“Eating Disorders can have serious medical and psychological consequences which,
left unchecked, can kill. Parents should address this issue and ask their children
to discuss how they feel about themselves”.
Tipper Gore
During adolescence, while the youngster is passing through choppy waters as they grow from adolescents to young adults, profound emotional, physical and biological changes occur. It is a time when young people's minds and bodies undergo intense changes, hence they feel out of control and are vulnerable to emotional difficulties. A significant difficulty they may face is that of body image and self-esteem. Incessant bombardment by countless, bottomless social media apps ceaselessly emphasise the ideal weight and the perfect look. Further, the same media focus the attention of the youngsters on celebrities or “influencers” that may have the illusory “perfect and ideal” figure! Consequently, the influence of these factors can make impressionable young individuals feel more sensitive and insecure about themselves. Unable to control much else, the perplexed teenagers, aspiring to achieve the ideal body shape, turn their focus to food: they either stop eating or start overeating or purging - all in an effort to maintain autonomy as well as control their weight.
Abusing food (eating too much or too little) is referred to as an “eating disorder” or ED. The three most common types are, 1. anorexia nervosa (AN), 2. bulimia nervosa (BN), and 3. binge eating disorder (BED). According to the American Psychiatric Association EDs affect up to 1. 5% of the population, 2. affect both genders between the ages of 12 years and 35 years and 3. are associated with preoccupation with food, weight or “body shape” (figure). More important to note is that an eating disorder is not “a phase”. It can last a lifetime and sadly has a high mortality rate. Thus, it is important for adults to remain vigilant as the level of seriousness depends on the duration of undereating or overeating and how often they do this. In most cases, the family, with appropriate guidance and understanding of the disorder, can offer the most stable environment for a young person to recover from an eating disorder.
The physical changes that take place in adolescent years, such as gaining fat or body and facial hair can be alarming to them and may cause internal agitation and the only thing they are actually able to control is what goes into their body - i.e food! As a result, eating disorders often begin with restricting certain food, quantity or meal timings, all of which gives them the feeling of being in charge. However, in adolescence, any lack of essential dietary nutrients has the potential to deprive them of the vital nutrition reaching the brain, body and bones. It is imperative that they consume adequate nutrients though a balanced diet. Many with eating disorders often have low self-esteem and poor body image - making them even more exploitable. Further, on social media the illusion is that there is a “perfect” person with a picture-perfect family, limitless wealth, time and abundant resources. Sadly, constant exposure to idealistic lifestyles can further contaminate the mind of a young person with ED. Research suggests that the influence of social media might be the significant cause of the rise in the number of young people having eating disorders and self-harming behaviour. It is important not to forget that young minds are often unable to evaluate subtle messages. Media on the other hand are excellent at distorting reality and hence it is difficult to protect a young mind from them. Additionally, family members, peers and bullies sometimes make reckless comments such as “you’ve put on weight”, “you’re so thin”, “you’ve filled out”, “you’re too fat to do that”. These types of comments are hurtful and demeaning, they can aggravate inferior feelings and stress in sensitive youngsters, leaving them in an endless cycle of preoccupation with their “look”. In severe cases, medical intervention is necessary and the family should seek professional help. Although the young person strives (helplessly) for autonomy, the literature is clear - family remains the bedrock of support.
Readers please note, a young person may not induce vomiting, purge after overeating but may do so after a normal meal with the aim of losing weight, forage all day, or an individual with AN may not be underweight. Nevertheless, all EDs are an illness and the individual abuses food not to be difficult but in a desperate effort for autonomy. Therefore, harsh punishment or criticism is ineffective and counterproductive and must be avoided, while empathy and understanding will be more constructive.
Below are brief descriptions of the three main eating disorders. However, please note that a medical expert should be consulted at the earliest opportunity as delay can cause more biological and psychological harm.
Anorexia Nervosa (AN) is the person’s inability to maintain a normal body weight and the relentless quest to weigh less by refusing to eat and even claiming that they are not hungry. This condition usually affects females but can affect young males. Onset is usually triggered as the adolescent tries to conform to society and media ideals of a slim acceptable person. However, this can quickly develop into fear of eating food and can lead to extreme weight loss. The condition can cause depression and anxiety as the feeling of being in control or euphoric from positive attention due to weight loss disintegrates. The person may also participate in strenuous exercise (too much and/or too often), strange rituals and admit that they have a “voice” instructing them. The “voice” is only present in AN.
Bulimia Nervosa (BN) is possibly more dangerous than other eating disorders because it can go unnoticed although the individual might be going through terrible psychological and emotional trauma. In some their weight stays the same or fluctuates, while others might be overweight. Either way, the vicious cycle continues to be propelled due to the intense fear of being “fat”. The individual might purge in secret, abuse laxatives and participate in other compensatory behaviour such as excessive exercise. They often have low self-worth and might be suffering from an early adversity (Post Traumatic Stress Disorder - PTSD) which is not present in AN. Studies indicate that in males, BN is associated with alcohol abuse and steroid abuse related to the Adonis syndrome where a young boy might want to look like his favourite male athlete.
Orthorexia has become common in developing countries. In this case the young person develops a pathological obsession for biologically pure food and excludes some food types from their diet. Sometimes parents or older siblings might be engaged in things like intermittent fasting, keto diets or avoiding carbs which can conflate healthy eating with weight control for the young person.
To conclude: EDs are a type of mental illness and could be potentially life-threatening. It is important for the family to seek the support from a psychologist or mental health professional. Families should bear in mind that the individual can be difficult to treat as they might be embarrassed and will not readily admit the problem. All young people want to be in control of themselves, and so, it must be made clear to them that the caring adults want to control the illness only and not them.
Nivedita M. Dhadphale
MSc (Psychology) (Strath), MBA (Strath).
PGD Psychology and Neuroscience of Mental Health (IOPPN, KCL)
Assistant Lecturer in Psychology at the British University of Bahrain.
Member British Psychological Society (BPS), Fellow Chartered Institute of Marketing (CIM), Member Applied Neuroscience Association (ANA).
More information can be found here:
(N.B: This article is for information purposes only, and queries should be directed to trained medical personnel).
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