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“I found my daughter’s comments about her body on her blog quite by accident. She had left her computer logged on and her blog was right there on the screen for me to read. I was shocked to see the extent to which she was restricting her food intake and how critical she was about herself. Apparently it all started when she was 12 and someone joked about her ‘puppy fat’ at Christmas. She had started to eat more healthily and exercise regularly, lost a few kilos and everyone, even I, complimented on how good she looked. But it has all spiraled out of control and she is spending a lot of time online, browsing websites that seem to promote dieting and even anorexia! She refuses to discuss any of this with me and is so angry with me for reading her blog that she hasn’t spoken to me since. Does my daughter have an eating disorder? Isn’t it normal to diet or want to be healthy and look good? What should we do to help her.” *

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* Fictional anecdote, resemblance to any real persons or situations is unintended.

In our world today, it is impossible to not be aware of one’s appearance or avail the options that exist to change it, from covering the grey in one’s hair to whitening teeth to cosmetic surgery. Weight loss and dieting seem to be fairly innocuous when thrown in with these. However, an eating disorder is very different from normal dieting to lose a few extra kilograms or pounds of weight or the occasional concern that someone may express over their appearance.

Eating disorders are characterized by severe disturbances in eating behaviours such as refusing to maintain a body weight that is normal for height and physical activity. There might be severe restriction of food intake and/or recurrent binge eating coupled with what is called ‘purging behaviours’ such as vomiting, misuse of laxatives and excessive exercise to get rid of calories consumed. In addition, there is a maladaptive and very unhealthy over-evaluation of body shape and weight such that personal worth is judged solely in terms of appearance or weight.

Depending on the symptoms exhibited, three separate diagnoses may be made, that is, Anorexia Nervosa (with a sole pursuit of weight loss, often successful because of the severity of weight control behaviours), Bulimia Nervosa (pursuit of weight loss punctuated by binge eating and purging episodes) or Atypical Eating Disorder with features that defy a neat categorization into either of the above.

While a proper evaluation of signs and symptoms needs to be done by a health professional, close friends and family can often spot excessive, abnormal and obsessive weight control methods. Skipping meals and eating only an apple for dinner, loo visits immediately after meals, unrealistic or abnormal rules for eating, long lists of taboo foods and severe, self-imposed consequences for breaking those rules (for e.g. 300 push-ups after dinner) are all examples of behaviours that should ring an alarm bell. In addition, the person often feels very low, negative about self, is overly critical and/or fluctuates between extreme despondency to an irritable over-confidence and self-righteousness, almost an attitude of ‘I know best’, especially when it comes to weight and eating.

Anorexia often starts during teenage years as dietary restriction, which then gets out of control. Bulimia often starts as an atypical eating disorder or anorexia, with many bulimics seeing themselves as ‘failed anorexics’, a belief that increases distress. In some cases, the disorder is short-lived requiring only a brief intervention, especially in younger persons or those with a brief history of the disorder. In some, the disorder becomes deep-rooted and requires intensive treatment with a small percentage requiring long term intervention and support.

Sadly, a person with an eating disorder pays a dear price for trying to achieve the illusory goal of happiness through weight control. Nearly every organ system is affected by dietary restriction with physical symptoms ranging from heightened sensitivity to cold and dizziness to amenorrhea (no menstrual cycles in post-pubertal females) and infertility. Anorexia is even associated with increased risk of death due to medical complications or suicide. The exclusive psychological focus on eating and weight and the dependence of self-worth on achieving unrealistic goals causes much distress and unhappiness. In many individuals, even after recovery from an eating disorder, residual features are common such as over concern about shape, weight and eating. Often many recovered individuals say that they wish they could get rid of all the nutritional and calorie knowledge they acquired or go back to eating ‘normally’ as they used to prior to the disorder. Even at the peak of the disorder, many individuals yearn to be free of the rules they set for themselves. The truth is that professional intervention and support can help them achieve the greatly desired control of their lives in a healthy way.

Currently, although eating disorders are more prevalent in Western societies and in female adolescents they are on the rise in other societies and in males as well. Other known associated risk factors include negative experiences while growing up such as critical comments from others about eating, shape and weight. Not everyone who has had such experiences develops an eating disorder; those who do often also have very low self-esteem and are perfectionistic.

The most gains from treatment are made when intervention involves some form of psychotherapy along with careful management of and attention to medical and nutritional needs. The psychological management of eating disorders is best done using a combination of methods that should ideally include cognitive behavior therapy to modify ways of thinking and behaviours maintaining the disorder and address the over evaluation of shape and weight. Where possible, intervention should be delivered by a multi-disciplinary team of healthcare professionals.

Shrimathi Swaminathan
Clinical Psychologist
Psynaptica