ABSTRACT
These women have anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), respectively. Despite differences in age and symptom patterns, there are unifying issues of normative development and developmental psychopathology that contribute to an enhanced understanding of these eating disorders. This chapter discusses the implications of such developmental issues for treatment both in terms of the significance of the age at which an individual presents for treatment and the developmental conflicts that may be involved in the etiology and maintenance of the eating disorder. Although weight preoccupation and eating disturbances may begin during childhood (Smo-
THE EATING DISORDERS AS A REFLECTION OF DEVELOPMENTAL CHALLENGES
The frequent onset of eating disorder symptoms during adolescence suggests that the developmental challenges of this period play a central role in the formation of AN, BN, and BED (Attie & Brooks-Gunn, 1992; Bruch, 1973, 1978; Johnson, 1991; Levine & Smolak, 1992; Pike, 1995; Steiner-Adair, 1986; Striegel-Moore, 1993). Increased rates of depression, anxiety, insecurity, and self-consciousness among adolescent girls suggest that this is a vulnerable stage of development for a wide range of individuals (Kandel & Davies, 1982; O'Malley & Bachman, 1983; Simmons & Blyth, 1987). Of particular relevance to the development of the eating disorders are the psychosocial changes as well as the physical and sexual maturation characteristic of adolescence. Whereas passage into adolescence appears to be the stage of transition associated with the highest risk for developing AN, the movement out of adolescence and into adulthood is associated with the highest rates of onset of BN and BED. However, common to all three eating disorders is the struggle to establish greater autonomy from one's family of origin, build more intimate relationships with others, integrate a changing body image, and develop a cohesive and stable sense of self in the course of this stage of development. Each of the eating disorders, with its particular pattern of symptoms, reflects a compromise solution to these challenges posed by adolescence.
