Eating Disorders, Addictions Tough to Treat in Teens
THURSDAY July 1, 2010 -- When it comes to treating eating disorders and addictions, the path to recovery may be even harder -- and less straightforward -- for children and teens than it is for adults, experts say.
"Disorders that start when you're young, in adolescence, no matter what the disorder, are always harder to treat and harder to recover from," said Dr. David Schlager, a clinical assistant professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine.
This applies both to a wide range of problems, he said, from eating disorders such as bulimia and anorexia, to addictions and mental illness.
No one knows exactly why this is so, in terms of brain chemistry, but adolescence can be hard enough even without these complications.
"There are so many crucial things going on, so much pressure to establish yourself in various ways," explained Schlager, who's also a psychiatrist with Lone Star Circle of Care. Mental health can be easier for adults, he reasoned, because "if you've made it to 30 you've carved out a little groove for yourself, most people will give you a little latitude."
Also, the bodies and minds of people suffering from any of these disorders work differently than those of healthy individuals, making the challenge even tougher.
"In anorexia, [which typically sets in between the ages of 14 and 17], when someone is severely underweight, their brain and their body tend to react differently," said Andrea Vazzana, a clinical assistant professor of child and adolescent psychiatry at New York University Child Study Center. "Someone who is severely underweight is likely to have difficulty concentrating, making good judgments. Reasoning becomes more difficult and their mood is affected. They're more irritable and depressed and anxious."
People with bulimia suffer from a similar problem. "They're binging and purging and their body is affected. They have the same preoccupation with weight [as anorexics] and, to a lesser extent than with anorexia, their judgment is impacted," Vazzana said.
But clinicians are at a disadvantage when it comes to treating troubled teens, because there's a dearth of research into what treatments actually work for the younger people.
For example, "there aren't a lot of treatments [for eating disorders], especially in adolescence, that have been proven to work," Vazzana said. Family therapy is one treatment that has shown good results in randomized, controlled trials.
There are good treatments that work for bulimia in adults but no one knows if they trickle down to children, though anecdotally they do seem to have some effect, Vazzana said. These include cognitive behavioral therapy and interpersonal therapy.
None of this means that parents should give up hope. Treating eating disorders, addictions and other mental health issues in younger people can be difficult, but it's not impossible, said Schlager.
"It depends on the condition. If it's one of the conditions that only have behavioral treatments and no medication, then it's hard first of all to get them [children] to participate in behavioral treatment," he said.
And, according to Vazzana, there's no evidence yet that 12-Step programs work for eating disorders, especially in younger people, because they require people to acknowledge their illness.
"To get a teenager to acknowledge that they have an illness and that they need care, that's narcissistically overwhelming," Schlager said. "Like most young people, they pretend it's not happening."
Wynn Oleson is a pseudonym for the author of My Daughter Is Bulimic and the Cat Has Hairballs: The 95-Pound Addict in the Room. She found that neither 12-Step programs for addiction, nor a host of other "adult-oriented" treatments, helped her daughter, who has struggled with both eating disorders and addiction.
"As a young girl, she was treated like anybody who showed similar symptoms -- meaning adults," Oleson recalled. "In the rehab center, her roommates were 35 or 40 years old. She was placed with hardened heroin addicts who had been in prison. They're not bad people. But they are very deep into their addiction and their stories to a young, impressionable girl from a very different background who has not lived that life, it's all pretty exciting stuff."
After several inpatient treatment programs failed, Oleson tackled her daughter's problems with her own brand of at-home family and cognitive behavioral therapy.
"What seems to work with young people, and what ultimately we did with our daughter, was go back and say my daughter is not at the point where she is able to logically process what's happening to her," Oleson said. "We had to go back and teach her some of life's basic lessons."
Olseon put together spread sheets outlining the choices her daughter might face with particular situations, such as a party, asking her what has happened at parties in the past and what decisions she could make now.
"My goals in writing the book were to help other families avoid some of the dangerous traps we fell into in trying to help our daughter -- to open the public's and the profession's eyes to the urgent need for new treatment methods for the young person 24 years and under," she said.
Today, Oleson said, her daughter is on the dean's list at college and "building healthy relationships with others and, little by little, with herself."
"She continues to be challenged, especially when stressed, by urges to fall back on old behaviors," Oleson added. "But she now understands what is driving that tension, has developed new healthy rewards, and has found goals in life that are greater than her desire for the addictions."
There's more on anorexia, bulimia and other conditions at the Academy for Eating Disorders.
Posted: July 2010