Source: storify.com
Tina had a bad day at work and despite having a hot meal waiting at home decides to grab a pizza. She orders 2 large pizzas, pretending it’s for her family and quickly eats them in the car. She eats them so quickly she almost chokes, but she feels the stress of the day melting away. Tina then throws the pizza boxes in the garbage and heads home to her family where she sits down to have dinner with them although feeling uncomfortably full. Tina feels ashamed and disgusted with herself as this happens on every occasion that she feels stressed or anxious.
Annie restricts herself to a fluid diet as she is fat and feels unattractive. She doesn’t understand why her family and friends lie to her and claim she’s too thin. She has lost 15 kilograms and with every kilogram she loses, she feels life is more worth living. Annie conceals her weight loss by wearing loose clothing and several layers of clothes. She throws away food her mother prepares and pretends she’s eaten it. Even though her periods have stopped and her hair is thinning, Annie knows it’ll all be worth it in the end.
Despite the opposite polarities in these 2 women, they both are suffering from distinct but severe eating disorders. Eating disorders are one of the most common mental illnesses among young women, yet are frequently overlooked and under-researched. One reason could be that they present rather cryptically, at times with multiple physical symptoms.
Eating disorders encompass three distinct conditions, namely Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder (BED). Anorexia nervosa is a serious condition. It has one of the highest mortality rates for a psychiatric disorder, with a 10% risk of death. An individual typically self-starves and undergoes excessive weight loss. Despite this, they are preoccupied with their weight and thoughts of becoming obese. Anorexia nervosa is associated with a host of physical ailments that can be life threatening. In short, it has to be detected early and treated promptly.
Bulimia Nervosa is characterised by binging on food. There is a sense of loss of control followed by purging, either by inducing diarrhoea or through vomiting. The individual is also preoccupied with their body image. There is seldom any drastic weight loss in Bulimia Nervosa.
Binge eating disorder (BED) has been ignored for decades and was trivialised as “overeating”. The key difference between the two is loss of control, where in BED there is an utter lack of control in eating and this is followed by shame, self- loathing and disgust. On most occasions, the overeating occurs in the absence of physical hunger.
So how does one detect symptoms of eating disorders? Despite the ominous consequences of these illnesses, there is no short, accurate screening test that can be easily used. However, there are several questions that can be asked, and may point to a potential eating disorder. These include:
- Does your pattern of food intake dominate your life?
- Do you feel a loss of control when you eat?
- Do you ever eat in secret?
- Do you believe you are fat when others say you’re too thin?
When a loved one displays certain “warning signs” such as irritability, social withdrawal, frequently weighing themselves, preoccupation with exercise, these should ring alarm bells of a possible eating disorder.
The management of eating disorders are complex and controversial. There appears to be limited evidence regarding the most effective modes of treatment. However, several general principles are used with encouraging results.
The treatment of Anorexia nervosa is multidisciplinary, involving a physician, nutritionist and psychiatrist. Restoring the patients’ ideal weight is the first step. In anorexia nervosa, after the patient is noted to be physically stable, the use of Family Based Therapy is the gold standard. This involves getting the parents involved, in a non-judgemental manner, to take control over the patients’ eating until they are slowly able to regain that control.
The use of Cognitive Behavioural Therapy (CBT) in Bulimia Nervosa is effective and identifies the individuals’ maladaptive thoughts about food before altering them. This treatment modality can also be used in BED.
Tina eventually confided in her husband who encourages her to seek professional help. After assessment, she was prescribed an antidepressant and given psychotherapy that focused on restructuring “triggering” thoughts that would lead to binge eating. She eventually was able to cope with her stress better.
Annie continued losing weight rapidly. She suddenly collapsed in school and was rushed to the emergency department. She had experienced a cardiac arrhythmia and subsequent cardiac arrest, and died instantly. At the time of her death, she only weighed 32 kg.
The above article is designed to bring about more awareness of eating disorders, which is seldom discussed in Malaysia. If you believe a loved one may exhibit some of these symptoms, seek your general practitioners or psychiatrist counsel immediately. Let us ensure no other woman suffers Annie’s fate.
Dr Sumeet Kaur is a psichiatrist working in Malaysia and a member of The Early Career Psychiatrists.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]