Puberty is a major transitional time in all of our lives. In the space of approximately four years our bodies change from that of a pre-pubescent child to that of an adult, capable of reproduction. Navigating all the physiological changes, and the accompanying social and emotional aspects, can be challenging and anxiety-producing for any young person. For some, these anxieties and stressors can be overwhelming; efforts to cope can transform into the development of an eating disorder.
Karina, a 9 year old child who I’ve been seeing, is quite aware that something big and dramatic is on the horizon. Recently, when talking with me about puberty, Karina declared: “I won’t be me and I like me the way I am.” She wonders and worries about how she will change and who she will become.
I focus on puberty because of its contribution to the development of a sense of self—something that changes, grows and becomes more complex over time and with experience. Indeed, our bodies significantly contribute to the sense of I or Me.
For example, as a young child I knew that I was agile and good at running and jumping. I could even beat most of the neighborhood boys! And I was proud of that. I had abilities and a dexterity that contributed to my early self-esteem and self-confidence. However, this changed with the onset of puberty at age 11. Gradually, my body became less supple; I had to develop alternative avenues of pride and self-confidence, which I did and most children do.
Puberty focuses attention on the body and raises many feelings and reactions. Of course, not everyone develops an eating disorder at puberty—eating disorders can emerge at any point in a person’s life. But for some particularly vulnerable pre-teens and adolescents, puberty may intersect with other individual factors, like social shyness, perfectionism and anxiety, as well as external factors, like parental expectations, criticism or conflict. This convergence can result in significant worry about food and body.
Stella, now a college student, speaks of her adolescence and her anorexia at that time. Looking back, she is now articulate about her early fear of these bodily changes, especially her growing sexuality. She remembers feeling acutely embarrassed and her wish “to be invisible” so that no one would pay her too much attention; she did not want her sexually mature body to be noticed.
Monitoring and restricting her food intake, and losing weight, helped Stella feel less out of control both physically and emotionally. Her insecurity and anxiety were assuaged by her pride in the ability to resist food and her capacity to renounce the pleasure of eating.
Controlling the intake of every morsel disconnected Stella from her body and her feelings. Instead, Stella’s experience of a good or bad day was directly connected to losing or gaining weight. This focus on food and weight constricted her ability to develop a fuller, more complex sense of self.
At that time, Stella was unable to fully understand or clearly articulate what she was feeling: anger at her parents, fear of boys and sexuality, anxiety about displeasing her parents or friends, or her discomfort with attention. Feelings—unnamed and unarticulated--were unsettling, and expressed in the language of food, calories, and control of weight.
As adults we can forget or minimize the many ways this key developmental stage affects the daily lives of young people. We are well aware of all the changes in young people during this time, but we’re observing from a distance. We were teenagers so many years ago! We often have memories of childhood and adolescence, but it’s difficult to recall the specific process of puberty, how it felt to have our bodies change in so many ways.
Parents, teachers, therapists and significant adults close to the pre-teen or adolescent must remember that, with so much in flux, the physiological changes of puberty can--and do!--create insecurity and anxiety. Holding this in mind enables us to listen more sensitively and be more effectively responsive.
Young pre-adolescents and teenagers feel vulnerable and uncertain about themselves and how others see them. Growing up involves coping and figuring out how to navigate this developmental stage and the changing sense of I and Me. As Stella said when speaking about her eating disorder: “It’s never just about the food!”
Jacqueline Ferraro, D.M.H. is Faculty and Supervisor in the Child and Adolescent Psychotherapy Training Program, William Alanson White Institute; Associate Director of the Parent Center, and Faculty and Supervisor of the Eating Disorders, Compulsions and Addictions Service, William Alanson White Institute. Dr. Ferraro is in private practice in Manhattan and New Jersey.