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It was Eating Disorders awareness week in some parts of the world recently, from 26th February to 4 March. It only makes sense that I speak about myself on such an occasion, a little late but I think it’s allowed, right? I was diagnosed with Binge-Eating Disorder and Anorexia Nervosa when I was 20 years old. I experienced symptoms when I was 18 when I first started going to college. I would often find myself eating heaps of food, for a long time. I don’t remember feeling hungry during that time. These episodes would often get especially bad when I had exams or when I had friendship-fall out or some other stressful situation. When I visited my parents during the holidays, my mom took me to my physician. She was very concerned about my food habits and apparently, I also looked as sad as I felt. The doctor gave me a diet plan and told me to exercise regularly but that just didn’t follow through past a maximum of two weeks. I went back to college after the vacation and my binge-eating continued, if not got worse. I would eat absolutely anything with no proportions in mind. It was all unhealthy food. Chocolates, cereals, ice-creams, take-aways, all foods that we enjoy! But sometimes and I am sure not as much as I ate. I felt extremely guilty while eating but so sad and so anxious that I felt that consuming copious amounts of food was my only way out. Sometimes I did feel good when I would finally fall asleep but sometimes it was just the same. I felt a need to continue binging. It was so bad that one of my friends had to take me to a school counsellor. My counsellor further referred me to her colleague and that’s when I was diagnosed with Binge-Eating Disorder.


I would spend hours looking at restaurant menus. I scrolled through food delivery apps for new restaurants and ordered so much food. I had put on unhealthy amounts of weight. I was basically a mess and I knew I had to change. It was a very difficult journey but I wanted and in fact, needed to take steps towards improving my condition. My food habits were affecting my health, physically and mentally. I would get fatigued very easily, I had severe acne, I had little to no energy, I would feel palpitations. Mentally I was just always drained. I had no motivation, I was extremely sad, hopeless and my academic performance was also severely affected. I was also horribly bullied for my weight gain by some of my classmates which made things even worse. This led me to go to the complete opposite end where I just stopped eating. Those two years before I was diagnosed with ED and before the treatment started were just terrible. I lost weight drastically because I would hardly eat anything throughout the day. Even when I had lost all of this weight, I saw myself as overweight. My entire day revolved around thoughts about food and weight. I was later diagnosed with Anorexia. Those years almost seem like a blur and I only remember the sadness and guilt I felt about my food habits. My journey with ED has been difficult and exhausting but I can say that I am finally going in the right direction now and things are improving now. This is why talking about ED and spreading awareness is so important and as a student of psychology now, I am understanding things better.


There is often a misconception that eating disorders are a lifestyle choice and only a dietary concern. In reality, EDs are extremely debilitating and can have several causes. Eds can be fatal and are characterized by severe disturbances in their eating behaviours and related thoughts and emotions. It can also involve preoccupation and obsession with food, weight and body shape. Some of the commonly known EDs are :


1. Anorexia nervosa: People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. It is characterized by a morbid fear of gaining weight and losing weight over-eating. Individuals with anorexia are proud of their diet and decreased body weight is a significant feature. They typically weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to lose weight. Anorexia nervosa has the highest mortality rate of any mental disorder. They are never satisfied with their weight loss and it tends to cause panic, anxiety or depression. They tend to not seek help as they are proud of their diet. Symptoms include:

  • Extremely restricted eating

  • Wanting to pursue thinness and unwilling to maintain a normal or healthy weight

  • Intense fear of gaining weight

  • Distorted body image, self-esteem depends on perceptions of body weight and shape and being unsatisfied or being in denial of weight-loss

  • Thinning of the bones (osteopenia or osteoporosis)

  • Anaemia, muscle wasting and weakness

  • Brittle hair and nails

  • Dry and yellowish skin

  • Lanugo: Growth of fine hair all over the body

  • Severe constipation

  • Low blood pressure slowed breathing and pulse

  • Damage to the structure and function of the heart

  • Brain damage

  • Multiorgan failure

  • Lowered internal body temperature, causing a person to feel cold all the time

  • Lethargy, sluggishness, or feeling tired all the time

  • Infertility

2. Bulimia nervosa: People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behaviour that compensates for this overeating such as induced vomiting/purging, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviours. People with bulimia nervosa may be slightly underweight, normal weight, or overweight. Symptoms include:

  • Chronically inflamed and sore throat

  • Swollen salivary glands

  • Worn tooth enamel and increasingly sensitive and decaying teeth

  • Gastrointestinal problems, intestinal distress and irritation from laxative abuse

  • Severe dehydration from purging of fluids

  • Electrolyte imbalance

3. Binge-eating disorder: People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa, the binge-eating disorder does not involve purging, excessive exercise, or fasting. Hence, people with binge-eating disorder are often overweight or obese. Symptoms include:

  • Eating unusually large amounts of food in a specific amount of time

  • Eating even when you're full or not hungry

  • Rushed eating during binge episodes

  • Eating until one is uncomfortably full

  • Eating alone or in secret to avoid embarrassment and feeling guilt, distress about eating

  • Frequently dieting, possibly without weight loss

EDs are not restricted to any particular race, ages, classes and genders. They tend to be diagnosed during adolescence, early adulthood but it may even have an onset later in life. Although both genders may have EDs, women tend to have a higher proportion of EDs. Researchers have found that EDs can be caused by a complex interaction of biological, psychological and social factors. 50% to 80% risk of developing EDs is due to genetic factors. It has also been found that genetic factors may increase the risk but environmental factors may actually induce it. Precipitating factors or ‘triggers’ may include abuse, bullying, life transitions, stress, separation, death of someone etc. Recently, social media has also increased the vulnerability of people to EDs. The constant race to look perfect, having a “perfect body”, hate comments from strangers about the slightest weight change. Treatments may vary according to the severity of the ED. It is usually a combination of psychotherapy and nutritional treatment and sometimes even medication. In many cases, EDs are accompanied by comorbid mental disorders or involve emotional disturbances that require professional attention. Thus, treatment is tailored to individual needs. EDs can be easily missed by those around the suffering individuals. Many people are concerned about their weight, their food intake and their fitness. Hence, it can be difficult to spot the difference between self-consciousness/fitness concerns and eating disorders. Moreover, individuals with EDs may put extra efforts to avoid being called out by others, making it far more difficult to identify someone’s disorders. Some of the spotting signs could be:

  • Avoiding places/situations that involve food

  • Obsessively watching their calories and measuring every meal

  • Entirely avoiding certain food groups like carbohydrates, fats etc

  • Taking laxatives or certain drugs like amphetamines

  • Consuming large amounts of food in a small amount of time, often in isolation

  • Finding hidden empty packets of food

  • Hoarding a large stash of fast, unhealthy food

  • Frequently going to the bathroom immediately after consuming food

  • Cutting out food entirely

  • Excessive exercising

  • Digestive problems, sore throat

  • Distorted body image and extreme weight changes, unrelated to dieting

If you see someone display some of these warning signs, the best option is to voice your concerns rather than trivialising these problems. The individual may find it very difficult to seek help, feel like they don’t need or deserve help. It would be a good thing to start with being patient, understanding and empathetic. Try to strike a conversation with the person in private suggesting that you are concerned for them. Do not give them ultimatums or lectures as they will be even more pressurizing and stressful for the individual. Eating disorders are extremely complicated and the person may be resistant to undergo any treatment. Hence, as a concerned friend/relative/partner, one needs to be extremely patient yet strong, calm and respectful. Instead of advising “ you just need to eat more carbs!” EDs are far more complicated than that and what the individual may require is a patient ear and an encouragement to seek help. Try to voice your concern and let them know that you care for them and avoid blaming them. As a family of a sufferer of ED, you can encourage healthy eating and healthy portions of food during the treatment. Setting meal times, eating together as a family, making food enjoyable can also be some additional tips. Besides this, it is always good to educate yourself as a family about the disorder, identify and be cautious about any specific triggers.

Conclusion

“How are you so skinny, you will be drifting away with the wind! Do you even fit into the clothes of a child? My God you are so fat. Don’t wear that, your fat shows in it. Look at you gulping food. If I was so fat, I wouldn’t leave my house and stop eating altogether”

I have heard all of this so many times that I am almost immune to it. But, I know how hurt and sad I would get when I heard such comments initially. Also, these comments show the irony of the body weight norms of society. I was overweight at some point and then lost quite a lot of weight, both of which resulted in me being insulted by people. That’s the sad reality I had to face. In times where I had to face some serious bullying, I found solace in some movie characters who looked similar to me like To the Bone, Girl Interrupted. I would watch interviews of people who are suffering from EDs too. Lady Gaga, Torian Bellisario, Hillary Duff quickly became my idols because they were brave enough to speak up against the hate that they would receive for their weight and body. As we venture into 2021, I hope we grow more compassionate and non-judgemental. EDs are extremely difficult as are most disorders to navigate around. I feel a sense of relief and even a lot of anxiety to be opening up about my journey with EDs but I want to talk more about it. I want to increase awareness about it and want to let more people know that EDs are not a choice, they are serious and harrowing conditions!!!

References:

Barlow, D. H., Durand, V. M., Lalumiere, M. L., & Hofmann, S. G. (2021). Abnormal psychology: an integrative approach. Nelson Education Ltd.

"I became an entirely different person". Beat. https://www.beateatingdisorders.org.uk/your-stories/recovery/became-entirely-different-person.

U.S. Department of Health and Human Services. Eating Disorders. National Institute of Mental Health.

https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml#part_145410

What Are Eating Disorders? https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders.


This article on 'Eating Disorders' has been contributed by Smruti Pusalkar, who is a graduate Psychology student from Fergusson College. She is part of the Global Internship Research Program (GIRP), which is under the leadership and guidance of Anil Thomas. GIRP is an Umang Foundation Trust initiative to encourage young adults across our globe to showcase their research skills in psychology and to present it in creative content expression.


Smruti wishes to develop herself to be a more patient listener and a sharp observer to understand the happenings of the world and grow increasingly empathetic. She is passionate about mental health and well being and plans to pursue a career in this field. She is extremely curious about psychology and wants to spread awareness about mental health problems to help those in need.


Anil is an internationally certified NLP Master Practitioner and Gestalt Therapist. He has conducted NLP Training in Mumbai, and across 6 other countries. The NLP practitioner course is conducted twice every year. To get your NLP certification


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