Eating disorders emerge most commonly during adolescence. Whereas anorexia nervosa tends to present earlier in adolescence, bulimia nervosa generally occurs in late adolescence. Some studies have suggested a trend over time for both disorders to occur at earlier ages (van Son et al. 2006). Adolescence is a vulnerable time in terms of physical, cognitive, and social development, and pubertal changes may trigger heightened anxiety that may contribute to anorexia nervosa.
Crisp (1997) speculated that anorexia nervosa is an attempt to avoid the developmental challenges of adolescence, because anorexia nervosa symptoms can at least temporarily circumvent the necessity of facing these challenges. For example, extreme weight loss can prevent the onset of puberty or in physically mature adolescents return the body to a preadolescent state. Similarly, preoccupations about weight and dieting to a large extent preclude social relations and are accompanied by a retreat into the family. The onset of puberty brings additional body weight and body fat composition changes. In vulnerable adolescents, concerns about being physically thin to be attractive are significantly accentuated. In general, the adolescent with bulimia nervosa desires to be thin and attractive for others, whereas the adolescent with anorexia nervosa desires to be thin as an end unto itself.
Perfectionism is a common characteristic of patients with anorexia nervosa (Halmi et al. 2000). These individuals tend to be school overachievers even though they are no more intelligent on average than their peers (Bryant-Waugh and Lask 1995). Unfortunately, the drive to an unattainable state of perfection may result in feelings of poor self-esteem and decreased self-efficacy (Forsberg and Lock 2006). Obsessionality, a sense of ineffectiveness, rigidity, and harm avoidance are other personality features that are common in patients with anorexia nervosa (Klump et al. 2000). In contrast, adolescents with bulimia nervosa are frequently noted to have interpersonal instability, Cluster B personality traits, and impulsiveness.
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