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Lifespan Development

9.1 Physical Growth and Development in Adolescence

Lifespan Development9.1 Physical Growth and Development in Adolescence

Learning Objectives

By the end of this section, you will be able to:

  • Identify the milestones of physical development in adolescence
  • Describe major aspects of brain development in adolescence
  • Explain the general health-care needs of adolescents

It's the sex ed unit in health class, and Latisha is learning some helpful information but also navigating the awkwardness she feels in the classroom. The teacher has explained the technical stuff and tries to make a joke here and there to be relatable, but she gives off a vibe of being uncomfortable, and that makes it harder for Latisha to bring up questions she has. The teacher showed a diagram and used the word “vulva,” but Latisha doesn't feel sure she knows what part of the female body that is and is too embarrassed to ask. Other students in the class have questions and observations running through their minds. “I'm starting to get stinky armpits after gym class and am not sure what to do about that.” “Does everyone notice when my voice cracks?” "I know I'm supposed to get underarm and pubic hair, but I found a dark hair near my nipple. Is this normal?"

It's normal for adolescents to have many questions about the developments their bodies are undergoing. In this section, you will learn more about the physical changes of the teen years and how to support healthy physical growth at this stage of the lifespan.

Physical Development and Activity

The lifespan period of adolescence entails the physical, cognitive, social, and emotional transitions of an individual from childhood to adulthood. The physical changes of adolescence are often dramatic and noticeable. Although growth and development typically occur in spurts, there is an expected order of physical development associated with the adolescent period.

From a purely physical standpoint, adolescence is the period of growth and development that transforms a child’s body into a fully grown adult body. During periods of rapid growth, developing teens may report temporary discomfort in the form of bodily aches and growing pains. Specifically, growing pains mainly affect children between four and fourteen years of age (Lehman & Carl, 2017; Pavone et al., 2011). With these new bodies comes re-learning how to move about fluidly through gross motor skills, as evidenced by the occasional physical awkwardness that often accompanies adolescent growth periods.

Muscle mass and fat tissue increase along with height, but the distribution of muscle and fat is typically different for adolescent males and females. In males, the shoulder to waist ratio increases with broader shoulders and a thinner waist, whereas in females, the hips increase relative to the shoulders and waist. These biological sex differences in muscle and fat distribution often result in slight to moderate size differences as well as differences in muscle strength, cardiovascular endurance, running speed, throwing velocity, and jumping ability over the course of adolescence. These sex-based differences are largely genetically and biologically based, although cultural and social expectations about the activities children participate in likely come into play as well (Beltran-Valls et al., 2019; Courtright, et al., 2013; Hyde, 2005). Children’s height and weight can also vary based on racial and ethnic background. Generally, children from African countries are a bit taller than those of European or North American descent, who in turn are a bit taller than those of Asian descent (Roser et al., 2021).

Though we see some physical differences based on things like ethnoracial heritage and sex assigned at birth, it is important to also note that there is wide individual variability. This individual variability in physical growth is based on a host of factors like inherited genes, nutrition and access to other environmental resources, like clean air and water. For example, several studies have found that people who live in less polluted areas are likely to be taller and have better skeletal maturation (Schell & Rousham, 2022).

In psychology, we are often interested in understanding both the group-level differences and the individual diversity and variability. For example, in competitive ice swimming, we often see that professional male swimmers often swim faster that professional female swimmers due to higher muscle mass and taller stature. However, females are more likely to close that distance when swimming longer distance, perhaps due in part to better protective insulation and buoyancy from having a higher body fat percentage (Oppermann et al., 2022). This demonstrates that multiple factors can impact and influence physical differences and how they in turn impact performance or skill differences.

Adolescence is also a crucial time during which individuals develop lifestyles and behavioral patterns that will endure across their lifetime. For this reason, routines promoting health, such as regular exercise, should be instilled as early lifestyle habits (Kumar et al., 2015). Several motivational factors influence teens’ interest and participation in physical activity and exercise, which in turn leads to differences in physical growth and overall strength. While research shows that adolescents give competition, social recognition, challenge, affiliation, fun or well-being as the main reasons for doing physical activity, other factors like parental guidance, body image, social anxiety, and lack of time may pose barriers (Peykari et al., 2015; Portela-Pino et al., 2019).

Social factors can also influence differences in physical activity and health behaviors. Gender differences are noted in adolescent participation in sport, exercise, and physical activity. For instance, Slater and Tiggemann (2010) noted that girls aged thirteen to fifteen years stopped participating in sports and exercise due to worries about their appearance. A follow-up study showed that teasing and body image issues further contributed to reduced participation in sports and other physical activities among girls aged twelve to sixteen years (Slater & Tiggemann, 2011). Overall, physical activity during adolescence is influenced by many factors including access to exercise and sports programs, and individuals’ motor competence and interests.

Brain Development

The same hormones that trigger physical development also lead to dramatic brain growth and development during adolescence. Over the past few decades, there has been a surge of research into the developing adolescent brain. We now know that the teenage brain, although undergoing rapid development, is immature until the midtwenties (e.g., American College of Pediatricians, 2022; Blakemore, 2008; Guyer et al., 2016). Adolescence marks the point where the brain achieves its full adult size and weight of roughly 3 pounds, yet brain development continues in several areas in early adulthood. This means that although we should expect growth across the period of adolescence, brain maturation continues beyond the adolescent period.

Several brain structures undergo particularly important developments during adolescence. The frontal lobe and the prefrontal cortex are the center of executive functioning—where rationality, decision-making, planning, and organization take place. A fully mature frontal lobe helps to regulate many of the brain’s structures and functions, especially through the process of inhibition of behaviors that may not be appropriate socially or for other reasons. Additionally, a collection of sub-cortical brain structures, known as the limbic system, is also developing over the course of adolescence. The limbic system includes the amygdala, responsible for emotional processing; hippocampus, which governs memory formation; thalamus, which controls sensory input and response; and hypothalamus, which is the control center for hormone production. Each of these brain structures connect and coordinate with other areas of the brain, especially the frontal lobe and prefrontal cortex (Figure 9.2).

Illustration of brain with hypothalamus, amygdala, and hippocampus labeled.
Figure 9.2 The limbic system regulates emotion and other behaviors. It includes parts of the cerebral cortex located near the center of the brain, including the hippocampus as well as the thalamus, hypothalamus, and amygdala. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

As stated earlier, the frontal lobe is intricately connected to the limbic system. This connection is crucial for regulating emotional responses and making decisions based on both logic and feelings. Research has shown that during adolescence, the development of the frontal lobe and its connections to the limbic system are still maturing; this can be associated with difficulties in managing emotions and impulsivity (Casey et al., 2008). This means adolescents are likely to sometimes have difficulties with things like inhibition, emotional regulation, and attention. For example, you might remember a time when you got really excited (limbic system activation) and found yourself blurting out something that you wish you hadn’t said before you could stop yourself (frontal lobe contribution).

Research confirms that developmental immaturities in the areas of response inhibition, cognitive control, attentional regulation, and other related complex cognitive skills result from gradual maturing of the prefrontal cortex and other frontal regions (Spear, 2013). Common behavioral experiences in adolescence—like testing risky behaviors, being distracted or having difficulty staying engaged, or failing to consider consequences of choices—result from the stage of brain development at this age. However, the frontal lobe develops swiftly during adolescence, allowing for increasingly complex cognitive tasks. It is the last structure to mature in humans, at around age twenty-five years.

Adolescents steadily increase their ability to recognize, process, and think in more sophisticated ways about emotional experiences, but the relative lack of coordination and integration between the limbic system and the prefrontal cortex means that emotions can frequently override careful planning and decision-making. For example, a fifteen-year-old might feel insulted by a friend’s poorly worded comment, though the insult might be very slight and have a history of complicated friendship experiences behind it. But because the frontal lobe isn’t yet efficiently connected to the amygdala, the offended teen lacks the fully developed ability to think through and weigh the consequences of her next move. We shouldn’t be surprised when she yells at her friend. This lack of impulse control is a marker of psychosocial immaturity during adolescence (Casey & Caudle, 2013; Icenogle & Cauffman, 2021; Steinberg & Scott, 2003).

To summarize, the connections between the decision-making center (prefrontal cortex) and the emotional areas (a.k.a. limbic system) of teens’ brains are still growing but not always at the same pace. Because of this, teenagers who are experiencing a lot of emotional arousal might find it difficult to articulate their thoughts or explain their actions as they are doing something.

With age and life experiences of adolescence, the brain’s synaptic connections increase, resulting in significant improvements in thinking and processing skills (American College of Pediatricians, 2022). At the same time, neural circuits or pathways that are not used are eliminated through synaptic pruning. You might guess that the loss of synapses, the connections between neurons, would result in loss of function or ability, but the opposite is true—synaptic pruning ensures that brain pathways that are more frequently used, and consequently are more important, are reinforced and strengthened.

Nutrition, Sleep, and Health Care

Adolescents’ bodies and brains undergo a tremendous amount of change that is taxing both physically and emotionally. What can adolescents and their caregivers do to help make this transition as healthy as possible? The answer may sound familiar: remind adolescents about the building blocks of a healthy life and model good health behaviors for them. In other words, proper nutrition, adequate sleep, and regular visits with a health-care provider.

Proper nutrition is essential for the rapid growth and development of adolescence. Dietary choices and habits established during adolescence greatly influence future health, and many studies report that teens consume few fruits and vegetables and insufficient calcium, iron, vitamins, and minerals for healthy development (Christian & Smith, 2018). Current recommendations for females and males at various points in adolescence and adulthood are shown in Figure 9.3. Females in mid-adolescence need an average of 1,800 calories per day, while males require an average of 2,200. Calcium, iron, and zinc are recommended essential nutrients, along with steady intake of other vitamins and nutrients (Das et al., 2017). For example, nine- to thirteen-year-old males and females require 8 mg of iron per day, but this increases to 11 mg for males and 15 mg for females from ages fourteen to eighteen years (NIH, 2013). This difference is due to differences in the role of puberty in the body.

Chart detailing Dietary Reference Intakes (DRIs) Recommendations for Macronutrients, Minerals & Vitamins for Females and Males in age groups: 9-13, 14-18, 19-30.
Figure 9.3 Though the numbers are often quite similar the nutritional needs of adolescents vary between sexes and at different age range. Notice the increased calorie need over the adolescent development stage and the lowered suggested calcium once adolescents reach age nineteen years. (data source: USDA; attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Adolescents’ nutritional status, which is the extent to which they meet their bodies’ nutritional needs, is influenced by their social, economic, and political contexts. For example, economic factors and local food systems affect families’ access to both nutritious and unhealthy foods. Cultural factors influence the foods on a teen’s plate and the prevalence (or absence) of home-cooked meals (Keats et al., 2018). Globally, total energy, protein, and fat intakes are higher among younger adolescent females than older females. Protein and fat intake is also higher in urban areas. Fruit and vegetable intake is relatively low, with just over one-third of females reporting eating vegetables daily and fewer than half reporting daily fruit consumption (Keats et al., 2018).

Sleep is an essential part of a healthy life and serves a restorative function for adolescents’ developing bodies and brains. The human growth hormone is secreted primarily during the deepest portions of sleep, making sleep particularly critical during the growth periods of childhood and adolescence. However, the prevalence of social media and excessive screen use at night have increased markedly in recent decades, and these habits can disrupt sleep onset and quality for teens (Cain et al., 2010). Significant health and educational concerns have been associated with even mild sleep deprivation, including greater risk for accidents and injuries, hindered learning, memory loss, aggression, metabolism changes, and poor self-esteem (Sharman & Illingworth, 2020).

Our sleep needs change across the lifespan. Based on sleep research, the Centers for Disease Control (CDC) provides guidelines for sleep requirements during adolescence: children ages six through twelve years need nine to twelve hours of sleep per night, whereas teens ages thirteen through eighteen years need eight to ten hours per night. Given these guidelines, data from the United States show that only 40 percent of middle school students and just 30 percent of high school students get the recommended amount of sleep. In other words, teens in the United States are sleep deprived. Only about 20 percent of U.S. teenagers sleep the recommended 9.25 hours a night (Hirshkowitz et al., 2015; National Sleep Foundation [NSF] 2006). This lack of sleep contributes to a variety of poor academic, physical, and mental health outcomes (Owens, 2014; Sharman & Illingworth, 2020; Winsler et al., 2015), despite the fact that adolescents tend to average two more hours of sleep on weekends than on school days (Galina et al., 2021; National Academy of Sciences, 2000; Wheaton et al., 2018).

A recent study of United States high school students found the odds of a sleep-deprived student feeling sad and hopeless increased by 38 percent for each recommended hour of sleep a student missed. Additionally, the odds of reporting serious suicidal ideation increased by 42 percent and the odds of having attempted suicide increased by 58 percent. (Winsler et al., 2015). The relationship between sleep duration and suicidal ideation was stronger for male teens, while sleep duration was more strongly associated with hopelessness for Native American and White students than for other minoritized students. While this study reveals a strong link between sleep deprivation and mental health issues in adolescents, we can’t say for sure that one causes the other. It’s also possible that pre-existing mental health problems or substance use can lead to poor sleep.

Psychologists have also uncovered another major change in adolescents’ sleep–wake cycle. The circadian rhythm is the body’s biologically based pattern of physiological events that follow a daily rhythm, including alertness levels, hunger, blood pressure, and sleepiness. Mary Carskadon and colleagues discovered that adolescents experience a phase shift in their sleep–wake cycle leading them to naturally wake up later and go to bed later if allowed (Taylor et al., 2005). This tendency is thought to result from an internal biological process related to pubertal changes in the secretion of melatonin (a hormone that aids sleep), as well as changes in adolescents’ sensitivity to ambient light. Further studies of adolescent sleep patterns support this finding. The American Academy of Pediatrics (2014) published a policy statement strongly recommending middle and high schools adjust start times to encourage and allow students to get adequate sleep, in turn improving physical and mental health, academic performance, safety, and quality of life. A literature review noted starting school later for adolescents led to general improvements in attendance and lower rates of tardiness, falling asleep in class, depression symptoms, and motor vehicle crashes (Wheaton et al., 2017).

Adolescents continue to need routine preventive health-care, including care that is sensitive and responsive to new health issues brought about by the developmental changes of adolescence. Older children (ages twelve to seventeen years) in the United States were less likely to receive sufficient preventive care, one or more visits in a year, compared to younger children (birth to eleven years) (Conmy et al., 2023). Preventive care includes any prevention or routine appointment with a doctor, dentist, nurse, or other health-care professional and includes screening for physical and mental health needs. For example, seeing a dentist for a cleaning every six months is a form of preventive dental care. Similarly, having your vision screened at an annual doctor’s appointment is preventive vision care. In terms of mental health preventive care, children and adolescents should be screened for abuse or unstable home environment, stress or anxiety, and depression. By adolescence, these screenings should also include suicide risk screenings. Notably, adolescents face a higher risk of depression and suicide risk compared to younger children, raising concerns about potential missed behavioral health issues. Overall, children of all ages received less preventive care in 2020 and 2021 compared to previous years (Conmy et al., 2023).

The American Academy of Pediatrics recommends checking the following during a teen’s annual medical checkup, which should include a physical exam: height and weight, body mass index (BMI), blood pressure, and condition of the skin and spine. Some providers may test for anemia, depression, cholesterol, hearing, vision, HIV, oral health, sexually transmitted infections (STIs), tuberculosis, and use of tobacco, alcohol, or drugs (Hagan et al., 2017). The routine immunization chart recommends following a continued vaccination schedule including vaccines that protect against meningitis and bloodstream infections, tetanus and human papillomavirus (HPV) (AAP, 2023).

Although adolescents are legally minors, professional organizations and state legislatures alike have recognized that teens need to be able to discuss their health concerns, make certain health-care decisions, and access certain health-related services with medical professionals in a confidential manner (Harris, 2017; Schapiro & Mihaly, 2021). Psychological research has shown that adolescents are nearly as capable as young adults of making informed, complex decisions (Icenogle & Cauffman, 2021; Steinberg, 2014). This marks a transition from childhood indicating that many adolescents may benefit from increased privacy, confidentiality, and more independence and consent rights when deciding whether or not, and how, to receive medical care (Berlin & Bravender, 2009; Sharko et al., 2018).

Intersections and Contexts

Supporting Pubertal Development for LGBTQ+ Adolescents

Most of what we know about the health of LGBTQ+ youth comes from limited research and focuses on mental health. For example, factors like being a sexual minority, facing bullying, and experiencing family rejection can increase suicidal thoughts and attempts among LGBTQ+ youth (Ryan et al., 2009).

There is limited research attending to the physical health of LGBTQ+ youth, partly because, like non-LGBTQ+ youth, they usually do not struggle with chronic physical diseases. For some transgender youth, puberty can mean increasing mental health risks, such as anxiety as their changing body may be incongruent with how they see themselves and identify. However, when teens have support from family members and medical health care that provides them with as much consent and individual rights as possible, they experience much lower risks of depression and anxiety (Brierley et al., 2024).

Teens with persistent gender dysphoria -- persistent psychological distress resulting from incongruence between their sex assigned at birth and their gender identity -- during early stages of puberty who have parental support are often considered eligible for a variety of medical supports and potential interventions such as the administration of puberty-delaying hormones (Garofalo, 2011; Hembree et al., 2017). The use of puberty-delaying hormones, under the close supervision of a medical doctor with appropriate expertise, may allow some youth extra time for the youth’s gender identity development while alleviating the dysphoria associated with the incongruent development of secondary sex characteristics during puberty (Hembree et al., 2017). This medical care, known as puberty suppression, is reversible and involves complex individual patient-doctor care choices (Jorgensen et al., 2024).

Transgender and gender-diverse individuals often face stigma and discrimination, resulting in mental and physical health disparities. Delays in initiating interventions can lead to disadvantages for this marginalized group, as puberty progresses before the treatment begins. Additional barriers, such as cost, insurance coverage, lack of education, and delays in treatment initiation persist, with the average age of initiation falling well beyond the start of puberty in the United States (Hembree et al., 2017). There are many individual differences in the best choices for any form of medical care or intervention and some youth may experience certain risks from puberty suppression, such as fatigue or headache or bone mass changes (Betsi et al., 2024). However, research on transgender youth and their families also finds that those who receive safe and medically supported puberty suppression and well-rounded medical care show improvements in quality of life, well-being, and psychological health (Betsi et al., 2024; Horton, 2024). While there is still much to learn in the field of best clinical and medical care for children and adolescents with gender dysphoria, pediatric groups like the European Academy of Paediatrics have concluded that all treatments should be evaluated to support “the child’s right to an open future” (i.e., that youth should be provided as many rights in making choices that impact their future autonomous adult lives as possible (Brierley et al., 2024; Jorgensen et al., 2024).

Health Risks during Adolescence

While most adolescents are healthy, unique health challenges that may impact their overall well-being still exist. Some of these challenges include sleep disruptions, eating disorders, substance use, mental health issues, and self-harm. The leading causes of death in adolescence are accidents, homicide, and suicide (CDC, 2022). Many of these health and mortality risks can be prevented through prevention and intervention efforts that focus on promoting protective factors (e.g., mental health and socioemotional support) and reducing risk factors (e.g., sleep issues and victimization).

Sleep Disorders, Mental Health, and Suicide Risk

As discussed earlier in this section, getting adequate sleep is important for adolescents’ growing brains and bodies. Although insufficient sleep accounts for most sleep issues, adolescents may also be at risk for particular sleep disorders. The most common sleep disorders in this age group include delayed sleep-wake phase disorder, insomnia, and obstructive sleep apnea (Moore & Meltzer, 2014). It’s critical to recognize that sleep disruption can significantly impact adolescents’ physical and mental health.

With all of the rapid changes that occur during adolescence, it is no surprise that mental health may become a challenge. The Youth Risk Behavior Survey Data Summary and Trends Report showed that from 2011 to 2021, the rate of adolescents reporting poor mental health increased dramatically (CDC, 2024). The National Institute of Mental Health (NIMH) estimates that around 50 percent of adolescents have a mental health disorder, with that number increasing across adolescence from around 45 percent in ages thirteen to fourteen years to 56.7 percent in ages seventeen to eighteen years (NIMH, 2023). Depression and anxiety are among the most common mental health disorders (NIMH, 2017). In adolescence, approximately 31.9 percent of individuals have an anxiety disorder and 40.6 percent have experienced at least one major depressive episode (NIMH, 2017).

One reason that anxiety and depression risk is higher in adolescence than in childhood is the increased disruptions in emotion regulation typical to that stage of the lifespan (Young et al., 2020). As you may recall, adolescents’ brains are still developing, particularly in those regions responsible for emotion regulation. Adolescents with a greater number of adverse childhood experiences (ACEs) are also at a greater risk of anxiety and depression (Lee et al., 2020). These statistics highlight the need for increased mental health awareness, early intervention, and accessible support services.

Unfortunately, without adequate support, adolescents facing mental health challenges may turn to unhealthy coping mechanisms such as substance use or self-harm. A meta-analysis on adolescent substance use found that mental health and substance use often occurred together (Halladay et al., 2020). Self-harm behaviors include any deliberate physical harm to the self and may be nonsuicidal or suicidal behavior. In particular, adolescents who have experienced childhood abuse and/or neglect are at the highest risk for self-harm behaviors, followed by those with psychological issues including personality disorders, depression, and anxiety (McEvoy et al., 2023). When left untreated or undetected, struggles with mental health and self-harm behaviors in adolescence can lead to an increased risk of suicide.

Suicide is the second leading cause of death among youth aged ten to twenty-four years in the United States (CDC, 2023). A report of high school students disclosed that in 2023, more than one in five contemplated suicide, and one in ten attempted suicide (CDC, 2024). While these statistics are staggering, the data showed that females and LGBTQ+ are at a higher risk of suicidal thoughts and behaviors, and attempted suicide. Some of these disparities in risk may be due to health-care disparities, higher risk factors, fewer protective factors, and increased victimization risks experienced by these groups (Gaylor et al., 2023). Research recommends that suicide prevention in adolescence focus on creating equitable health-care access, reducing risk factors, and promoting socioemotional and mental health support (Gaylor et al., 2023). Suicide prevention in adolescence is an urgent priority, and while some strides have been made in inventions, continued research is necessary (Wasserman et al., 2021).

Maladaptive Eating and Eating Disorders

When all goes right, adolescents get the nutrition they need through healthy eating habits. However, this stage of development also marks a vulnerable period for the emergence of maladaptive eating behaviors and eating disorders. Between 2018 and 2022, the number of times young people under age seventeen years in the United States sought medical help for eating disorders more than doubled (Pastore et al., 2023). While eating disorders can affect anyone, they are more prevalent in women than in men, and individuals in Western countries are at a higher risk than those in Asian countries (Qian et al., 2022). Asian American and non-Hispanic White youth are also at a higher risk of eating disorders, though it is likely that eating disorders are underdiagnosed and less likely to be detected in Black, Hispanic, and other minoritized youth, and these youth may be at an increased risk of specific eating disorders (Barakat et al., 2023; Gorrell et al., 2021). The consequences of these disorders extend far beyond unhealthy eating habits, with individuals facing an increased risk of depression, substance use, and long-term physical health problems. In many cases, eating disorders begin with maladaptive eating behaviors.

Maladaptive eating behaviors can include eating too much or too little in terms of nutritional needs and can occur in bodies of any size (Brytek-Matera, 2021). Risk factors for maladaptive eating behaviors include difficulties with emotion regulation, unhealthy attitudes toward food, stress and mental health struggles, perfectionism, and cultural pressures such as pressures to diet or adhere to a certain body image (Barakat et al., 2023; Brytek-Matera, 2021; Hampton-Anderson & Craighead, 2021). In males and females, internalizing societal and media messages about ideal physical appearance is also associated with increased risks of maladaptive eating behaviors and disordered eating (Vankerckhoven et al., 2024). For example, if an adolescent believes that their body must meet a thin ideal or muscular ideal as portrayed by the media, they are more likely to struggle with maladaptive eating.

The American Psychiatric Association (2022) defines eating disorders as involving long-term struggles with eating that alters food consumption and impairs physical and/or psychological health. The most prevalent eating disorders include anorexia N=nervosa, bulimia nervosa, and binge eating disorder (Crone et al., 2023). Anorexia nervosa typically involves food restriction. Bulimia nervosa includes episodes of binge eating followed by purging through vomiting or excessive exercise. Regular episodes of uncontrollable overeating indicate binge eating disorder. Other eating disorders that may be diagnosed include avoid/restrictive food intake disorder or an unspecified eating disorder (American Psychiatric Association, 2022). It’s important to note that not all individuals with eating disorders are underweight, and individuals who are in a normal weight to overweight range may still struggle with an eating disorder.

While each of these eating disorder diagnoses is distinctive, many of the symptoms can overlap (Table 9.1). Behaviors associated with an eating disorder left untreated may lead to malnourishment and health consequences across a wide range of body systems, including the skin, hair, nails, blood, major organs, and brain functioning (NIMH, 2017).

Symptoms Health Consequences
Restricted eating Anemia and blood pressure problems
Intense fear of weight gain Muscle loss and weakness
Distorted body image Brittle hair and nails
Excessive thoughts related to body size Problems with the skin including dry skin
Underweight Fatigue
Unusual eating patterns such as over or undereating, binge eating, or fasting Gastrointestinal problems including damage to organs, ulcers, constipation, reflux, and diarrhea
Forced vomiting, use of laxatives or diuretics, or other purging behaviors Throat, neck, and jaw problems (especially in cases of forced vomiting)
Excessive exercise Dehydration and electrolyte imbalance
Lack of appetite Organ failure and damage to heart functioning
Sudden or dramatic weight change Brain damage
Table 9.1 Common Symptoms and Health Consequences of Eating Disorders Sources: American Psychiatric Association (2022; NIMH (2024)).

Eating disorders are complex mental health issues that can be harmful to both physical and emotional well-being (Smink et al., 2014). Having a supportive family environment, high self-esteem, and self-efficacy, as well as a positive body image can all be protective factors for teens at risk of maladaptive eating and eating disorders. Prevention and intervention efforts that focus on promoting resilience, healthy identity development, and positive body image can help reduce the risk of eating disorders (Vankerckhoven et al., 2024). For those adolescents who struggle with eating disorders, cognitive behavioral therapy has been shown to be an effective treatment for a range of eating disorder types (Hay, 2020; Q da Luz et al., 2020).

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