Girls' Dieting and Depression: An Adolescent Crisis

Colette Dowling, LCSW

Author of the following article on couples counseling and real love, NYC psychotherapist Colette Dowling, LCSW, has also written The Cinderella Complex: Women's Hidden Fear of Independence, a best seller in twenty-three languages, and other books on relationhip issues.

NYC psychotherapist Colette Dowling,LMSW, author of the following article on girls, dieting and depression, has written 8 books on women's psychological issues, including The Cinderella Complex: Women's Hidden Fear of Independence, which was published in 23 languages.

Dieting has a relationship to depression in girls. Some girls start dieting as a way of coping with depression. Others become depressed because extreme dieting affects their serotonin levels.

Adolescence, for girls, signals nothing less than a developmental crisis. At the time of life when boys start becoming proud of their bodies--their muscles, their penises, the expressive arc of their urine--girls become preoccupied with whether or not their bodies measure up. They have an idea of a perfect feminine physique that can never be realized. In our society it is all too easy for girls to develop distorted body image. In an effort to perfect themselves they diet excessively and succumb to eating disorders. Some become depressed about their apperance, even suicidal.

A study published by the Commonwealth Fund a decade ago found that 1 out of 4 girls are depressed. The information that came out in this government-sponsored report was appalling--beyond what anyone had imagined was happening to girls. An alarming 29 percent "reported suicidal thoughts, 27 percent said they were sad 'many times' or 'all the time,' and one-third of older girls said they felt like crying 'many days' or 'every day'." A quarter of the girls said they had at some point wanted to leave home because of the violence. One in three of the girls in high school had thought about suicide in the two weeks prior to the survey!

Adolescence is a time when girls begin to develop a huge emotional investment in the goal of "perfection". The idea of perfection allows girls to remain passive. Maintaining the illusion of perfection is how female adolescents defend themselves against taking the huge, impossible-seeming risk of doing--of becoming a woman.

Psychologists have found that in females, self-esteem peaks at the age of nine. This is when girls are the most self-accepting they may ever be. Most girls, at nine, still have an integrated sense of their bodies. And then, at ten and eleven, their connection to the body becomes fragile and self-esteem starts its precipitous fall. Suddenly, they're not talking any more about what they really think and feel. They've become preoccupied with size, worried about looking "too big". Big means, among other things, strong and self-sufficient.

Adolescence, for girls, is a time of frantic dieting. Many girls at 12 and 13--and even younger--are setting themselves up for uncontrollable eating disorders by the time they're 15 and 16. Scientists now know that dieting is the trigger for these illnesses, if not their cause. Up to 25 percent of adolescents--90 percent of them girls--regularly purge to control their weight, a survey conducted by the Commonwealth Fund found. Nearly one in five ninth grade girls admitted to having binged and purged.(Bulimia is now known to be related to obsessive compulsive disorder, and is so described in psychiatry's Diagnostic and Statistic Manual. Anorexia is the perilous self-starvation disease connected with extreme distortion in body image.) What possibly could be the matter, here? Surely this epidemic of eating disorders can no longer be attributed to Twiggy and all the skinny models that came down the pike after her.

Biology may play a much bigger role than we've realzied. For girls, adolescence is a time of delicate hormonal balance. The extreme dieting so many engage in causes dangerous drops in estrogen, which in turn affects brain serotonin--a neurotransmitter that has a huge balancing influence on mood, sleep and appetite. Estrogen is necessary for the production of serotonin in the brain. When girls strip too much fat off their bodies their estrogen drops and this lowers their serotonin levels.

Brain serotonin is related to both compulsive behavior and obsessional ideas. So here is the possible biological sequence, which I learned of when researching my book, "You Mean I Don't Have to Feel This Way?" Girls who diet soon can't stop thinking about food and weight because lowered brain serotonin has caused the obsessive component of the illness to kick in. Ultimately they find themselves caught in a trap of uncontrollable, self-destructive behavior that is highly influenced by de-stabilized brain metabolism.

True, food restriction has to be pretty severe before such a cascade of biochemical events kicks in. Minor dieting won't do it. But because their self-image is so precarious, girls often go off the charts in restricting food intake. Often they exercise compulsively as well.

Carol Gilligan was the first to report the psychological phenomenon of "splitting" in teenage girls, a disconnection between mind and body, thoughts and feelings. In a famous series of studies that led to her becoming director of a new Gender Studies department at Harvard, Gilligan announced that splitting had become so pervasive, and so potentially impairing of identity, it signified a "developmental crisis" in females.

Since Freud, the so-called "flight from self" has been considered predictable--and even inevitable--for female adolescents. What had so long been recognized as a falling apart time for girls was glanced at, taken note of, and dismissed as part of the "normal" development of young females. It is far from normal, and girls need all the help adults can give them in developing a relaxed appreciation of their bodies and themselves.

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NYC psychotherapist Colette Dowling, LMSW, is best known for uncovering women's psychological conflicts with independence in her best-selling The Cinderella Complex: Women's Hidden Fear of Independence. She has also written on the unique mental health issues of midlife women in her book, Red Hot Mamas: Coming Into Our Own at Fifty.

Colette is a graduate of The Smith College School for Social Work, where she received an M.S.W. She has done advanced training at The Institute for Contemporary Psychotherapy, in New York. Ms. Dowling has a private therapy practice in Manhattan York and specializes in the treatment of women.

To hear Colette speaking on what it's like starting therapy with someone new, click the audio button.

For more information on girls, dieting and depression go to for Colette's book, "The Frailty Myth: Redefining the Physical Potential of Women and Girls". (Random House, 2001.)

NYC psychotherapist Colette has a private practice in Manhattan. Her profile can be found at the Psychology Today Directory of Therapists.

For more information on girls and women's psychological issues see Colette's website

Copyright Colette Dowling, 2006-2010