Eating disorders are a growing problem amongst young people as they enter the digital space with greater frequency and use social media more often. 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 young people to suffer from eating disorders (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 my child'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 a young person’s overexposure to the images they see of bodies online is when they internalize these ideals and compare their bodies to the ones on the screen. This is a doomed 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 your child to internalise them as something they can and should be able to obtain. Not obtaining this ideal shape can then cause more hardship 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. On social media, having more likes and followers are easy indicators of a person’s popularity and their online achievement. This can easily shape your child’s sense of self-worth. Social media allows your child 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 a child 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. Young people can easily become trapped in a world where they are anxiously waiting for likes and comments, then feeling disappointed and hurt if they do not receive them, even deleting the post so that more people are not witness to their ‘failure’. This anxiety, worry, and insecurity can manifest in an eating disorder. 

How can I tell if my child has an eating disorder?

There are several signs of eating disorders, although they will change depending on the type of eating disorder that your child is suffering from. Generally, signs include:

• Distorted perception of their own 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

How can I stop this from happening to my child?

• Consume better media: your child likely consumes a lot of media on a daily basis, so make sure this content is as body-positive as possible – look up shows and movies beforehand to check their content through reviewing sites like Common Sense Media and Kids-In-Mind
• Take a social media break together: if your child is very affected by images online, suggest that you can both take a break from social media by deleting or deactivating your accounts
• Reassure and reaffirm them: many people suffer from insecurity because of the lack of affirmation they get - so encourage your child to feel confident in their own body
• Highlight their non-physical attributes: although it is helpful to remind your child that they are beautiful and attractive, also be sure to draw attention to other characteristics, such as their wit, artistic or musical ability, strength, quick reading, baking skills, or anything else! This helps them develop an image of a person's worth that is not tied to their appearance.
• Enjoy healthy eating together: as a family, make a point to have balanced meals and to be active outdoors. If these are part of your family's daily lifestyles, it will also be easier to spot any changes to it if your child develops an eating disorder.
• Be a good role model: as helpful as it is to stress your child's positives to them, it is equally important to be as kind to yourself. Children can be very perceptive, so if they see you mentioning your desire to lose weight or unhappiness with your body often, they may turn this critique onto themselves.
• Be openly positive about your own body: prevent your child from feeling ashamed about their body by talking about your own positively and openly. Comment on how strong you feel one day or how beautiful you feel on another.
• Bring up the issue: if a celebrity is struggling with an eating disorder in the news, like Demi Lovato, or a show has a storyline about it, like our own Tanglin, commend the person for their struggle instead of hiding or stigmatising the issue.

However, it is important to remember that eating disorders are a type of mental illness. This means that no matter what you do or how many precautions you take, there is a chance that your child suffers from it anyway. This does not reflect any failure on either of your parts. Instead, consider it an opportunity for the family to come together to help one of your own recover and get better. Read about eating disorders more at Not Just Surface Damage – a compilation of stories by survivors of eating disorders – or the Health Promotion Board.

I think my child needs 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