Eating disorders

07 Sep 2018

Eating disorders are a growing problem amongst people as they use and navigate the digital space with increasing frequency and ease. The distorted senses of body image that can arise from the digital world, and the peer and parental pressure felt to appear a certain way, have caused more people to suffer from eating disorders every year (Lee, Lee, Pathy and Chan, 2005).

What are eating disorders?

Eating disorders are illnesses that manifest as extreme, unhealthy eating patterns. They are not lifestyle choices, but mental conditions that affect a person's eating habits (Salafia, Jones, Haugen and Schaefer, 2015).They are not tied to a specific body shape or type: someone suffering from an eating disorder may be very thin, at a healthy weight, or overweight. Although eating disorders mainly affect young women, they can affect anyone from any gender, age, race, and income level.

According to the Diagnostic and Statistical Manual, Fifth Edition (May, 2013) from The American Psychiatric Association, eating disorders can be broken down into several types, and a person can have more than one type at any point. Here are the more common types of eating disorders:

  • Anorexia nervosa: someone either partially or totally stops eating and weigh themselves repeatedly. An anorexic often thinks of themselves as "fat" even when they are not, and shows intense fear and anxiety at the thought of gaining weight. Anorexia nervosa has the highest mortality rate of any mental illness.
  • Bulimia nervosa: someone engaged in a cycle of binging and purging. Binging involves consuming large amounts of food - in comparison to what the person usually consumes - in a very short period of time, usually during an emotional period. Purging follows because of the guilt from overeating.
  • Binge-eating disorder: someone has periods of uncontrolled and continuous eating to the point of being uncomfortably full, without purging or fasting after. Binging is often triggered an emotional event that causes the person to turn to food for comfort, after which they often feel guilt and self-hate.
  • Orthorexia nervosa: someone exercises excessively and obsesses over eating food that is considered "healthy". They often reject food that is perceived as unhealthy such as carbohydrates or food with oil and butter. An orthorexic can eliminate such a large amount of food that they become emaciated, which results in anorexia orthorexia. However, these are two different illnesses that often come from different intentions: anorexics often try to lose weight whereas orthorexics try to attain a purely healthy body.

Why does someone get an eating disorder?

Like other mental illnesses, there are many reasons someone may get an eating disorder. Here are some common issues that have been noted:

  • Unhealthy perceptions about body image, often caused by peer and parental pressure as well as digital and mainstream media
  • Taking part in an activity that places emphasis on weight or size, like wrestling or ballet
  • Emotional upheaval, such as a major change in someone's life
  • Desire to control, from the feeling that they have lost control over their lives
  • Obsessive Compulsive Disorder
  • Depression

How can a TV show or Instagram affect someone’s mental health?

There is a lot of research describing the effect of both social and traditional mass media on someone's perception of themselves. The problem of someone’s overexposure to the images they see online is when they internalize these ideals and compare their bodies to the ones on screen. This is an unfair comparison from the beginning since the images, as we all know, are not real. However, these images are often very realistic, making it more likely for someone to internalise them as something they can and should be able to obtain. Not obtaining this ideal shape can then cause more anxiety for this person than for the person who is able to recognise the media content as an unrealistic standard and one they don’t feel the need to live up to.

One unique feature of the online world is social media, which is not just visual, but highly interactive. Having more likes and followers are indicators of a person’s popularity on social media, which can easily shape their sense of self-worth. Social media allows everyone to get real-time feedback and validation. They know that specific messages, images, and presentations of themselves are ‘liked’ better by other people, and the anonymous nature of some social media also lets them know when images or messages are not liked by others. These positive and negative comments and posts put huge amounts of pressure on someone to present themselves in only one way – the ‘right’ and ‘likeable’ way – online.

By virtue of the fact that people can selectively choose what to post and which versions of themselves to present, social media is often about someone’s appearance. People follow celebrities and online influencers, they have apps such as VSCO Snapseed to edit and filter their photos before posting them, they even have apps like Huji or Kuji Cam to make their photos look like they were taken on film – a new and popular fad – and they spend a lot of time talking about how they look. It is not unusual for people to spend a lot of time thinking about how to pose, when the light strikes best, where the best backdrops are, and even when the best time to post a photo to get optimum likes is – all for one photo.

Ultimately, the stronger the connection between how someone looks and how much they are worth – the more effort they put into curating their online identity – the greater the potential for body image issues. It is easy to become trapped in a world where you are anxiously waiting for likes and comments, then feeling disappointed and hurt if you do not receive them, even deleting the post so that more people are not witness to your ‘failure’. This anxiety, worry, and insecurity can manifest in an eating disorder.

What are the signs of an eating disorder?

  • Distorted perception of one’s weight
  • Obsession with others bodies, particularly through checking their social media
  • Extreme preoccupation with food
  • Tying emotional state to eating habits
  • Inability to concentrate
  • Moodiness and sudden mood changes
  • Appearing to be cold in warm places
  • Lethargy
  • Social withdrawal
  • Avoiding social situations that involve food
  • Becoming secretive about food

I think someone I know has an eating disorder. How can I help them?

  • Reassure and reaffirm them: an eating disorder is not a choice, so remind them that they did not ask to suffer
  • Highlight their non-physical attributes: although it is helpful to remind your friend that they are beautiful and attractive, also be sure to draw attention to other characteristics, such as their wit, artistic or musical ability, or baking skills. It is helpful for your friend to develop an image of a person's worth that is not tied to their appearance.
  • Change your media habits: look up content that is body positive and consume that instead – this means the movies you watch, the music you listen to, and even the games you play
  • Avoid negative body talk: you might want to complain about how fat or ugly you feel one day, but avoid this talk – it might trigger them into thinking about how they look like, which can be a difficult spiral to stop.
  • Encourage them to get professional help: a mental illness is not something that should be navigated alone, and research shows that people with eating disorders are more likely to recover with the help of professional therapists, dietitians, and physicians. It might be difficult to bring up, but if you think they are suffering, gently bring up the option of professional help.

I think I might have an eating disorder.How can I get better?

  • Reassure yourself: an eating disorder is not a choice, so do not blame yourself for having it.
  • Find your triggers: recognise what makes you more likely to relapse so that you can avoid these situations. For example, if someone constantly makes triggering comments, you are allowed to avoid their company. Or if a particular social media app brings you down, you can delete it. Take small steps to counter the impact of external triggers on your eating habits.
  • Take a social media break: if you are affected by the images you see and the comparisons you make online, delete or deactivate all your social media accounts – you can even get your friends to join in.
  • Make more media: if you are particularly affected by images online, start creating media, like digital art or music, to understand just how much work goes into creating them.
  • Increase your self-esteem: take part in activities that you like, like learning a new language or skill or volunteering somewhere, to remind yourself of your worth beyond your appearance.
  • Tell the people around you: not only could your family and friends be an invaluable source of support, but it is also easier to stick to healthy eating habits with several people keeping an eye on you and joining you, such as having healthy meals together.
  • Be inspired: if you can, hear from survivors of eating disorders at Not Just Surface Damage
  • Get professional help: a mental illness is not something that should be navigated alone, and research shows that people with eating disorders are more likely to recover with the help of professional therapists, dietitians, and physicians. To start with, you can ask your family doctor if they can help.

I think I need professional help. Where can I go?

  • Eating Disorders Programme at SGH – provides medical and psychological support
    Phone: 6321 4377
    Email: eatingdisorders@sgh.com.sg
  • Singapore Association for Mental Health – support on various mental illnesses
    Phone: 1800 283 7019