Sex Differences in Adolescent Anorexia and Bulimia Nervosa: Beyond the Signs and Symptoms

Abstract

Purpose of review: We review research related to sex differences in eating disorders (EDs) in adolescents. Prior work has explored clinical differences, thus, we examine literature in areas identified as playing an etiological or maintenance role in EDs including: genetics, hormones, neurocognitive inefficiencies, and reward circuitry. Recent findings: Sex steroids appear to a play role in the unmasking of genetic risk for development of EDs and puberty may be a heightened period of risk for females. While neurocognitive differences have been well studied in adults with ED, research with adolescents has been less conclusive. Recent work suggests that neural circuitry involved in reward and punishment may play role in development and maintenance of EDs in females. Males are underrepresented in these areas of research. Summary: Given known sex differences in healthy adolescents, it is likely there are sex differences in the putative biological etiology/maintenance of EDs. Males should be included in future research.

Bulimia symptoms in Czech youth: prevalence and association with internalizing problems

“…It should be mentioned, however, that in spite of these gender differences in internalizing problems, the patterns of internalizing problems in relation to a CLBS were not gender-specific, that is, both boys and girls with a CLBS reported similarly increased internalizing problems, as compared to boys and girls without a CLBS. This is in line with previous reports suggesting that males and females report similar levels of overall psychological distress and impaired quality of life associated with disordered eating behaviors [57].…”

“…This might have several explanations. While males are more likely to have a history of higher weight prior to ED onset [ 57 ], research shows that men tend to be more satisfied with their bodies than women [ 58 ] and that the ideals for men are about muscularity and leanness [ 59 , 60 ], rather than thinness, which is the ideal for women. The fact that women are largely subjected to an idealization of thinness [ 61 ], expectations from society concerning an unrealistic appearance [ 62 ] and pressure to be thin from different forms of media [ 63 , 64 ] could contribute to body dissatisfaction when at a healthy BMI range.…”

Viral time capsule: a global photo-elicitation study of child and adolescent mental health professionals during COVID-19

“…We are starting to see some of the negative consequences of COVID-19 on the mental health of children, adolescents, and their families, and as the pandemic persists, sequelae will likely only increase in severity and magnitude. There is considerable and historic underinvestment in mental health across the globe, especially in LMICs [ 57 ], despite the burden of mental illness globally [ 58 ]. Open before us is an opportunity to build a better system, one that is embedded in sustainable adaptations of mental health delivery and “informed by ethics- and rights-driven considerations” [ 54 ].…”

Host Starvation and Female Sex Influence Enterobacterial ClpB Production: A Possible Link to the Etiology of Eating Disorders

“…For instance, puberty in girls is typically accompanied by an increased appetite [50], which in some individuals may cause restrictive feeding behavior and, hence, may trigger risk factors to develop ED. Thus, a possible inhibition of ClpB production in puberty by estrogens may play an indirect role in the mechanisms of etiology of ED, which often start during adolescence [51].…”