Anorexia in Adolescents: A Narrative Review

Abstract

The prevalence of anorexia nervosa has ranged from 27% in non-clinical samples to 85% in samples of adolescents with eating disorders, with twice the prevalence noted in females. Several correlates of anorexia are reported in the recent literature reviewed here including vegetarian diets, personality characteristics such as internalizing and perfectionism as well as behavior problems including impulsivity, dysregulation and being victimized. Comorbidities have included social anxiety, depression and suicidal ideation. In most of these studies, it is not clear which is the primary disorder, as most of the samples are cross-sectional rather than longitudinal. Several of the correlates have also been identified as risk factors including gender, early attachment disturbances, excessive Internet use and negative effects of COVID-19. Potential underlying mechanisms have included involvement of the prefrontal area of the brain based on fMRI and evoked potential research. Fortunately, negative effects of anorexia including decreased body fat mass and bone density as well as lower cortical thickness and less grey matter have been reversed following weight gain. Other effective interventions have included cognitive behavior and dialectical behavior therapy. This narrative review involved entering the terms eating disorders and adolescents into PubMed and PsycINFO. The search yielded 251 papers for the last five years, but following exclusion criteria including case studies and non-English papers, this review is a summary of the research reported in 49 papers. The recent literature on eating disorders in adolescents is predominantly focused on correlates and risk factors for anorexia along with some studies on comorbidities and potential underlying mechanisms for anorexia. Although there are virtually no studies on the effects of anorexia except its effects on body mass and bone mineral density, several intervention studies appear in this literature. Related studies are focused on orthorexia. This narrative review is accordingly divided into sections on the prevalence of anorexia, comorbidities, correlates, risk factors, potential underlying mechanisms and interventions. In a separate section, the smaller literature on orthorexia and drunkorexia is briefly reviewed.