FAQ on Eating Disorders

1. What are eating disorders?

Eating disorders are illnesses that manifest themselves in extreme unhealthy eating patterns. They are mental conditions that affect eating habits but need not be tied to a specific body type; someone with an eating disorder can appear very thin, healthy weighted or above healthy weight. Although symptoms of these disorders emerge primarily in young women, eating disorders can affect anyone from any gender, age, ethnicity and income level.

There are a few main types of eating disorders, which have been highlighted below. An individual with an eating disorder can suffer from more than one of the following types of disorders. The following describes the symptoms and not the causes of eating disorders.

Anorexia Nervosa involves the partial or total abstinence from food (solids or liquids) because she/he believes any amount of food will cause weight gain. An anorexic often perceives herself/himself as ‘fat’ despite being otherwise and has an intense fear of gaining weight. This is reflected in an unhealthy preoccupation with food and exercise, and sometimes purging through self-induced vomiting and laxative abuse.

Bulimia Nervosa is often associated with binge-eating disorder as a bulimic is often engaged in a cycle of binging and purging. Binging is characterized by the consumption of a very large amount of food (in comparison to what the individual normally consumes) in a short period of time and is frequently emotionally induced. Purging arises from the guilt of overeating and includes self-induced vomiting, laxative abuse, excessive exercising and extreme fasting.

Binge-eating Disorder involves binging excessively with periods of uncontrolled, impulsive and continuous eating to the point of being uncomfortably full, with no compensatory behaviour (purging) after. Bingeing is usually triggered by an emotional event that causes the individual to turn to food as a means of comfort, but post-binge often experiences extreme guilt and self-loathing.

Orthorexia Nervosa is a relatively lesser-known eating disorder which involves the extreme exercise and obsession with eating what is perceived to be ‘healthy’ foods. They reject any food that is perceived as unhealthy such as food with oil, butter, carbohydrates etc. Sometimes orthorexics eliminate such a large number of foods from their diet that they become emaciated, which results in anorexia orthorexia. However, anorexia and orthorexia are different illnesses that arise from different intentions with anorexics usually seeking to lose weight whereas orthorexics typically seek to attain pure, clean and healthy bodies.

2. What causes eating disorders?

As with any other mental illness, eating disorders are complex, multi-layered diseases that arise from various psychological, mental and emotional issues that vary from individual to individual. However there are a few broad issues that have been observed to lead to eating disorders.

  • Depression
  • Body image, as promoted by the media as well as peer and parental pressure. The comments and attitudes of friends and parents can also cause an individual to develop certain negative perceptions regarding their bodies.
  • Past traumatic experiences such as physical, emotional or sexual abuse.
  • Emotional upheaval such as major changes in an individuals life (for example, the loss of a friend or family member, ending of a relationship, moving to a new home, school or job, major personal disappointments)
  • Individual’s need for control. Various factors could result in the individual feeling a loss of control over their lives, resulting in the use of their bodies and eating habits as a means of reclaiming control.
  • Obsessive Compulsive Disorder

3. How can I tell if I or someone else has an eating disorder?

General:

  • Distorted perception of own weight,
  • Extreme preoccupation with food,
  • Emotional state tied to eating habits,
  • Self-loathing comments,
  • Reduced concentration and thinking ability,
  • Becoming very secretive about food,
  • Moodiness, shakiness and irritability,
  • Obsessive rituals (such as eating only certain foods at certain times),
  • Social withdrawal and isolation and
  • Avoidance of social situations that include food

Anorexia:

  • Constantly reading about food and nutritional information but never consuming it,
  • Distorted perception of healthy weight,
  • Loss of menstrual period,
  • Development of fuzzy hair on body (to protect from the cold since the body is no longer producing fat),
  • Exercises in an extreme manner,
  • Excessive calorie counting,
  • Dramatic weight loss unrelated to illness,
  • Gets very cold easily,
  • Dry and brittle hair and poor skin tone,
  • Dresses in large clothes or layers to hide the extent of weight loss

Bulimia:

  • Shame and secretiveness in consumption of food (especially binges),
  • Swollen throat glands,
  • Blisters on knuckles and fingers,
  • Frequent and secretive trips to the bathroom after meals,
  • Hoarding food

Binge-eating Disorder:

  • Consumes a very large amount of food when experiencing stressful or unhappy emotions,
  • Eats secretively or is ashamed of the amount consumed,
  • Significant weight gain in small period of time (not representative of BED in all cases),
  • Hoarding food

Orthorexia:

  • Obsession with nutritional information,
  • Extreme selectiveness when choosing and buying food,
  • Exercises in an extreme manner,
  • Dramatic weight loss (for some cases),
  • Excessive pre-planning of meals

4. What should I do when someone I know has an eating disorder?

Support is extremely important for someone experiencing an eating disorder, even if they might act like they do not want your help. Let your friend know that you are there for him/her by providing a listening ear and reassuring and affirming him/her in their inner beauty. Let them know that what they’re doing is unhealthy and you want to help. You should not exert excessive pressure on him/her to seek treatment, as this may result in a worsening of the relationship or ineffective treatment. However if the disorder has reached a life-threatening level, you should inform a figure of authority that you feel is trustworthy (teacher, parent etc.) in order to get your friend the emergency help she/he needs.

5. I/Someone I know has an eating disorder, where can I get help?

Eating disorders can be treated and there are various treatment centres locally that you can go to. Letting a close friend or family member know about your problem and your desire to seek treatment is a good way to start. This way, you have the support of someone you are comfortable with and can turn to during the treatment process.

Obtaining treatment is the next step. Some places you can go to are the SGH Eating Disorders Programme, the Mount Elizabeth Psychological Medicine Clinic, Behavioural Health Services Clinic or the Novena Psychiatry Clinic. There is also a support group called Support for Eating Disorders Singapore for people who have or had an eating disorder and their caregivers that meets monthly to share their stories and support one another. Treatment is not just limited to counselling services, and in centres like SGH you will have access to psychiatrists, psychologists, nutritionists and therapists to facilitate in your rehabilitation.

It is very important to be open to the treatment process as well, because even though the doctors and therapists have your recovery in mind, an eating disorder is a mental illness that only the patient is capable of overcoming completely. It’s very possible to be able to lead a full and confident life at a healthy weight you are comfortable with, but remember you have to want to get better!

6. What can I do to prevent an eating disorder?

As of yet, there has been no scientific proof of ways eating disorders can be prevented, however there are a few ways you can protect yourself from succumbing to an eating disorder

As an individual:

  • Learn about healthy eating and an active lifestyle from the right sources. The Health Promotion Board (http://www.hpb.gov.sg/healthyliving/default.aspx) offers a useful and comprehensive guide on living healthy. By maintaining a healthy weight and feeling good from the inside, you will feel good on the outside as well.
  • Surround yourself with positive influences and be a positive influence yourself! Friends who are confident in their body image will encourage you to feel the same and vice versa. Take advantage of your confidence to reaffirm your less confident friends in their natural beauty.
  • Be active! Not just in physical activities, join and participate in activities that you love. Involvements in meaningful activities leave lasting positive impacts on your outlook and mental health.
  • Communicate with your friends and family. By learning how to listen and share your problems with people you love, you’ll be able to sort out the various emotional issues that come your way rather than bottling them up and leaving yourself vulnerable to other negative outlets

As a parent:

  • Reassure and reaffirm your child constantly about their inner and natural beauty. A large percentage of insecurity in individuals arises from never having been affirmed as a child. The simple act of encouraging them to feel confident in their bodies and selves could be enough to protect them against insecurity-based eating disorders in the future.
  • Help in teaching them about the benefits of healthy eating. Emphasize the importance of living healthily by incorporating balanced meals into their diets, encouraging them to be active in school and outdoors and teaching them about moderation.
  • Act as a positive influence yourself. Don’t encourage body insecurities in front of them by making disparaging remarks about your own or others’ bodies. Instead, teach by example by being confident in your own body.

7. I have overcome an eating disorder, but how do I stay on track?

See the points above on maintaining a balanced, full lifestyle that helps to protect against eating disorders. You can also participate in Support for Eating Disorders Singapore (SEDS), the eating disorder support group for patients and survivors who can help you sustain your recovery. Keeping in touch with your doctors or counsellors, or appointing one of your friends or family members as a mentor to whom you can turn to when you feel like you’re in danger of relapsing is also a useful way of staying on track.

Links

Not Just Surface Damage
A compilation of stories by survivors of eating disorders in Singapore. Wonderfully written and designed.

Something Fishy
Dedicated to raising awareness and providing support to people with Eating Disorders, and their loved-ones…

Olive Tree: Eating Disorders Symptoms and Treatment
The page is a good resource for information about eating disorders including descriptions and risk factors. However the support services that they provide is only available to employees of companies subscribing to their Employee Assistance Programme.

More resources here: Eating Disorders