What is an Eating Disorder?

An eating disorder is a mental and physical illness that involves complex and damaging relationships with food, eating, exercise and body image. Eating disorders do not discriminate but is mostly found amongst young women where there is marked distortion of body image, pathological desire for thinness and self-induced weight loss by a variety of methods such as dieting, exercise, intermittent fasting etc.

What causes Eating Disorders?

The causes of eating disorders vary between genetic, biological, behavioral, psychological and social factors. Many people with eating disorders may also experience some common mental illness such as

• Depression
• Anxiety disorders
• Obsessive-compulsive disorders
• Phobias of certain foods
• Issues with self-esteem and body image

Body Mass Index (BMI) is a ratio  between weight and height and is used to evaluate if an individual is at an unhealthy weight at a given height.

BMI = weight in kg / (height in metres)2

Women             Men

<19.1               <20.7                 – underweight

19.1 – 25.8        20.7 – 26.4      – ideal weight

25 .8 – 27.3       26.4 – 27.8      – marginally overweight

27.3 – 32.2        27.8 – 31.1       – overweight

32.3 – 44.8        31.1 – 45.4       – very overweight or obese

>44.8                  > 45.4               – morbid obesity

Types of Eating Disorders

Anorexia nervosa

This is a condition where individuals usually engage in persistent energy intake restriction, have an intense fear of gaining weight or engage in behaviours that interfere with physiologic weight gain with a distorted perception of body weight or shape. Individuals with this condition, excessively limit calories or use other strict methods to lose weight such as using laxatives, diet aids and vomiting after eating.

Symptoms and signs are mainly due to the effects of starvation or vomiting. This includes; loss of muscle mass, dry skin, brittle hair and nails, anaemia, eroded tooth enamel ( dental caries), hypothermia, bradycardia, atrophy of breasts, peripheral neuropathy , amenorrhea etc.

Common psychiatric symptoms include; attention and concentration problems, irritability, depression, low self esteem, loss of appetite, reduced energy, insomnia, loss of libido etc

Most patients will be treated by Psychiatrists and Psychologists as outpatients with a combined approach of

• Medications
• Psychotherapy: Cognitive behavioral therapy, family therapy
• Nutritional education

Inpatient management may be necessary for patients with significant medical or psychiatric problems as determined by the Psychiatrist/ Psychologist.

If untreated, this condition carries one of the highest mortality figures for any psychiatric disorder (10 – 15%)

It treated, 1/3 recover fully, 1/3 recover partially, 1/3 develop chronic problems.

Bulimia nervosa

This refers to a mental condition where individuals lose control over how much they eat (binge)and then take drastic action to not put on weight (purge). This may be done by self-induced vomiting, taking laxatives, periods of starvation, excessive exercising, water fasting or use of drugs such as appetite suppressants thyroxine or diuretics. Usually, such individuals may have normal weight. 

The physical signs and symptoms may be similar to Anorexia nervosa. Specific problems related to purging includes; electrolyte imbalances, gastrointestinal problems such as constipation, steatorrhea, peptic ulcers, dental erosions, cardiac failure etc

Management is similar to Anorexia nervosa. Admission is required for patients with suicidality, physical problems, extreme refractory cases or if pregnant.

Prognosis is generally good, unless there are significant issues of low self-esteem or evidence of severe personality disorders. Half recover over 10 years with treatment.

Binge eating disorder (BED)

This differs from Bulimia nervosa in the sense that BED involves no recurrent use of inappropriate behaviors to compensate for binge episodes. It also does not include an individual’s perception of body shape and weight.

Avoidant/ restrictive food intake disorder (ARFID)

This causes the individual to limit food intake by volume and/or variety. This avoidance of food may be based on appearance, smell, texture, taste, packaging, fear of adverse consequences, lack of interest in food or a past negative experience with the food, to a point where it may lead to nutritional deficiencies, failure to thrive or other negative health outcomes. Most people with this condition will still maintain a healthy body weight. They may experience gastrointestinal reactions to adverse foods such as retching, vomiting or gagging, there is no concern for body image or an attempt to lose weight. Symptoms of ARFID may be associated with Autism, Anxiety disorders, Anorexia nervosa and obsessive-compulsive disorder.

Pica

This involves an individual eating one or more nonnutritive, non-food substance, which is inappropriate to the developmental level of the individual and culturally unsupported, on a persistent basis for at least one month. Some common causes are anaemia, autism, malnutrition, schizophrenia.

Pica can cause surgical emergencies such as intestinal obstructions, as well as more subtle symptoms such as nutritional deficiencies and parasitosis. Risk factors include; psychological trauma, maternal deprivation, family issues, parental neglect, pregnancy and a disorganized family structure.

See a doctor for assessment and appropriate treatment.

Regurgitation disorder/ rumination syndrome

This refers to repeatedly and persistently bringing food back up into the mouth without nausea or gagging. This is not due to any medical condition or another eating disorder. Sometimes regurgitated food is rechewed and reswallowed or spit out. Common symptoms include acid-induced erosion of the oesophagus and enamel, halitosis (bad breath), malnutrition, severe weight loss and an unquenchable appetite. This eating disorder may mimic the binging and purging in bulimia and gastroparesis.

There is presently no cure for rumination, however supportive therapy and diaphragmatic breathing has improved 56% of cases and total cessation in an additional; 30% in one study of 54 adolescent patients who were followed up 10months after initial treatment.

What are Emotions?

Emotions refer to the reactions an individual gives to a significant event. Examples include happiness, sadness, anger, joy, disappointment, surprise etc.

Emotional abuse is a type of abuse which consists of belittling. manipulating or undermining other people's feelings, self confidence and mental health. Though this type of abuse is usually common in romantic relationships,  emotional abuse may occur in any relationship including that between family, colleagues or friends.

Emotional abuse may take several forms. This may include:

• Constant accusations of cheating, jealousy or possessiveness
• Name calling, insults or verbal abuse
• Withholding affection or attention
• Gaslighting
• Constant criticisms or controlling someone's behaviour
• Controlling someone with threats and intimidation
• Isolating an individual from their job, friends and family
• Constantly Blaming someone for things they didn't do
• Trivialising the other person's concerns

Misunderstanding and minor squabbles in a relationship are common but if being with the person makes you feel afraid, disrespected, ignored, belittled or insulted then it is possible you are being emotionally abuse. Emotional abuse may be subtle but its consequences can be as severe as that of physical abuse. Emotional abuse leaves invisible scars, making you doubt yourself, reduce your self confidence,  mar your self esteem etc. Other may develop mental illness such as major Depressive disorders, generalised anxiety disorders, eating disorders, mood disorders etc.

In dealing with Emotional abuse, the first step involves the ability of the victim to recognise the abuse. Seek help from a psychologist / psychiatriclst or a domestic violence hotline, get out of that abusive relationship,  prioritise yourself, set boundaries, stop blaming yourself and build a better support system.

Trying to appease the abuser, hoping he would change someday, reasoning out his actions will not stop the emotional abuse.

Emotionally Unstable Personality Disorder

>>Refer to Borderline Personality Disorder<<

This refers to the voluntary of involuntary passage of feces by a child who is 4 years and above who has been potty trained, outside of toilet trained contexts after organic causes have been excluded. This term is usually used in children and should have occurred at least once in a month for at least 3 months. it is commonly known as fecal incontinence in adults. This may or may not be associated with constipation.

In the subtype with constipation and overflow incontinence, the feces are usually poorly formed and leakage is continuous, and this occurs both during sleep and waking hours. In the type without constipation and overflow, the feces are usually deposited in prominent location and may be associated with conduct disorder or chronic encopresis.

Children with encopresis usually experience:

• Difficulty holding their stool until they get the toilet
• Passing stools in cloths
• Hiding or avoiding bowel movements
• Feeling bloated and having abdominal pain
• Loss of appetite

Psychological causes of encopresis may include emotional stress, behavioral challenges or fear that affects the actions of the child. Encopresis is more common in boys than girls. Risk factors such as ADHD, Autism spectrum disorder, Anxiety or depression and use of medications that may cause constipation such as cough suppressants.

Treatment includes an urgent assessment by a pediatrician, nutritional education and psychological assessment. A child who has encopresis may experience embarrassment, frustration, same, anger, depression and low self-esteem.

Exams Stress

Exam stress is very common amongst students before an exam. A small amount of this stress is necessary to keep you focused but too much if it can be counterproductive and hence affect your performance negatively. An individual will experience exam stress when

• They feel unprepared or have not had time to learn for the exams.
• They have learnt a lot of things within a short period and are required to recall every bit of information during the exam
• They need to pass the upcoming exam to be able to move up the academic ladder
• Their family depends on the success of that exam
• They lack confidence in themselves to pass that exam

An individual who is experiencing exam stress will show symptoms of feeling moody, overwhelmed, out of touch with friends, difficulty making decisions, poor sleep, poor appetite, racing heartbeat, fidgeting, nail biting, feeling confused etc.

In order to prevent exam stress;

• Start studying early for the exam
• Have a clean and organised study area with all the materials you will need to study.
• Create a realistic study plan and execute it
• Do well to sleep well, so you can wake up well rested
• Take breaks in between studies
• Practice relaxation techniques to help you calm down. This includes meditation, yoga, deep breathing exercises etc.
• Practice healthy lifestyle such as eating balanced diets, exercising, good sleep etc.
• Stay away from people who make you anxious or make you feel less of yourself.
• Ask your peers or teacher if you need help understanding something

A communication disorder refers to any condition that affects an individual’s ability to understand, recognise or apply language and speech to engage in a dialogue effectively. Examples of such disorders includes Autism spectrum disorder, expressive language disorder, mixed receptive - expressive language disorder and specific language disorder.

In expressive language disorder, there are difficulties with verbal and written expressions. Children with this condition usually have symptoms of comprehension issues, expression problems (difficulty explaining exactly what they mean), incomplete thought, odd sentence structure, unclear descriptions, word finding issues, delayed language and sometimes frustration. A child with this condition may reduce conversations with others and turns to throw tantrums because they are being misunderstood. They usually feel intimidated by their peers and become withdrawn.

Some causes include; new language learners, Autism,Language delays etc.

Some common symptoms also include limited vocabulary, difficulty with plurals, challenges getting ideas from head and paper, problem expressing thoughts clearly or social withdrawal.

Management involves seeing a pediatrician for thorough assessment. Psychoeducation and Psychoeducation. Individuals may also require constant practice of serious.