Of course, our bodies are changing from the moment we are born to the moment we die. We grow, we become ill and get well, we exercise or stop exercising, we age.

By definition, adolescence is a difficult time, a period of rapid growth and development. No big revelation there, but a point worth keeping in mind. Hormones flood the body, triggering an incredible number of physical and emotional responses. A young teenager’s body grows in all directions-taller, wider, thicker. The overall shape changes too. Most of these changes are directly related to sexual development.

For boys, maturity means broader shoulders, facial hair, deeper voice, and genital enlargement. Each of these is basically a desirable event, serving to enhance the boy’s feelings of masculinity. One other point: Nobody sees the changes in a boy’s sexual organs. They are-no pun intended-a private matter.

Maturity is a different experience for a girl. The physical changes are more obvious to everyone. Her breasts develop, her hips widen. The reproductive organs mature and menstruation begins. Her sexual growth takes more of a psychological toll. Girls can’t help comparing themselves to their peers; boys can’t help noticing the change.

With the onset of menstruation, a girl comes to associate maturity with perhaps excruciating pain, blood, uncontrollable mood changes, and the “hassle” of dealing with menstrual flow. The female body needs a certain percentage of fat tissue before menstruation can begin and continue. Maturity is thus directly tied to an increase in body fat.

The massive physical overhaul of adolescence requires an enormous amount of energy to sustain it. That energy, of course, comes from food. No wonder teenagers are always hungry!

As a rule, kids handle the trauma of adolescent development surprisingly well. It is, after all, an exciting time. The thrill of dating, the sense of growing independence, and the incredible energy of being young compensate, at least to some degree, for the stress of change.

Not everyone, however, is well equipped emotionally and psychologically to adjust to these physical and social demands. For some young girls, this sudden awareness of their sexuality, plus the pressure to develop new kinds of relationships with boys (and with other girls, for that matter) is too much. Add to this mix a family situation that fails to prepare the girl to cope with such changes and you have a recipe for trouble.

Whether consciously or unconsciously, some girls connect eating and body development. They think, “If I could just control my eating, I can control the changes in my body.” Doing so means they can avoid all the problems of puberty.

One of my patients, a fourteen-year-old girl named Kate, reached 112 pounds. She then became anorexic and starved herself down to 83 pounds. During treatment she agreed to return to a weight between 101 and 105, which was the range at which menstruation had stopped. She stated adamantly that she “never wanted to get back up to one hundred and twelve again.”

We explored the reason for her attitude. It turns out that, shortly before her illness began, she had walked past a construction site. In typical fashion, the construction workers whistled at her; one yelled out, “Nice ass, baby!”

Unfortunately, this type of emotional harassment exists everywhere, and I think it’s disturbing to every woman. Teenagers, sadly, are often least able to cope with it. Kate felt humiliated and embarrassed. Later she began to sense, more or less consciously, that if her weight dropped she wouldn’t have to cope with that kind of abusive and unwanted sexual attention. A girl of eighty-three pounds, whose body has the silhouette of a ten-year-old, is at very low risk of being told she has a “nice ass.”

Of course, girls are often flattered at being noticed by people they know and like. They appreciate compliments from people they trust. But for a girl who is overwhelmed by such attention, or who is unprepared to deal with it, the “safer” option might be to starve herself and avoid such confrontations entirely. That option-anorexia nervosa-is anything but safe.

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