Eating Disorders
What Is an Eating Disorder?
Eating disorders encompass psychological conditions leading to unhealthy eating patterns. Often, they stem from fixations on food, body weight, or physique. However, it is worth noting that it can be difficult to spot, and does not affect people with any particular body type more than others.
If unchecked, they can escalate to life-threatening health issues. They are among the most fatal mental health conditions, followed by opioid addiction.
Symptoms vary widely among individuals. Typical signs include extreme food restriction, binge eating, and purging actions such as vomiting or excessive exercise.
It is noteworthy that certain demographics, including men and gender-nonconforming individuals, are increasingly diagnosed with these disorders.
This prevalence can be attributed to societal pressures, stigmas, and specific challenges they face, which often deter them from acknowledging their condition or seeking timely intervention.
Eating Disorder Symptoms
Behavioural Symptoms
If someone you know exhibits the following behaviours, they might be grappling with an eating disorder:
To identify if someone else is exhibiting behavioural symptoms of an eating disorder, look out for these signs:
Disappearing food stocks.
Hidden food stashes in unusual spots.
Signs of forced vomiting.
Emotional Symptoms
Eating disorders often manifest in subtle emotional signs that can be easily overlooked. Those grappling with such conditions frequently exhibit the following:
Physical Symptoms
Physical symptoms of eating disorders include:
Eating Disorders Causes and Risk Factors
Causes
Firstly, there is a genetic link. If a close family member has battled an eating disorder, the likelihood of another family member developing one increases.
Secondly, certain personality characteristics, such as a high degree of perfectionism (also seen in disorders like obsessive-compulsive disorder), impulsivity, and heightened emotional sensitivity (eg anxiety, stress, depression), can predispose individuals to these conditions.
Moreover, recent scientific investigations highlight potential biological causes. Imbalances in serotonin and dopamine (neurotransmitters), which regulate mood and appetite, might be influential.
Risk Factors
Weight bullying
Weight bullying, a distressing experience many face, can profoundly affect one’s relationship with food. When individuals are ridiculed or shamed for their body size, it often leads to diminished self-worth.
This emotional turmoil can urge a person to engage in unhealthy eating habits. Peer pressure and derogatory comments from trusted figures like teachers or parents intensify the internal struggle.
As a result, some may resort to restrictive diets, binge eating, or other harmful behaviours. Moreover, these habits usually spiral into a full-blown eating disorder.
Recognising the link between weight bullying and these disorders is crucial to fostering a supportive environment for everyone, regardless of size or appearance.
Body Image
Negative body image, stemming from dissatisfaction with one’s appearance, can lead individuals to harmful behaviours.
From childhood, societal influences shape our perceptions of ourselves. As we grow, comments and attitudes from those around us, especially when negative, become internalised. Over time, these external voices become our own, leading many to view their bodies through a critical lens.
Persistent negative self-talk can exert such a strong influence that individuals may find themselves resorting to self-destructive habits, including extreme dieting or excessive exercise.
These behaviours represent extreme attempts to conform to perceived beauty standards or ideals. The intense desire to reduce body fat or attain a specific appearance can lead to severe harm over the long term.
By adolescence, a significant proportion of individuals already face these challenges. Studies indicate that over half of young girls and a third of boys are unhappy with their bodies.
This dissatisfaction is not limited to the younger generation. An alarming 60% of adult women and 40% of men report negative feelings about their appearance. This widespread sentiment, often called “normative discontent”, highlights the ubiquity of the issue.
Beauty Standards
Understanding the nuanced ways in which beauty standards impact various groups is crucial. Evidently, these standards, perpetuated by media and societal norms, contribute significantly to the prevalence of eating disorders.
Addressing these issues requires a multifaceted approach, from promoting body positivity to providing culturally competent healthcare.
By recognising the harmful effects of these unrealistic ideals and working towards a more inclusive understanding of beauty, we can hope to reduce the incidence of eating disorders and the pain they cause.
Female Ideals
The media’s portrayal of the ‘perfect’ female body has long been controversial. A glance at any fashion magazine showcases extremely thin women, with the average female fashion model’s body mass index (BMI) being a mere 16, significantly below the healthy range of 18.5 to 24.9.
Digital enhancements further increase this unrealistic ideal – shaving inches off waists, hips, thighs, and face.
Over the decades, the female beauty ideal has shifted towards an even thinner silhouette. For instance, the body size of Playboy models and Miss America winners decreased significantly from the 1950s to the 1990s.
Today’s standards not only emphasise extreme thinness but also a specific bust size, creating an ideal that is nearly impossible for most women to achieve healthily.
On the other hand, fatness is stringently linked to unhealthy bodies. This black-and-white thinking (assigning bodies to “good” and “bad”) is harmful for both the younger and older generation.
Male Ideals
While women face pressure to be ultra-thin, men grapple with different expectations. The ideal male physique is often portrayed as muscular and toned.
This leads many to engage in behaviours like overexercising or consuming muscle-building substances. However, when men engage in these behaviours, it is very rarely considered a problem because it is viewed as them being strong.
These thoughts are deeply rooted in how society creates and enforces gender norms, expectations, and biases.
This drive to achieve the ‘perfect’ body can lead to disorders like muscle dysmorphia, sometimes referred to as reverse anorexia.
The societal pressure for men to conform to these standards can be just as damaging as the thin ideal imposed on women.
Gender-Nonconforming Ideals
LGBTQ youth, especially those identifying as transgender or nonbinary, face unique challenges when it comes to body image and eating disorders.
Research indicates that body dissatisfaction is a prevalent stressor among transgender individuals, increasing their risk for disordered eating.
For instance, transgender boys/men and nonbinary youth assigned female at birth (AFAB) report higher rates of diagnosed and suspected eating disorders.
The stress of conforming to societal gender norms, combined with the internal struggle of aligning one’s physical appearance with one’s gender identity, can exacerbate feelings of body dissatisfaction and lead to harmful behaviours.
Moreover, racial and ethnic backgrounds play a role in the prevalence and diagnosis of eating disorders among LGBTQ youth.
Native/Indigenous and Multiracial LGBTQ youth report higher rates of diagnosed eating disorders. Similarly, Black LGBTQ youth suspect they have an eating disorder at four times the rate of being diagnosed.
Eating Disorder Types
Anorexia Nervosa
Anorexia nervosa, often termed ‘anorexia’, predominantly emerges during adolescence or early adulthood. While it is more prevalent among women, men and gender-nonconforming people can also be affected.
At its core, anorexia is characterised by a distorted self-perception. Individuals often see themselves as overweight, even when they are critically underweight. This leads to severe calorie restriction and avoidance of certain foods.
Key symptoms encompass:
- Rigorous eating limitations
- An overwhelming fear of weight gain, even when underweight
- A distorted body image, with denial of the severity
However, it is pivotal to move beyond mere weight when diagnosing anorexia. The outdated reliance on body mass index (BMI) can be misleading. For instance, ‘atypical anorexia’ denotes significant weight loss, even if the individual is not categorically underweight.
Moreover, anorexia often intertwines with obsessive-compulsive tendencies. Many people struggle with constant food-related thoughts, hoarding food, binge-watching food-related videos (eg mukbang videos) or even collecting recipes obsessively.
Social eating can become challenging, and spontaneity may diminish due to a heightened need for environmental control.
Anorexia branches into two subtypes: the restricting type and the binge-eating and purging type. The former involves weight loss through dieting or excessive exercise, while the latter might include binge eating followed by purging activities, such as vomiting or over-exercising.
The repercussions of anorexia are profound, ranging from bone thinning and infertility to severe organ damage.
Bulimia Nervosa
Bulimia nervosa is characterised by cycles of binge eating followed by compensatory behaviours. During these binges, individuals consume large quantities of food, often in secret, and experience a lack of control. This overindulgence frequently leads to feelings of guilt and shame.
Post-binge, they might engage in various actions to counteract potential weight gain. These range from fasting and excessive exercise – to more harmful methods like self-induced vomiting and misuse of laxatives or diuretics.
Such behaviours, while intended to provide relief, often increase emotional distress such as anxiety.
It is crucial to note that, unlike anorexia, bulimia nervosa is not always evident. Those affected can span a range of body weights, from underweight to obese.
However, if significantly underweight, the diagnosis leans towards anorexia nervosa binge-eating/purging type.
Subtle signs might hint at bulimia nervosa:
- Regular bathroom visits post meals.
- Persistent sore throat or dental issues from frequent vomiting.
- Unexplained use of diet pills or diuretics.
- Episodes of dizziness or fainting due to dehydration.
- Excessive engagement in physical activities, especially after eating.
The repercussions of bulimia nervosa can be severe, with risks like oesophageal tears or cardiac issues.
Cognitive behavioural therapy has shown promise in treating bulimia, focusing on normalising eating patterns and addressing underlying emotional triggers. Some also benefit from antidepressants or family therapy.
Binge Eating Disorder
BED, or binge eating disorder, is characterised by episodes where individuals consume vast amounts of food in a short span, coupled with feelings of lost control and distress.
Distinctively, unlike bulimia nervosa, those with BED do not employ regular compensatory actions like vomiting or excessive exercise post-binge.
BED is linked to severe health risks, from obesity to cardiovascular issues. Recognising the signs early can prevent long-term complications.
The diagnostic criterion for BED includes consistent binges (minimum once weekly for three months). Additionally, people exhibit three or more of these behaviours:
- Rapid consumption of food
- Eating past the point of comfort
- Consuming vast quantities without hunger
- Isolating oneself during binge episodes due to embarrassment
- Experiencing intense guilt or self-disgust post-binge
Cognitive behavioural psychotherapy, tailored for BED, is the most effective treatment. Interpersonal therapy in Singapore or online and specific medications are also efficient in managing this disorder.
Other Specified Feeding and Eating Disorder (OSFED)
This classification addresses eating disturbances that, while causing significant distress and functional impairment, do not align with the specific criteria of more common disorders.
An example is “atypical anorexia nervosa”. Individuals with this condition may experience substantial weight loss and demonstrate behaviours and concerns about weight or shape that align with anorexia nervosa.
However, they do not meet the weight criteria for anorexia due to a higher baseline weight. It is imperative to recognise that the rapidity of weight loss, irrespective of initial weight, can precipitate serious medical complications.
Thus, while OSFED might not fit traditional categories, its potential implications are profound and require attention and professional support.
Avoidant Restrictive Food Intake Disorder (ARFID)
Avoidant restrictive food intake disorder (ARFID) involves issues more than picky eating. Those affected might limit their diet based on food colour, texture, or smell, not just taste.
Unlike anorexia or bulimia, ARFID is not about body image concerns. Instead, individuals might experience genuine fear around food, stemming from past negative experiences like choking or vomiting. Others might simply lack interest in eating altogether.
It is crucial to differentiate between a phase and a persistent issue. While ARFID can manifest at any age, it is predominantly observed in children. If not addressed, it can hinder growth due to inadequate nutrition, leading to severe health complications.
Recognising the nuanced differences between ARFID and other eating disorders is the first step towards effective intervention and support.
Pica
Pica is a unique and rare eating disorder where people eat inedible items without any nutritional benefit.
For example, depending on what is accessible, some of the items they could eat includes:
- Paper
- Soap
- Chalk
- Metal
- Glass
- Pebbles
- Charcoal
Young children or toddlers may usually eat these objects due to curiosity, especially because babies explore the world with their mouth in the first few months.
Pica is quite different.
The condition is not diagnosed in those under two years, as this behaviour is a standard developmental phase.
People generally assume that a person may have a condition such as pica for attention seeking.
However, having this eating disorder is not merely a phase or preference but is often linked with conditions like autism spectrum disorder and intellectual disabilities.
There are a lot of risks of this disorder. Eating inedible things could cause intestinal obstructions. For example, someone could consume lead from paint chips.
Rumination Disorder
Rumination disorder is characterised by voluntary regurgitation, re-chewing, and either re-swallowing or expelling of food post-consumption.
While it can manifest at any life stage—from infancy to adulthood—it is essential to distinguish it from gastrointestinal issues or other eating disorders.
For a definitive diagnosis, this behaviour should persist for at least a month and not be a symptom of another mental condition.
However, if it coexists with disorders like intellectual disability, its severity should necessitate distinct clinical intervention.
Eating Disorder Recovery
The process could be confusing and complicated without professional support. However, with consistent therapy and social support, recovery is possible.
The two primary types of treatment plans used to treat eating disorders include online psychotherapy and medication.
Psychotherapy
Individual Therapy: This one-on-one approach allows individuals to explore deep into the root causes of their disorder. Moreover, personalised therapy fosters self-awareness and coping strategies.
Group Therapy: Sharing experiences with others can be therapeutic. It provides a platform for mutual support and understanding, often alleviating feelings of isolation.
Family Therapy: Eating disorders do not just affect the individual. Involving family can create a supportive environment. Family therapy addresses the unhealthy relationship that the person shares with food, explores any cultural and familial dynamics that may be contributing to the disorder, and promotes collective healing.
Medication
Medication, along with psychotherapy, can be an effective and holistic way to treat eating disorders.
Consuming meds can be especially helpful when you have coexisting mental health conditions, such as depression or anxiety.
Some commonly prescribed medications include:
- Antidepressants
- Antipsychotics
- Mood stabilisers
Integrated Approach
An integrated approach means integrating several different types of interventions to provide holistic support (ie addressing both physical and mental symptoms).
Usually, psychotherapy, medication, and alternative treatment options are used together to create an integrative therapeutic plan.
Integrative psychotherapy addresses both the psychological and physical aspects of the disorder.
For example, a person with anxiety could have mental signs such as overthinking and irrational fears. On the other hand, physical symptoms could include lack of sleep, shaking, and headaches.
Frequently Answered Questions
How to help someone with an eating disorder?
Wanting to help someone who has an eating disorder can be confusing. The key point to remember is that their condition should never get worse than it was before.
Hence, the right way to go about this is to first suggest seeking professional support.
Below are some ways you can offer help without causing further harm:
- Try to start a non-judgmental conversation. Listen actively and make sure that you make them feel validated and heard. Avoid offering solutions – sometimes, just being heard is therapeutic.
- Gently suggest seeking advice from healthcare experts. Remember, the decision ultimately lies with them. Hence, try not to push or force this option.
- Regularly invite them for activities or catch-ups. Even if they decline, your gesture reinforces their importance in your life.
- Celebrate their achievements, no matter how small.
Why do models have anorexia?
The fashion industry’s relentless pursuit of the ‘perfect’ figure has inadvertently placed undue pressure on models, leading many to develop eating disorders.
While anorexia is widely recognised, it is just one facet of a broader issue. The underlying reasons are multifaceted: societal standards, industry expectations, and personal pressures converge, pushing models towards unhealthy eating habits.
Beauty standards in the fashion industry are not merely about achieving a certain size; it is about maintaining it. This constant scrutiny can lead to secretive behaviours, with some models resorting to extreme measures like excessive water intake (as a replacement for meals), which can be detrimental to health. Bulimia, though less discussed, is equally prevalent and poses its own set of health risks.
The industry’s emphasis on a singular body type does not just affect models; it sends a message to society about what’s deemed ‘beautiful’.
It is crucial to understand the depth of this issue, as it is not just about fashion but about the well-being of individuals within the industry.
How to tell someone about your eating disorder?
Talking about your eating disorder with someone you trust is a great step! Know that you are on the right path.
Below are some tips you can keep in mind while having this conversation:
- Choose a location where you feel the most comfortable. The main point to remember is that the environment should not be triggering in any way.
- Try sitting side-by-side or walking with the person you are talking to. Alternatively, you can also write a letter or send a few texts to start the conversation.
- Reflect on who in your life might be supportive and understanding without hurting you.
- If you are overwhelmed, ask the person to pause the conversation or choose not to answer their question.
- If the conversation becomes too intense, let the person know you want a break and find it challenging to continue discussing your problem. You could suggest having this conversation sometime later.
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