordered eating behaviors.

A study published online in Archives of General Psychiatry, a JAMA/Archives journal, examines the prevalence of eating disorders from a population-based study, looking at comorbidity with other mental disorders, illnesses and rates of impairment.

The study, led by Sonja A. Swanson, ScM, of the National Institute of Mental Health in Bethesda, Maryland, and colleagues, gathered data from the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), which provided a nationally representative sample of adolescents. The researchers wanted to look at lifetime and past-year prevalence of various eating disorders, such as anorexia nervosa, bulimia nervosa, binge eating disorder and subthreshold eating disorders.

The study would examine sociodemographic variables and clinical correlates with patterns of comorbidity of other mental disorders. The researchers would also determine the level of role impairment and evidence of suicidal symptoms. In order to gather this information from the adolescents, the researchers interviewed 10,123 participants, each aged between 13 and 18 years.

The analysis revealed that when asked about lifetime presence of eating disorders, anorexia was present at a rate of 0.3 percent, bulimia at a rate of 0.9 percent, binge eating disorder at a rate of 1.6 percent, subthreshold anorexia at a rate of 0.8 percent, and subthreshold binge eating disorder at a rate of 2.5 percent. The 12-month rates for anorexia, bulimia, binge eating disorder, subthreshold binge eating disorder were 0.2 percent, 0.6 percent, 0.9 percent, and 1.1 percent, respectively.

The analysis showed that there was not a significant gender difference when it came to anorexia and subthreshold binge eating disorder. However, bulimia, binge eating disorder and subthreshold anorexia were more prevalent in girls.

Over half of the adolescents with each type of eating disorder also met criteria for at least one other DSM-IV disorder. There were strong associations with psychiatric disorders, a high level of social impairment, and suicide.
Many of the adolescents had sought some type of treatment, but few had received treatment specifically designed to aid in recovery from an eating disorder.

The study provides information on the prevalence of eating disorders among adolescents. With so few adolescents receiving treatment for eating disorders, the study will be useful in raising awareness about early detection and appropriate treatment options.

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David B. Herzog, M.D., Debra L. Franko, Ph.D., Pat Cable, RN

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David B. Herzog, M.D., is the Harvard Medical School Endowed Professor of psychiatry in the field of eating disorders at Massachusetts General Hospital and the director of the Harris Center at Massachusetts General Hospital.
Debra L. Franko, Ph.D., is a professor in the Department of Counseling and Applied Educational Psychology at Northeastern University and the associate director of the Harris Center at Massachusetts General Hospital
Pat Cable, RN, is the director of publications at the Harris Center.