When Eating Disorders Substitute for Accomplishment Among Adolescent Girls

Last week, Lara Pence, Psy.D, MBA, and site director of The Renfrew Center of Texas spoke at another of the informative webinar series that Renfrew offers from time to time. Her topic: eating disorders, tweens and teens, and in particular, the interplay between eating disorders and a young person’s (she focused on girls) psychological and social development.

Eating disorders are a heart- and family-breaking illness at any stage of life, but Dr. Pence made the case that adolescence is an especially dangerous time to suffer from one because it is a time when kids are developing the mental and emotional “scaffolding” for adulthood. Their brains are still developing, and it’s been shown that certain areas of the brain can actually decrease in size under the siege of serious anorexia nervosa. (Marcia and I write about this in our book: Though these changes are reversible with recovery, it’s not something parents want to hear is happening to their child.)

Dr. Pence harked back to Psych 101, and developmental psychologist Erik Erikson’s model for the stages of psychosocial development. According to Erikson, the ages of 6 to 11 (what he calls Stage 4) are a time when children ideally develop the virtue of competence. They wonder how they can be “good” at home, in school and in sports. It is also a developmental phase crucial to building confidence: being praised for effort, or “industry” helps do that, while ridicule can result in inferiority, low self-esteem and lack of motivation.

One of the problems of the hyper-pressurized environment that many children these days face, asserts Dr. Pence, is that in this developmental stage (she defined it as ages 5-12), the question to children seems no longer to be “what can I be good at?” but instead, “how many things can I be good at?” Too much pressure sets adolescents up to be unsuccessful, to “focus on the one thing they got wrong, not the ten things they got right.” They begin to experience feelings of inferiority, which in turn increases the risk for unhealthy behaviors.

“We’re sending the message to girls every day that they can be anything they want to be. What they’re hearing is, ‘You should be the best at everything,” said Dr. Pence. “It’s too much. The amount of pressure girls are under these days does not match what they can handle, and they’re crumbling.”

Evidence of this “crumbling” can be heard in the phone calls that Dr. Pence gets calls on a monthly basis from parents of 8- and 9-year-old girls seeking to get their daughters into treatment.

In their hunger for praise, girls who are feeling a sense of inferiority “grab on to anything to get attention, and often an eating disorder is a brilliant way of getting attention when nothing else seems to work,” said Dr. Pence, citing one client who said of her father. “I know it sounds stupid, but because he’s is finally paying attention, I know I’m good at something. It’s too bad that something is my eating disorder.”

In my next blog post, I’ll continue this account of Dr. Pence’s presentation and include some of her tips for parents.