Weight change and appetite disturbance as symptoms of adolescent depression: Toward an integrative biopsychosocial model

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Abstract

The Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.] lists weight change and appetite disturbance as a single compound symptom of depression at all ages. Nonetheless, assessment of these symptoms is complicated during adolescence by normative increases in body weight and appetitive drive as well as heightened rates of body dissatisfaction, dieting, and eating disorders. This review outlines biological and psychological mechanisms that may change the relation of weight change and appetite disturbance to depression during adolescence. We propose a developmental model of the relation of these symptoms to the disorder and use the model as a framework to summarize findings, limitations, and future directions of research. Although the literature suggests that weight change and appetite disturbance are related to adolescent depression, preliminary evidence suggests that interpretation of weight and appetite symptoms may depend on developmental level.

Section snippets

Facts about adolescent weight, appetite, and depression

In the simplest sense, weight and appetite regulation can be conceptualized as a feedback system. The brain receives input signals and then induces output signals to neural and hormonal systems that regulate metabolism and modulate food seeking behavior (Bray & Tartaglia, 2000). A variety of psychological and biological factors, many of which are in flux during adolescence, has the potential to complicate this relation (Schlundt, Hill, Sbrocco, Pope-Cordle, & Kasser, 1990). People consume more

Factors that influence adolescent weight, appetite, and depression

Adolescents clearly face a variety of opposing physiological, behavioral, and psychological forces. In the following section, we review several factors that could affect the apparent relation of weight and appetite disturbance to depression during adolescence, insofar as they (a) affect weight and/or appetite, (b) relate to depression, and (c) change during adolescence. Highlights of this review are summarized in Table 1.

A developmental model

Clearly many factors that influence weight, appetite, and depression undergo change during adolescence. These factors include psychological and behavioral variables (e.g., exercise, body dissatisfaction, dieting, eating disorders, stress), secretion of gonadal and peripheral hormones (e.g., cortisol, testosterone, estradiol, progestin, pituitary growth hormone, leptin), hypothalamic activation and neuropeptide levels (e.g., neuropeptide Y, melanocortins), and regulation of the reward system

Studies on the relation of weight change and appetite disturbance to depression

As a first step toward understanding the effect of development on the relation of appetite disturbance and weight change to depression, we reviewed empirical studies of these relations in child, adolescent, and adult samples. Three key questions guided this review. First, how prevalent are weight gain, weight loss, appetite increase, and appetite decrease in depressed children, adolescents, and adults? Second, are there developmental differences in these rates? Third, are the rates of weight

Discussion

Six major conclusions emerged from this review. First, many of the factors that control appetite and weight change during adolescence are also associated with depression (see Table 1). Second, these factors are in flux especially during puberty, creating a need for a developmental model in order to understand the relation of weight and appetite to depression to change during this period (see Fig. 1). Third, as anticipated by our developmental model, the prevalence of appetite and weight loss in

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    Melissa A. Maxwell was supported in part by a National Institute of Mental Health Training Grant (T32-MH18921).

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