The Role of Brain Development and Hormonal Effects On Adolescent Eating Disorders

Adolescents differ from adults in many ways, including physiology, brain development and environmental triggers, which requires specialized treatment for eating disorders. Most important, the brain of an adolescent is not the same as that of an adult, creating significant differences in how eating disorders arise and how they should be addressed.

Years of research on adolescent and adult brains has confirmed that even when a young person appears to reach adulthood, brain development continues up to age 25 for females and maybe longer for males. The frontal lobe is last to develop, particularly those areas that involve good decision making. For more on that research, see: www.nature.com/neuro/journal/v2/n10/abs/nn1099_861.html.

This gradual maturing of the prefrontal cortex helps the young adult with increasingly complex and controlled responses to social situations and decision making. An adolescent’s approach often may be the opposite of what you would expect: Adults rely more on patterns and produce quick responses, whereas adolescents slow down their thinking and consider all the possibilities. Consider, for example, what happens if you ask both groups whether it is a good idea to swim with sharks.

When confronted with risky scenarios, adults depend on past experiences and mental images of possible outcomes to deliver a quick, visceral response. They immediately envision swimming with sharks and the likely bad outcome, so their response to the question is no.

Adolescents, on the other hand, have less life experience and fewer imprints of the obviously safe response to such a situation, so they don’t immediately answer that it’s a bad idea to swim with sharks. They imagine the possible outcomes and decide whether it’s a good idea or not. Some will respond that it’s not a bad idea at all, that swimming with sharks might be exciting. In some scenarios, that open-minded approach is not a bad thing, but for adolescents faced with societal pressures and doubts about self-worth and body image, the brain that is not fully developed can put them at risk for making bad decisions.

If the adolescent is concerned about being overweight, they might think it would be a good idea to skip meals. After eating too much, they might consider purging by vomiting. The adult mind would look at these questions and immediately recognize that the risk is too great and these are activities to avoid. But the adolescent mind can look at the same scenario and see it as perfectly reasonable  –  not because the adolescent isn’t smart, but because the brain isn’t fully capable of making rational decisions.

The rapidly changing hormones in an adolescent’s body also can affect brain chemistry and development in ways that can lead to poor decision making. Particularly with young women, the effects of hormonal changes, such as shifts in body fat and development of breasts, can trigger negative perceptions of body image. For more about how hormonal changes affect the adolescent brain, see: www.health.harvard.edu/mind-and-mood/the-adolescent-brain-beyond-raging-hormones.

Understanding the ways in which adolescent brains are different is important to addressing eating disorders in the most effective way possible. In our experience at Rosewood Centers for Eating Disorders, we know that in treating adolescents we need to be more concrete in what we say and expect. We need to walk them through any interpretations we expect them to have after a discussion, unlike letting adults make those conclusions.

Treatment of adolescents can take longer because the brain is not fully formed, and these patients may need more support from family and outside resources after leaving treatment.

When adolescents with eating disorders are treated without an understanding of their unique needs and the limitations of their brain development, treatment can be ineffective and even counterproductive. The patient’s lack of progress may be seen as willful resistance or failure by the treatment team, resulting in frustration all around, when in fact the treatment has been ineffective because therapists and family members expected the adolescent to respond as an adult. That is physically not possible because the adolescent’s brain is different.

Parents intuitively see some of these differences, realizing that their kids make risky decisions they likely wouldn’t make as adults, so they put rules and restrictions in place to guide them. The same principle should be applied to supporting adolescents with eating disorders. Their ability to make the right decision is not fully formed, so they often cannot be expected to make healthy choices.

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When patients fail and engage in risky behaviors, it sometimes is because they were expected to respond as adults when they simply cannot. For that reason, it often is prudent to establish rules regarding food, diet and exercise to provide the structure they need until the brain is fully formed. Until they are ready, adolescents should not be left on their own to make important decisions about their eating disorders.

The riskiest times for many adolescents are the periods of transition, usually at age 14 when they are moving from middle school to high school, and at 18 when they leave home. Parents and therapists especially must be aware of the challenges facing adolescents at these times and ready to provide the support structure that will help them make the right decisions.

Rosewood addresses these issues with a unique family week program for adolescents with eating disorders. At the beginning of treatment, all immediate members of the patient’s family, age 12 and up, are invited to participate in a week-long educational effort. Our therapists help the entire family learn about brain development and how it can influence eating disorders. In addition, we discuss how eating disorders can slow the brain’s development by robbing it of nutrients at a critical time. Some adolescents who have experienced eating disorders for some time can be shown to have brains that are not as mature as their actual age would indicate. The result is that the adolescent’s brain function is behind the level of his or her peers, whose brains also aren’t fully developed.

Family support is a primary focus of our program, more so than would be found at other treatment centers. Part of any adolescent’s treatment for eating disorders at our center is helping the family understand how to set up a home environment that is conducive to the patient using the tools learned in therapy. That means creating structure with scheduled meal times, family meals, organized meal plans and other systems that will help the adolescent make the right decisions. Adolescence can be a trying time for anyone, especially when complicated by an eating disorder. The typical work of an adolescent is figuring out identity, values and who they will be in the world. They are moving toward independence from the family of origin, starting romantic relationships and new friendships and gaining a sense of morality and purpose in life. At the same time, they are learning to control themselves and their environment.These motivations and stressors can lead some adolescents to eating disorders, but effective treatment is available from professionals who understand that young people have a different way of perceiving the world around them. Matching the adolescent with the right treatment program can help get him or her through this challenging part of life.