- Describe health and sexual concerns during adolescence
- Discuss concerns associated with eating disorders
Health Concerns During Adolescence
Adequate adolescent nutrition is necessary for optimal growth and development. Dietary choices and habits established during adolescence greatly influence future health, yet many studies report that teens consume few fruits and vegetables and are not receiving the calcium, iron, vitamins, or minerals necessary for healthy development.
One of the reasons for poor nutrition is anxiety about body image, which is a person’s idea of how their body looks. The way adolescents feel about their bodies can affect the way they feel about themselves as a whole. Few adolescents welcome their sudden weight increase, so they may adjust their eating habits to lose weight. Adding to the rapid physical changes, they are simultaneously bombarded by messages, and sometimes teasing, related to body image, appearance, attractiveness, weight, and eating that they encounter in the media, at home, and from their friends/peers (both in person and via social media).
Much research has been conducted on the psychological ramifications of body image on adolescents. Modern day teenagers are exposed to more media on a daily basis than any generation before them. Recent studies have indicated that the average teenager watches roughly 1500 hours of television per year, and 70% use social media multiple times a day. As such, modern day adolescents are exposed to many representations of ideal, societal beauty. The concept of a person being unhappy with their own image or appearance has been defined as “body dissatisfaction.” In teenagers, body dissatisfaction is often associated with body mass, low self-esteem, and atypical eating patterns. Scholars continue to debate the effects of media on body dissatisfaction in teens. What we do know is that two-thirds of U.S. high school girls are trying to lose weight and one-third think they are overweight, while only one-sixth are actually overweight (MMWR, June 10, 2016). 
Dissatisfaction with body image can explain why many teens, mostly girls, eat erratically or ingest diet pills to lose weight and why boys may take steroids to increase their muscle mass. Although eating disorders can occur in children and adults, they frequently appear during the teen years or young adulthood (National Institute of Mental Health (NIMH), 2019). https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml Eating disorders affect both genders, although rates among women are 2½ times greater than among men. Similar to women who have eating disorders, some men also have a distorted sense of body image, including muscle dysmorphia or an extreme concern with becoming more muscular.
Because of the high mortality rate, researchers are looking into the etiology of the disorder and associated risk factors. Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors (NIMH, 2019). Eating disorders appear to run in families, and researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders. Researchers have also found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. The main criteria for the most common eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder are described in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, DSM-5 (American Psychiatric Association, 2013).
Health Consequences of Eating Disorders
For those suffering from anorexia, health consequences include an abnormally slow heart rate and low blood pressure, which increase
s the risk for heart failure. Additionally, there is a reduction in bone density (osteoporosis), muscle loss and weakness, severe dehydration, fainting, fatigue, and overall weakness. Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Individuals with this disorder may die from complications associated with starvation, while others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.
The binging and purging cycle of bulimia can affect the digestive system and lead to electrolyte and chemical imbalances that can affect the heart and other major organs. Frequent vomiting can cause inflammation and possible rupture of the esophagus, as well as tooth decay and staining from stomach acids. Lastly, binge eating disorder results in similar health risks to obesity, including high blood pressure, high cholesterol level
s, heart disease, Type II diabetes, and gall bladder disease (National Eating Disorders Association, 2016).
Eating Disorders Treatment
To treat eating disorders, getting adequate nutrition and stopping inappropriate behaviors, such as purging, are the foundations of treatment. Treatment plans are tailored to individual needs and include medical care, nutritional counseling, medications (such as antidepressants), and individual, group, and/or family psychotherapy (NIMH, 2019). For example, the Maudsley Approach has parents of adolescents with anorexia nervosa be actively involved their child’s treatment, such as assuming responsibility for feeding their child. To eliminate binge eating and purging behaviors, cognitive behavioral therapy (CBT) assists sufferers by identifying distorted thinking patterns and changing inaccurate beliefs.
Link to Learning
Visit National Eating Disorders Association to learn more about eating disorders.
Developing sexually is an expected and natural part of growing into adulthood. Healthy sexual development involves more than sexual behavior. It is the combination of physical sexual maturation (puberty, age-appropriate sexual behaviors), the formation of a positive sexual identity, and a sense of sexual well-being (discussed more in depth later in this module). During adolescence, teens strive to become comfortable with their changing bodies and to make healthy, safe decisions about which sexual activities, if any, they wish to engage in.
Earlier in the physical development section, we discussed primary and secondary sex characteristics. During puberty, every primary sex organ (the ovaries, uterus, penis, and testes) increases dramatically in size and matures in function. During puberty, reproduction becomes possible. Simultaneously, secondary sex characteristics develop. These characteristics are not required for reproduction, but they do signify masculinity and femininity. At birth, boys and girls have similar body shapes, but during puberty, males widen at the shoulders and females widen at the hips and develop breasts (examples of secondary sex characteristics). Sexual development is impacted by a dynamic mixture of physical and cognitive change coupled with social expectations. With physical maturation, adolescents may become alternately fascinated with and chagrined by their changing bodies, and often compare themselves to the development they notice in their peers or see in the media. For example, many adolescent girls focus on their breast development, hoping their breasts will conform to an ideal body image.
As the sex hormones cause biological changes, they also affect the brain and trigger sexual thoughts. Culture, however, shapes actual sexual behaviors. Emotions regarding sexual experience, like the rest of puberty, are strongly influenced by cultural norms regarding what is expected at what age, with peers being the most influential. Simply put, the most important influence on adolescents’ sexual activity is not their bodies, but their close friends, who have more influence than do sex or ethnic group norms (van de Bongardt et al., 2015). 
Sexual interest and interaction are a natural part of adolescence. Sexual fantasy and masturbation episodes increase between the ages of 10 and 13. Masturbation is very ordinary—even young children have been known to engage in this behavior. As the bodies of children mature, powerful sexual feelings begin to develop, and masturbation helps release sexual tension. For adolescents, masturbation is a common way to explore their erotic potential, and this behavior can continue throughout adult life.
Many early social interactions tend to be nonsexual—text messaging, phone calls, email—but by the age of 12 or 13, some young people may pair off and begin dating and experimenting with kissing, touching, and other physical contact, such as oral sex. The vast majority of young adolescents are not prepared emotionally or physically for oral sex and sexual intercourse. If adolescents this young do have sex, they are highly vulnerable for sexual and emotional abuse, sexually transmitted infections (STIs), HIV, and early pregnancy (https://pedsinreview.aappublications.org/content/34/1/29). For STI’s in particular, adolescents are slower to recognize symptoms, tell partners, and get medical treatment, which puts them at risk of infertility and even death.
Adolescents ages 14 to 16 understand the consequences of unprotected sex and teen parenthood, if properly taught, but cognitively they may lack the skills to integrate this knowledge into everyday situations or consistently to act responsibly in the heat of the moment. By the age of 17, many adolescents have willingly experienced sexual intercourse. Teens who have early sexual intercourse report strong peer pressure as a reason behind their decision. Some adolescents are just curious about sex and want to experience it. 
Becoming a sexually healthy adult is a developmental task of adolescence that requires integrating psychological, physical, cultural, spiritual, societal, and educational factors. It is particularly important to understand the adolescent in terms of their physical, emotional, and cognitive stage. Additionally, healthy adult relationships are more likely to develop when adolescent impulses are not shamed or feared. Guidance is certainly needed, but acknowledging that adolescent sexuality development is both normal and positive would allow for more open communication so adolescents can be more receptive to education concerning the risks (Tolman & McClelland, 2011). 
Adolescents are receptive to their culture, to the models they see at home, in school, and in the mass media. These observations influence moral reasoning and moral behavior, which we discuss in more detail later in this module. Decisions regarding sexual behavior are influenced by teens’ ability to think and reason, their values, and their educational experience. Helping adolescents recognize all aspects of sexual development encourages them to make informed and healthy decisions about sexual matters.
Freud and Sexual Development
According to Sigmund Freud, adolescents are in the genital stage of psychosexual development. This stage begins around the time that puberty starts, and ends at death. According to Freud, the genital stage is similar to the phallic stage, in that its main concern is the genitalia; however, this concern is now conscious. The genital stage comes about when the sexual and aggressive drives have returned, but the source of sexual pleasure expands outside of the mother and father (as in the Oedipus or Electra complex).
During the genital stage the ego and superego have become more developed. This allows the individual to have a more realistic way of thinking and to establish an assortment of social relations apart from the family. The genital stage is the last stage and is considered the highest level of maturity. In this stage a person’s concern shifts from primary-drive gratification (instinct) to applying secondary process-thinking to gratify desire symbolically and intellectually by means of friendships, intimate relationships, and family and adult responsibilities.
- anorexia nervosa:
- an eating disorder characterized by self-starvation. Affected individuals voluntarily undereat and often overexercise, depriving their vital organs of nutrition. Anorexia can be fatal
- binge-eating disorder:
- an eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States
- body dissatisfaction:
- negative subjective evaluation of the weight and shape of one’s own body, which may predict the onset, severity, and treatment outcomes of eating disorders
- body image:
- a person’s idea of how their body looks
- bulimia nervosa:
- an eating disorder characterized by binge eating and subsequent purging, usually by induced vomiting and/or use of laxatives
- sexual self-stimulation, usually achieved by touching, stroking, or massaging the male or female genitals until this triggers an orgasm
- muscle dysmorphia:
- sometimes called “reverse anorexia” this is an obsession with being small and underdeveloped; extreme concern with becoming more muscular
- primary sex characteristics:
- the parts of the body that are directly involved in reproduction, including the vagina, uterus, ovaries, testicles, and penis
- secondary sex characteristics:
- physical traits that are not directly involved in reproduction but that indicate sexual maturity, such as a man’s beard or a woman’s breasts
- sexually transmitted infections (STIs):
- diseases that are spread by sexual contact, including syphilis, gonorrhea, genital herpes, chlamydia, and HIV/AIDS
- Christian P, Smith E, R: Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks. Ann Nutr Metab 2018;72:316-328. doi: 10.1159/000488865 ↵
- Markey, Charlotte (2019). "Teens, Body Image, and Social Media." Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/smart-people-don-t-diet/201902/teens-body-image-and-social-media. ↵
- MMWR, (206, June 10). Youth risk behavior surveillance- United States, 2015: Morbidity Weekly Report, 65 (6). Altlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. ↵
- van de Bongardt, D., Reitz, E., Sandfort, T. & Dekovic, J (2015). A meta-analysis of the relations between three types of peer norms and adolescent sexual behavior. Personality and Social Psychology Review, 19 (3), 203-234. ↵
- Adolescent Sexuality Trisha Tulloch, Miriam Kaufman Pediatrics in Review Jan 2013, 34 (1) 29-38; DOI: 10.1542/pir.34-1-29 ↵
- Tolman, D.L. & McClelland, S.I. (2011). Normative sexuality development in adolescence; A decade in review, 2000-2009. Journal of Research on Adolescence, 21 (1), 242-255. ↵