The Wellness Insider has explored the issues of emotional eating, binge eating and body image intimately over the last few months. If you’ve been reading our articles, you might have noticed the term “eating disorder (ED)” used quite frequently. But what does it mean to have an eating disorder? How does it impact your life? How serious is this condition?
What are Eating Disorders?
As a psychologist, I have seen my share of clients with ED, most frequently teenage girls and young women. I have often heard family members of these individuals dismiss the very real problems of the affected individual, seeing it as merely “a passing phase”. This is a common misconception. EDs are a range of serious psychological disorders, one with potentially fatal consequences if left untreated. It is characterised by abnormal or disturbed patterns of dieting and eating that may cause health problems and emotional/social impairment.
Though they exist on a continuum, there are three formal categories:
1) Anorexia Nervosa is a refusal to sustain a normal body weight that is healthy or one that is expected for the individual’s age and height. Typically, this means that a person is less than 85% of his/her acceptable weight. Despite being underweight, an individual with anorexia remains fearfully preoccupied with thoughts of gaining weight.
2) Bulimia Nervosa is characterised by episodes involving binge-eating where the individual consumes an unusually large amount of food in the span of one to two hours, followed by desperate attempts to negate the consequences of the binge through unhealthy behaviours. These include the misuse of laxatives and diuretics, self-induced vomiting, severe caloric restriction or excessive exercising. The person feels out of control while bingeing and is unable to stop even if they want to.
3) Eating Disorder Not Otherwise Specified (EDNOS) encompasses EDs that do not meet the full criteria of anorexia or bulimia but still cause social and emotional distress. Examples include chewing and spitting out food, purging without binge-eating and conversely, binge-eating without compensatory behaviours.
Statistics & More Facts
It is a myth that only women suffer from EDs; 10 to 15% of the population wi
th anorexia and bulimia are men. The assumption that men don’t have EDs means that they are also more likely to die from an ED due to late detection and treatment. Another common misconception is that EDs are a Western construct and therefore exists only in the West. With the westernisation of the concept of beauty, fashion, television and social media, ED has, in fact, become prevalent world over. Worldwide, there are approximately 70 million people suffering from this condition.
In Singapore, the rates of EDs started to climb in the 1990s, especially among university students. An interesting finding from a study conducted during that period indicated that the current status of ED in Asia could be the unfortunate result of the Trim and Fit (TAF) programme, which was aimed at addressing weight-loss in childhood obesity.
A 2006 study found that 7.4 percent of young Singaporean women with an average age of approximately 16 were at risk of developing an ED (http://www.smj.org.sg/article/prevalence-and-profile-females-risk-eating-disorders-singapore). Moreover, another 2015 study found that Singaporean women tended to have more severe forms of anorexia and, more worryingly, the rates of anorexia increased by 115 percent from 2003 to 2010. For more of such alarming facts, check out our article on 17 Facts About Body Image and Eating Disorders.
Causes & Consequences of EDs
Though it might be convenient to blame Western cultural ideals of thinness for the proliferation of EDs, the truth is that EDs are complex disorders with a genetic component that is strongly influenced by biological and environmental factors. Such factors can include:
- Research has found that altered brain circuitry in some sufferers may contribute to the development of the ED.
- Body image dissatisfaction and low self-esteem.
- Dieting, especially restrictive dieting in which individuals take extreme measures to lose weight.
- Temperament, particularly those with perfectionistic traits, impulsivity, obsessive thinking and neuroticism (emotional instability and hypersensitivity).
- Social pressure to be thin.
- Being teased or bullied about weight, and weight stigma, where an individual is discriminated against due to their body weight.
- Trauma, particularly when caused by physical or sexual abuse. The ED is a consequence of trying to reclaim control or manage intense emotions associated with traumatic memories.
As you may have surmised, EDs have profound impacts on all aspects of an individual’s life. Not only are they generally less able to function due to medical complications, they are also more likely to be affected by psychological and social consequences.
Anorexia nervosa often involves putting the body in a state of semi-starvation, which can adversely affect the functioning of most of your organ systems. This can manifest in symptoms like constipation, intolerance of low temperatures, bradycardia (an unusually low heartbeat), skin dryness, hypotension (abnormally low blood pressure), and a loss of menstrual periods in women. It can also cause problems with kidney, cardiovascular, gastrointestinal and hormonal functioning, alterations in brain structure, anaemia, loss of muscle mass, and insufficient bone calcium (osteoporosis). In worse cases, death can result either due to starvation, substance abuse or suicide.
A common occurrence in both anorexia and bulimia is self-induced vomiting, in which the individual forces themselves to regurgitate the food they have consumed following a meal (i.e. “to purge”) for fear that they have overeaten and might put on weight. Such behaviour can lead to swollen salivary glands, destruction of teeth enamel and disruptions in electrolyte and mineral balances in the body. Laxative abuse is also widespread and can lead to long-term disturbances of regular bowel function.
Other than these devastating health consequences, EDs can adversely affect one’s psychological functioning. First, EDs often co-occur with other mental health conditions, most commonly mood disorders, anxiety disorder and alcohol and/or drug abuse.
Secondly, the burden of anxiety, self-doubt, and feelings of guilt and shame often leave the individual with an ED in mental and emotional anguish. They constantly feel out-of-control of their lives, and claw at regaining control through their dysfunctional relationship with food and their bodies. They are preoccupied with obsessive thoughts about food and weight, and their self-image remains perpetually distorted. The fear of their impaired lifestyle being discovered leads to them being hypervigilant, whereby they worry about others watching their eating habits and confronting them about it.
EDs negatively affect an individual’s performance in school or at work; it can be difficult trying to concentrate given the preoccupation with food and weight. Interpersonal relationships are not spared. The fear of consuming or over-consuming can be so intense that they stop attending social gatherings that involve meals. They might start to avoid meeting friends, choosing instead to isolate themselves and feel increasingly alienated and lonely. Romantic relationships suffer as the person gradually loses interest in sex and becomes emotionally distant. Fights with family members over meals are not unusual, as the others in the household struggle with worry and frustration to help the affected member.
Treatment & Recovery
Individuals with EDs are unwilling to seek treatment and even when they do arrive at a clinic, they can be hugely resistant to efforts aimed at increasing their body weight or changing their eating habits. Re-nutrition and bringing the individual back to a healthy weight range is usually the first course of action, and it is necessary for them to be closely monitored by a multi-disciplinary medical team.
Following that, some studies have found psychotherapy and counselling to help with associated thoughts and behaviours. Family therapy has shown to be particularly effective for adolescents and young people. Additionally, the individual usually requires regular monitoring after being discharged.
Early detection and treatment are crucial for these individuals, especially since it can be a matter of life and death. Relapses are common and the individual tends to struggle most of their life with diet and weight issues. Based on personal experience with some clients though, I daresay not all hope’s lost. I have seen many individuals recover from the grasps of debilitating EDs through the strong support of their families and loved ones. One of my clients recounts:
Every step felt like an uphill battle. But I did it. I never thought I could have a healthy relationship with my food and body, I never thought I could love myself for being me.
If you know anyone suffering from eating disorders, or suspect that a loved one could be at risk of developing one, don’t hesitate to seek help for them. The sooner, the better.
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- The clinical profile of patients with anorexia nervosa in Singapore: a follow-up descriptive study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469850/
- Eating disorders in Singapore: a review. https://www.ncbi.nlm.nih.gov/pubmed/12625093
- Prevalence and profile of females at risk of eating disorders in Singapore: http://www.smj.org.sg/sites/default/files/4706/4706a5.pdf
- National Eating Disorders Association (NEDA): https://www.nationaleatingdisorders.org/about-us
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