Human Growth and Development Theories/Adolesant Years

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THIRD EDITION

Human Development A Cultural AoDroach

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chapter 8

Adolescence;t

PHYSICAL DEVELOPMENTSECTION 1 'S

Metamorphosis: Biological Changes of Pubertyi’ The The Physical Changes of Puberty The Timing of Puberty Cultural Responses: Puberty Rituals

Health Issues in Adolescence

Eating Disorders Substance Use

COGNITIVE DEVELOPMENTSECTION 2

Adolescent Cognition

Piaget's Theory of Foimal Operations haformation Processing: Selective Attention and Executive Function

Social Cognition: The Imaginary Culture and Cognition

Education and Work Schools: Secondary Education Work

Audience a

I: and Advances in Memory a

nd the Personal Fable

I 1 i'

S'.

& ii-:

EMOTIONAL AND SOCIAL DEVELOPMENT L-

SECTIONS b

Emotional and Self-Development Emotionality iir Adolescence: Storm and Stress? Self-Development in Adolescence Gender Development

Cultural Beliefs: Morality and Religion , Moral Development

Religious Beliefs The Social and Cultural Contexts of Adolescence Family Relationships Peers and Friends

Love and Sexuality

Media Use

Problems

Crime and Delinquency

Depression i.

328

Adolescence 329

ADOLESCENCE IS A TIME OF DRAMATIC CHANGES. ALTHOUGH THE PHYSICAL CHANGES OF PUBER TY ARE THE MOST OBVIOUS, there are other dramatic

;■ changes as well, in family relations, peer relations, sexual ity, and media use. Adolescents also change in how they tlaink and talk about the world around them..• I

around age 10 or school with their p

11. They spend most of their days iin eers. Outside of school, too, they spend

most of their leisure time with other persons their age—- friends and romantic partners. A substantial proportion of their daily lives involves media use, mduding mobile phones, electronic games, television, and music.

But another cultural form of adolescence is prevalent in most of the developing world, including Africa, Asia, and South America. In this kind of adolescence, a typical day is spent not mostly with peers in school but with family bers, working (Schlegel, 2010; Schlegel & Barry, 2015). Girls spend most of their time with their mothers and other adult

mem-

Adolescence is a cultural construction, not simply a bio logical phenomenon or an age range. Puberty— set of biological changes involved in reaching physical and sexual

y maturity—is universal, but adolescence is more than the I events and processes of puberty; Adolescence is a period of

the life span between the time puberty begins and the time adult status is approached, when yoimg people ing to take on the roles and responsibilities of adulthood t their culture. To say that adolescence is culturally constructed means that cultures vary in how they define adult status and

^ in the content of the adult roles and responsibilities adoles- I cents are learning to fulffil. Almost all cultures have

are prepar- ty ! m

some

women, learning the skills and knowledge necessary to ful fill the roles for women in their culture. Boys spend most of their time with adult men, learning to do what men in their culture are required to do, but they are aUowed more time

H-

with friends than adolescent girls are. Some adolescents in developing countries go to school, but for others school is something they left behind by the end of childhood.

We will discuss both of these forms of adolescence in the course of this chapter, and the many variations that exist within each form. We will also discuss the ways that the traditional cultural forms of adolescence in developing cocrntries are changing with exposure to industrialization and globalization.

l^ykind of adolescence, but the length, content, and daily expe- liriences of adolescence vary greatly among cultures (Larson

. et al., 2010). There is no definite age when adolescence begins ?pr ends, but it usuaUy begins after age 10 and ends by age 20, ^0 it comprises most of the second decade of life. !,:■ Today, adolescence takes two broad cultural forms. In ^developed countries, adolescents usually begin puberty

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330 Chapter 8

SECTION 1 PHYSICAL DEVELOPMENT

Learning Objectives

List the physical changes that begin puberty and summarize the

surprising changes in brain development during adolescence.

Describe the normative timing of pubertal events, cultural variations, and how being early or late influences emotional and social

development.

Identify the main gender differences in puberty rituals worldwide.

Describe the prevalence, symptoms, and treatment of eating disorders.

Summarize rates and trends in adolescent substance use arid classify adolescent substance use into four categories.

8.1

8.2

8.3

8.4

8.5

PHYSICAL DEVELOPMENT:

The Metamorphosis: Biological Changes of Puberty Adolescence begins with the first notable changes of puberty. In the course of puberty, the body is transformed in many ways and reaches the capacity for sexual reproduction. After growing at a steady rate through childhood, early in the second decade of life chil

dren begin a remarkable metamorphosis that includes a growth spurt, the appearance of pubic hair and underarm hair, changes in body shape, breast development and menstrua tion in girls, the appearance of facial hair in boys, and much more. The changes can be exciting and joyful, but adolescents experience them with other emotions as well—fear,

surprise, annoyance, and anxiety. New research also reveals some unexpected findings in brain development.

adolescence

period of the life span between the time puberty begins and the time adult status is approached,

when young people are prepar

ing to take on the roles and responsibilities of adulthood in their culture

The Physical Changes of Puberty List the physical changes that begin puberty and summarize the surprising changes in brain development during adolescence.

The word puberty is derived from the Latin word pubescere, which means "to grow hairy." This fits; during puberty hair sprouts in a lot of places where it had not been before! But adolescents do a lot more during puberty than grow hairy. Puberty entails a biological revolution that changes the adolescent's anatomy, physiology, and physical appearance. By the time adolescents reach the end of their second decade of life they look much differ ent than before, their bodies function much differently, and they are biologically prepared

for sexual reproduction.

LO 8.1

puberty

changes in physiology, anato

my, and physical functioning that develop a person into a

mature adult biologically and

prepare the body for sexual

reproduction HORMONAL CHANGES During middle childhood the proportion of fat in the body

gradually increases, and once a threshold level is reached a series of chemical events is

triggered beginning in the hypothalamus, a bean-sized structure located in the lower part of the brain (Livadas & Chrousos, 2016; Paris et al., 2017; Plant, 2015). These events lead the ovaries (in girls) and testes (in boys) to increase production of the sex hormones.

Adolescence 331

70 5 400 U

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S 503000) c

oo ■o 30<D 200 CO

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1 2 3 4 5

Pubertal stage 1 2 3 4 5

Pubertal stagens.

Figure 8.1 Hormonal Changes in Puberty different hormonal paths at this life stage.Girls and boys follow very

SOURCE: Nottelmann et al. (1987).

estrogens hormones that have es

pecially high levels in females from puberty onward and are mostly responsible for female primary and secondary sex characteristics

androgens hormones that have

especially high levels in males from puberty onward and are mostly responsible for male primary and secondary sex characteristics

estradiol the estrogen most important in pubertal development among girls

sex

two classes of sex hormones, the estrogens and the androgens. With respect to pubertal development, the most important estrogen is ^Lrogen is testosterone (Herting et al., 2014; Lawaetz et al, 2015; Shirtcliff et al., 2009Estradiol and testosterone are produced in both males and females and teougho ̂ childhood the levels of these hormones are about the same m ^ Brooks-Gimn, 2006). However, as you can see m Figure 8.1, once pu e ty g

There are

m.*rnre“»diol production is about eight times as >^8^' " “ “ “ h:torepubertg,butotdp.houth,s»asMghmm^.«

only about four times as high (Melmed et al., other kinds of bodily changes of puberty; the

ance

was

contrast, testosterone production in before puberty, but in females it isit was

2016). These hormonal increases lead to two maturation of the primary and secondary sex characteristics.

rty. on.

til- characteristics

(eggs) in femalesPRIMARY AND SECONDARY SEX CHARACTERISTICS Primarydirectly related to reproduction: specifically, the production of ,and sperm in males. The development of ova and sperm takes place quite differentlynipH in Chanter 2. Females are bom with all the ova they will ever have, and they have about 300,000 ova at the time they reach puberty (Normaiy menarche (her first menstrual period) and begins havmg menstrual cycles one ovum (egg) “s 28 days o, so. Females release about 400 ova h. the course o, them rsp.odue-

to coiwTmllt sperm to toeir testes when they are bom. However wheu tbey"prod„ee sperm (ceded spermarche) around age 12, males^ ■ u- ^ uHpq Thpre are between 100 and 300 million sperm m the typical male

faverage male produces mllhons (Johnson, 2016), If you are a man, you will probably produce over a m.lbon sperm durmg the time you read this chapter-even if you are a fast reader.SecoLarv sex characteristics are the other bodily changes resulting from the ns

sex

ova

are

■of

ra-

:ar. testosterone

the androgen most important in pubertal development among boys

sex characteristicsprimary production of ova (eggs) and

and the development ofsperm the sex organs

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menarche first menstrual period

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ir-

beginning of development of sperm in boys’ testicles atad

puberty

in Figure 8.2. secondary sex

brain development In addition to the hormonal *“Ses and development *aianens - --- ̂ -Cyretatedtoteptaduce.

ly IS

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332 Chapter 8V^,

'n MalesFemales

Skin oil and sweat

Underarm hair

Sper'mptoi'udllon]

Menarche J

'Cfianpln’volce^

anz. Growth spurt

Pubic hair

Breast development

il ls•J; 16 171513 1410 129 11

i! Age

Figure 8.2 Timing of the Physical Changes of Puberty NOTE: The bars show the range at which each change begins for 90% of the popuiation studied.

SOURCE: Based on Chumiea et al. (2003), Goldstein (1976).

logical de-velopment in adolescence (Giedd et al., 2015; Silverman et al., 2015; Taber-Thomas & Perez-Edgar, 2015). Some findings have been surprising, overturn

ing previous views. It has long been known that by age 6 the brain is already 95% of its adult size.

However, when it comes to brain development, size is not everything. Equally if not

more important are the synaptic connections between the neurons. Now scientists have

learned that a sharp increase in synaptic connections occurs around the time puberty

begins (ages 10-12), a process called overproduction or synaptic exuberance. Earlier studies

neuro

J 1

Many dramatic physical changes take place in the course of adolescence. Here, a boy at the outset of puberty and again in his late teens.!

Adolescence 333

had shown that overproduction occurs during prenatal development and through the first 3 years of life, but it turns out that overproduction occurs in early adolescence as well (Giedd et al., 2015). Overproduction of S)maptic connections occurs in many parts

of the brain during adolescence but is especially concentrated in the frontal lobes, where

most of the higher functions of the brain take place, such as planning ahead, solving problems, and making moral judgments.

Overproduction peaks at about age 11 or 12, but obviously that is not when our cog nitive abilities peak. In the years that follow, a massive amoimt of synaptic pruning takes

place, in which the overproduction of synapses is whittled down considerably—synapses that are used remain, whereas those that are not used wither away. In fact, between the

ages of 12 and 20 the average brain loses 7% to 10% of its volmne through synaptic prun ing (Giedd et al., 2015; Laviola & Marco, 2011). Synaptic pruning allows the brain to work

efficiently, as brain pathways become more specialized. However, as the brain spe-more cializes it also becomes less flexible and less amenable to change.

Myelination is another important process of neurological growth in adolescence. Myelin is a blanket of fat wrapped around the main part of the neuron, and it increases

V' the speed of the brain's electrical signals. Like overproduction, myelination was pre viously thought to be finished prior to puberty but has since been found to continue

t through the teens (Giorgio et al, 2010; Markant & Thomas, 2013). This is another indi- 1 cation of how brain functioning becomes faster and more efficient during adolescence, .i „ However, like synaptic pruning, myelination also makes brain functioning less flexible

and changeable. J: Finally, one last recent surprise for researchers studying brain development in ado- i lescence has been the growth of the cerebellum. This is perhaps the biggest surprise of V: all, because the cerebellum is part of the lower brain, well beneath the cortex, and had

•I long been thought to be involved only in basic functions such as movement. Now, how- research shows that the cerebellum is important for many higher hmctions as well.

.tv ,j ever,

L such as mathematics, music, decision-making, and even social skills and understanding

I' humor. It also turns out that the cerebellum continues to grow through adolescence and well into emerging adulthood, suggesting that the potential for these functions continues

I; to grow as well (Tiemeier et al., 2009). In fact, it is the last structure of the brain to stop § growing, not completing its phase of overproduction and pruning until the mid-20s, even

after the frontal lobes (Taber-Thomas & Perez-Edgar, 2015).

I, The Timing of Puberty I LO 8.2 Describe the normative timing of pubertal events, cultural variations, and

how being early or late influences emotional and social development.

it A great deal of variability exists among individuals in the timing of the development

|; of primary and secondary sex characteristics, as Figure 8.2 shows. For example, among i; girls, underarm hair could begin to appear as early as age 10 or as late as age 16; among Kiboys, the change in voice could begin as early as age 11 or as late as age 15 (Fisher & K Eugster, 2014). On average, girls begin puberty 2 years earlier than boys, gv The norms in Figure 8.2 are for White American and British adolescents, who have been

for many decades, but three studies demonstrate the varia-’Studied extensively in this area [tions that may exist in other groups. Among the Kikuyu, a culture in Kenya, boys show the fet physical changes of puberty before their female peers, a reversal of the Western pattern [(Worthman, 1987). In a study of Chinese girls, researchers found that pubic hair began [to develop in most girls about 2 years after the development of breast buds, and only a Tew months before menarche, whereas in the Western pattern girls develop pubic hair P^uch earlier (Lee et al., 1963). Also, in an American study (Herman-Giddens et al., 1997; perman-Giddens et al, 2001), many African American girls were found to begin develop-

breast buds and pubic hair considerably earlier than White girls. At age 8, nearly 50%

334 Chapters

of the African American girls had begun to develop both, compared with just

15% of the White girls. This was true even though African American and VVhite girls were similar in

their ages of menarche. Similarly, pubic hair and genital development began earlier for African American boys than for White boys. Studies such as these indicate that it is important to

investigate further cultural differences in the rates, timing, and order of pubertal events.

Given a similar cultural environment.

breasts or pubic hair or

variation in the order and timing of pubertal

events among adolescents appears to be due more similar two people areto genetics. The

genetically, the more similar they tend to be in | the timing of their pubertal events, with idenh- j cal twins the most similar of all (Ge et al, 2007;

den Berg, 2007; Willemsen & Dunger, 2016).van However, when cultural environments vary, the !

timing of puberty also varies, as we shall see next. j In the Kikuyu culture in Kenya,

boys reach puberty earUer than girls.

CULTURE AND THE TIMING OF PUBERTY Culture includes a group's technologies. The age nt which puberty be-and technologies include food production and medical

gins is strongly influenced by the extent to which food production provides adequate nu trition and medical care protects health, throughout childhood (Eveleth & Tanner, 1990;^

care.

Papadimitriou, 2016). . . r '' Persuasive evidence for the influence of technologies on pubertal timmg comes from^^

historical records showing a steady decrease in the average age of menarche m Westerit countries from the mid-19th to the late 20th century. This kind of trend in a popula tion over time is caUed a secular trend. A declining secular trend for age of menarche has occurred in every Western country for which records exist, as shown in Figure 83 _ (Sorensen et al., 2012). Menarche is not a perfect indicator of the initiation of puberty^^,; the first outward signs of puberty appear much earlier for most girls, and of course,

good indicator of when othe^

'.e

menarche does not apply to boys. However, menarche is a

secular trend

change in the characteristics of a population over time

14.0 -I IBelgium

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Netherlands, 1970 1980 1990 2000

Year of study

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Poland

Portugal

Spain

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^US 1890 1910 1930 1950 1970 1990 2010

Year of study 1830 1850 1870 1.

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Figure 8.3 The Secular Trend in Age of Menarche Why did age of reaching menarche decline? SOURCE: Sorensen et al, (2012).

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Adolescence 335

events have begun in girls, and it is a reasonable assumption that if the downward trend in the age of puberty has occurred for girls, it has occurred for boys as well. Menarche is also the only aspect of pubertal development for which we have records going back so many decades. Scholars believe that the downward trend in the age of menarche is due to improvements in nutrition and medical care during the past 150 years (Archibald et al, 2003; Papadimitriou, 2016). As the inset to Figure 8.3 shows, age of menarche has been unchanged since about 1970, when access to adequate nutrition and medical care

had become widespread in developed countries. Further evidence of the role of nutrition and medical care in pubertal timing comes

from cultural comparisons in the present. The average age of menarche is lowest in developed cormtries (currently about 12.5 years old), where adequacy of nutrition and medical care is highest (Papadimitriou, 2016; Sorensen et al, 2012). In contrast, men

arche takes place at an average age as high as 15 in developing countries, where nutri tion may be limited and medical care is often rare or nonexistent. However, in countries

such as China and South Korea that have undergone rapid economic development in recent decades, the average age of menarche has been declining (Ji & Chen, 2008; Park et al., 1999; Sohn, 2017).

SOCIAL AND PERSONAL RESPONSES TO PUBERTAL TIMING Think back for a

moment to when you were passing through puberty. What were your most memorable pubertal events? How did you respond to those events—and how did the people arormd you respond?

Social and personal responses to puberty are intertwined, because how adolescents

respond to reaching puberty depends in part on how others respond to them. In devel oped countries, social and personal responses may depend on whether adolescents reach

puberty relatively early or relatively late compared with their peers. When adolescents spend time in school on most days, surrounded by peers, they become acutely aware of how their maturation compares to others'.

A great deal of research has been conducted on early versus late maturation among adolescents m the West, extending back over a half century. The results are complex: They differ depending on gender, and the short-term effects of maturing early or late appear to differ from the long-term effects.

Research consistently shows that the effects of early maturation are usually nega tive for girls. Findings from a variety of Western countries concur that early-maturing girls are at risk for numerous problems, including depressed mood, negative body image, eating disorders, substance use, delinquency, aggressive behavior, school problems, and conflict with parents (Graber, 2014; Harden & Mendle, 2012; Westling et al., 2008). Early

. maturation is a problem for girls in part because it leads to a shorter and heavier appear- t ance, which is a disadvantage in cultures that value slimness in females.

Iv It can also be troublesome because their early physical development I’’■ draws the attention of older boys, who then introduce them to an i; older group of friends and to substance use

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Early-maturing girls are at high risk for problems, in part because they attract the interest of older boys.

, delinquency, and . early sexual activity (Graber et al., 2010; Skoog & Stattin, 2014). " " y Studies of the long-term effects of early maturation for girls are y mixed, with some finding that the effects diminish by the late

'teens and others finding negative effects well into emerging I adulthood (Graber, 2014; Posner, 2006; Weichold et al., 2003).

H In contrast to girls, the effects of early maturation for P^oys are positive in some ways and negative in others B (Mendle & Ferrero, 2012). Early-maturing boys tend I* have

more favorable body images and higher popularity |than other boys (Graber et al., 2010; Weichold et al., 2003). :?;The earlier development of facial hair, lowered ft other

voice, and

secondary sex characteristics may make early-maturing

336 Chapter 8

boys more attractive to girls. Early-maturing boys may also have a long-term advantage. One study that followed early-maturing adolescent boys 40 years later found that they had achieved greater success in their careers and had higher marital satisfaction than later-maturing boys (Taga et al., 2006). However, not everything about being an early- maturing boy is favorable. Like their female counterparts, early-maturing boys tend to become involved earher in delinquency, sex, and substance use (Beyens et al., 2015;

Westling et al., 2008). Late-maturing boys also show evidence of problems. Compared to boys who

mature "on time," late-maturing boys have higher rates of alcohol use and delin

quency (Mendle & Ferrero, 2012; Skoog & Stattin, 2014). They also have lower grades in school (Weichold et al., 2003). There is some evidence that late-maturmg boys have elevated levels of substance use and deviant behavior well into emerging adulthood

(Biehl et al., 2007; Graber, 2014). Late-maturing girls have relatively few problems (Weichold et al., 2003).

Cultural Responses: Puberty Rituals LO 8.3 Identify the main gender differences in puberty rituals worldwide.

mitzvahs and bat mitzvahs, the Cathohc ritual of confirmation, and the quinceanera

that takes place at age 15 for girls in Latin American cultures are aU examples of puberty rituals that have developed to mark the departure from childhood and the entrance

into adolescence. Puberty rituals are especiaUy common in traditional cultures. Alice

Schlegel and Herbert Barry (1991) analyzed information on adolescent development across 186 traditional cultures and reported that 68% had a puberty ritual for boys, 79% for girls (Schlegel & Barry, 1991).

For girls, menarche is the pubertal event most often marked by ritual (Schlegel & Barry, 2015). In fact, in many cultures menarche initiates a monthly ritual related to, menstruation that lasts throughout a woman's reproductive life. It is remarkably com mon for cultures to have strong beliefs-usually negative-concerning the power of menstrual blood (Tan et al., 2017). It is often believed to present a danger to the growth and life of crops, to the health of livestock, to the likelihood of success among hunters, and to the health and well-being of other people, particularly the menstruatingwom- » an's husband (Buckley & Gottlieb, 1988; Johnston-Robledo & Christleq 2013; Marvan

Trujillo, 2010). Consequently, the behavior and movement of menstruating women || are often restricted in many domains, including food preparation and consump^n, social activities, religious practices, bathing, school attendance, and sexual ; « Menarche is often believed to possess special power, perhaps because It is a gir^s A menstruation, so the restrictions imposed may be even more elaborate an ex ens

Bar

puberty ritual formal custom developed in

many cultures to mark the de parture from childhood and the entrance into adolescence

(Yeung & Tang, 2005). • oi event ,! Traditional puberty rituals for males do not focus on a particular bio ogic , ̂ ■ parable to menarche for females, but the rites for males nevertheless share some co ̂ „

mon characteristics. Typically, they require the young man to display ^ and endurance (Gilmore, 1990; Schlegel & Barry 2015). Daily life in traditional

in warfare, hunting, fishing/ anq^

com

i ■

often demands these capacities from yormg men reatum^ tasks. Thus, the rituals could be interpreted as letting them know what wi ® . of them as adult men and testing whether they will be up to adulthood s ̂ ̂

often violent, requiring boys to submit to an „ ‘.^1, the Amhara of btmo|t,_

uared off and : j:- tchthq^^.:- N

the past, rituals for boys were engage in bloodletting of various kinds. For example, among boys were forced to take part in whipping contests in which they sq ated each other's faces and bodies (LeVine, 1966). For more information, wa

Puberty Rituals. t;

Adolescence 337

Watch PUBERTY RITUALS

in the West, people m Although these rituals may sound cruel if you have grown up » in these cultures believed that the rituals were necessary for boys to make the passage M out of childhood toward manhood and to be ready to face life's challenges. In all these '* ■ cultures, however, the rituals have declined in frequency or disappeared altogether m

recent decades (Schlegel, 2010; Schlegel & Barry, 2015). Because traditional cultures changing rapidly in response to globalization, traditional puberty rituals no longer

seem relevant to the futures young people anticipate. However many African cultures still maintain public circumcision for boys as a puberty ritual (Schlegel & Barry, 2017).

Female circumcision in adolescence, which involves cutting or altering the gemtalj also remains common in Africa, with rates over 70% m many countries and above 90 /o

. in Mali, Egypt, Somalia, and Djibouti (Chibber et al., 2011; Toubia, 2017). The physical " ■' of circumcision are much more severe for girls than for boys. Typically, a

and the possibility of infection is high. Afterward many urinate, and their risks of uri-

are

consequences great deal of bleeding occurs,

ai; girls have chronic pain whenever they menstruate or ^ • i, L', nary infections and childbirth complications are heightened (Eldm, 2009). Critics have

termed it female genital mutilation (FGM) and waged an international campaign against V , it (Barrett, 2016; Odeku et al., 2009). Nevertheless, it remams viewed in many African b cultures as necessary in order for a young woman to be an acceptable marriage partner i ■

" ?

:1: Si

!; ' (Toubia, 2017). T '

Western cultures that areCritical Thinking Question: Are there any rituals in , . ^cimlSbk .0 the puber^ rituals in traditional cultures? ShouM P~P>; ‘"“jcultures recognize and mark the attainment of puberty more than they do now? If SO, why, and how?

PHYSICAL DEVELOPMENT: Health Issues in Adolescence

fSc-'-;

■'Like middle childhood, adolescence is a life stage when physical health is gerierally functions more effectively in middle childhood and ado-

■y-

f Sood. The immune system Hscence than earlier in development, so susceptibhity to infectious diseases is lower.

338 Chapters U--

P Diseases that will become more common later in adulthood, such as heart disease ‘

and cancer, are very rare during adolescence. However, unlike middle childhood, ! adolescence is a time when problems arise not from physical functioning but i from behavior. Two common problems of adolescence are eating disorders j and substance use. ' J

Eating Disorders LO 8.4 Describe the prevalence, symptoms, and treatment

of eating disorders. ]

For many adolescents, changes in the way they think about their bodies !

are accompanied by changes in the way they think about food. Girls, in :

particular, pay more attention to the food they eat once they reach adoles

cence, and worry more about eating too much and becoming overweight '

(Jones et ah, 2014; Nichter, 2001). This is especially true in the United States.

Currently, about 31% of American 10- to 17-year-olds are overweight or

obese by medical standards (Kaiser Family Foundation, 2015). However,

60% of American adolescent girls and 30% of boys beheve they weigh too much (Gray et ah, 2011).

These perceptions can lead adolescents to exhibit eating disordered

behavior, including fasting for 24 hours or more, use of diet products, purging (intentional vomiting or use of laxatives), and use of laxa

tives to control weight. In the United States, about 23% of adolescent

girls and 10% of boys in grades 9-12 report engaging in eating disor

dered behavior in the past 30 days (Office of Disease Prevention and

Health Promotion, 2017). Similar findings have been reported in other Western countries. In a national study of German 11- to 17-year-olds, one

third of girls and 15% of boys reported symptoms of eating disorders (Herpetz- Dahlmann et ah, 2008). In Finland, a large study of 14- to 15-year-olds found eating disordered behavior among 24% of girls and 16% of boys (Hautala et ah, 2008).

The two main eating disorders are anorexia nervosa (intentional self-starvation)

and bulimia (binge eating combined with purging). About three percent of American adolescents have experienced anorexia nervosa or bulimia (NIMH, 2017). Nearly all (90%) of eating disorders occur among females. Most cases of eating disorders have | their onset among females in their teens and early 20s (Smink et al., 2013).

Anorexia is characterized by three primary symptoms (American Psychiatric | Association, 2013);

Young women with anorexia nervosa often see themselves as

too fat even when they are so thin their lives are at risk.'t

anorexia nervosa

eating disorder characterized by intentional self-starvation

bulimia

eating disorder characterized

by episodes of binge eating

followed by purging 1. eating less than needed to maintain a body weight that is at or above normal weight

for height,

2. intense fear of weight gain; and

3. distorted body image with undue influence of body weight or shape on self-evaluation.I

i One of the most striking symptoms of anorexia is the cognitive distortion of body

image (Striegel-Moore & Franko, 2006). Young women with anorexia sincerely believe themselves to be too fat, even when they have become so thin that their lives are threat

ened. Standing in front of a mirror with them and pointing out how emaciated they

look does no good—the person with anorexia looks in the mirror and sees an over

weight person, no matter how thin she is. The video Anorexia Nervosa: Tamora provides an example of this.

Adolescence 339

Watch ANOREXIA NERVOSA: TAMORA

Like those with anorexia, persons with bulimia have strong fears that their bodies will become big and fat (Campbell & Peebles, 2014). They engage in binge eating—eating a large amount of food in a short time—then purge themselves; that is, they use laxatives or induce vomiting to get rid of the food they have just eaten during a binge episode. People with bulimia often suffer damage to their teeth from repeated vomiting (because stomach acids erode tooth enamel). Unlike those with anorexia, persons with bulimra typically maintain a normal weight, because they have relatively normal eating patterns between episodes of bingeing and purging (Striegel-Moore & Franko, 2006). Another difference from anorexia is that persons with bulimia do not regard their eating patterns as normal. They view themselves as having a problem and often hate themselves after binge episodes.

Self-starvation among young women has a long history in Western countries, and 'i was once considered a sign of religious devotion, hundreds of years ago (Vandereycken &

van Deth, 1994). Today, eating disorders are most common in cultures that emphasize ; slimness as part of the female physical ideal, especially Western countries (Latzer et al,

2011; Piat et al, 2015). Presented with a cultural ideal that portrays the ideal female body V as sUm, at a time when their bodies tend to become less slim and more rounded, many

ji, adolescent girls feel distressed and attempt to resist or modify the changes taking place ip their body shape. Young women who have an eating disorder are at higher risk for other i|7: mental health disorders, such as depression and anxiety disorders (Rojo-Moreno et al., || 2015; Swanson et ah, 2011). Eating disordered behavior is also related to substance use,

especially cigarette smoking and binge drinking (Pisetsky et ah, 2008). Although mainly a Western problem, eating disorders are increasing in parts of the

world that are becoming more Westernized. For example, on the island nation of Fiji/ ha^tionally the ideal body type for women was round and curvy. However, after tele-

; vision was introduced in 1995, mostly with programming from the United States and other • Western countries, the incidence of eating disorders rose substantially (Becker

Interviews with adolescent girls on Fiji showed that they admired the television characters and wanted to look like them. This goal, in turn, led to

FiS^fij incidence of negative body image, preoccupation with weight, and purging ke- .(Becker, 2004).

■ -3

k' h' if:

f';?

340 Chapters

XHe »ain «„.s f« and psychotherapy, but the success of these approache chronically ill LLd for anorexra m hospital prograrns unprove^ “ t are success- despite treatment (Lock, 2015). Similar y,^^^ g ^ recovery is ful in about 50% of cases, are rep irrg adults with a history of eating often slow (Smink et al., 2012). ^ physical health, disorders often contmue to show sign^ ^ (Berkman et self-image, and social <=' „,„mally die from

caused dy .her, weigh, loss, .he highes. mor.ahfy rate of any psychiatric disorder (Smink et al., 201 ).

Substance Use and classify

LO 8.5 Summarize rates and trends in adolescent substance us.

adolescent substance use into four categories.

In Auierican sodety^substance^use dl°Mororml*Sfuture.org^ 2017), use pol and 2» ̂;P;rpariX:)"w"^ »' t”' ^^ exceeded by rates of usmg

also higher than for cigarette in the past month in the

electronic va-(at least once notably, rates of smoking cigarettes are now norizers for smoking (12%). Rates of marijuana Loking: 23% of high school seniors reported usmg marijuana 2016 MTF survey. hiorhest among Native Americans, fol-

In general, substance use in adolescence is tughest among^

have declined sharply among American adolescents

use are

adolescents lowest

cigarettes, and marijuana nearly all types of substance use since peaking around 1980 (Miech et al., 2017).

Rates of substance use in adolescence vary aero World Health Organization (WHO) investigated

;ueru„e„ts in Canada and the Um.ed States tov waged large-scale public health campaigns agamst smoking, whereas European countries have ^ Cigarette smoking among young people is o p ticular concern, because in the long run smoking is the source of more illness and fllegal drugs combined, and because th' of persons who smoke begin m their e y

Western countries. A study by the of alcohol and cigarettes among

of the results is shown in Canada and

use

Rates of cigarette smoking and alcohol use are higher in most

European coimtries than in Canada or the United States. Here, adolescents in Germany.

(Tohnston et al., 2014). of Yotmg people use substances for a vane y

purposes, which can be classified as expenmen L, social, medicinal, and addrcf.ve 1992). Young people who take par in . P tal substance use try a substance once or pe P a few times out of curiosity and then do not it again. Social substance use

during social activities

of involves the use

with one or substances

■ C‘i: 13

common friends. Parties and dances aremore

Adolescence 341

Alcohol use among 15-year-olds, weekly 35

] Boys Girls 30- -- ;

25 -

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o s: 15-

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Figure 8.4 Substance Use in Western Countries I;', SOURCE: Based on WHO (2016).

‘►f\h"-i

I settings for social substance use in adolescence and emerging adulthood. Medicinal

substance use is undertaken to relieve an unpleasant emotional state such as sad- |iess, anxiety, stress, or loneliness. Using substances for these purposes has been de- ,scribed as self-medication (Reimuller et ah, 2011). Young people who use substances

p|pr self-medication tend to use them more frequently than those whose purposes ip,re rnainly social or experimental. Finally, addictive substance use takes place when ^rllf^rson has come to depend on regular use of substances to feel good physically P?^P®y‘^hologically. People who are addicted to a substance experience withdrawal ^^grnptoms such as high anxiety and tremors when they stop using it. Addictive sub- jjP^ance use involves the most regular and frequent substance use of the four catego- ^i§s described here. |||R;'AU substance use in adolescence and emerging adulthood is considered "problemsomething that adults generally view as a problem if young people engage in

self-medication

use of substances to relieve

unpleasant emotional states -iP

owever, the four categories indicate that young people may use substances in diverse ■ ' diverse implications for their development.

1®

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