Changing Disturbed Eating Behaviour

A negative body image can bring about eating disturbances, such as anorexia nervosa or bulimia nervosa. These are problems that gradually build over time. If you worry about looking fat, it may lead to an excess in diet and exercise. Chronic dieting may lead to binge eating, which can precipitate purging (vomiting). Not only does having a negative, "fat-phobic" body image predispose you to disturbed patterns of eating, but having an eating disorder undermines your body image

Adolescents, especially girls in trying to attain a zero figure body or having a negative body image often obsess about what they eat and weight gain, leading to extremes in diet control and exercise. Eating disorders which may arise as a consequence are anorexia nervosa and bulimia nervosa. Experts from MIND India Wellness Centre address issues pertaining to mental health and wellbeing in this space

A 16-year-old girl, student of class X, from a joint family of suburban background presented with a history of decreased food intake of two years. She was initially a thin built girl, but as per her family members, she started to gain weight when she turned 14. Though she did not appear overtly fat, she was sometimes criticised by family members and peers for the rapid weight gain, which prompted her to join a gym.

In addition, in the quest to lose weight she started imposing dietary restrictions on herself. Gradually her food intake started decreasing from three proper meals and frequent snacking to a mere 2-3 bowls of vegetables per day. Repeated efforts by parents and family members to make her eat failed miserably and were attended by crying spells and outbursts of anger. She started losing weight rapidly and suffered from absent menstruation (amenorrhoea) within a year. but continued with the restricted dietary routine.

A month prior she also started to remain sad throughout the day, lost interest in previously enjoyable activities and started to have poor sleep along with decreased attention and concentration. At the time of presentation her food intake consisted of a few biscuits per day only. Anthropometric (body) measurements revealed weight -- 39.5kg, height --162 cm and BM -- 15.05 Kg/m2. She appeared weak, bony, pale, with fine hair over her face. She had prominent bones, especially her jaw.

Her secondary sexual characteristics were poorly developed. She was hospitalised due to severe deterioration in condition and relevant investigations were done to rule out any endocrine, metabolic or any other medical disorder which could explain the weight loss and amenorrhoea. In addition, careful psychological evaluation was done to rule out any co-morbid psychological disorders.

Initially she reported decreased appetite and food sticking in her throat as the reason for not eating. However, after rapport was established, she gradually revealed fear of becoming fat as the reason for her dietary restrictions. Interestingly, she equated being thin with being beautiful and successful which seems to be quite distortive and pathological in nature and is regarded as an eating disorder, namely Anorexia nervosa.

Eating disorders are of two types: Anorexia Nervosa where there is loss of appetite or the inability to eat, and it can be a symptom of various diseases. When a person has anorexia nervosa, they intentionally restrict their food as part of a serious and potentially life-threatening mental health disorder. This often involves emotional challenges, an unrealistic body image, and an exaggerated fear of gaining weight. Bulimia nervosa on the other hand is also an eating disorder but is opposite to anorexia in its symptoms. In Bulimia, the person usually eats large amounts of food at one time (binge) and then gets rid of it, (purges). The physical, behavioural and emotional symptoms vary. The exact cause of anorexia and bulimia are unknown — it may be a combination of genetic factors and learned behaviours, but both are related to body image issues.

Body image can broadly be defined as the internal evaluation of one's appearance, in contrast with physical attractiveness, which is an external rating of appearance. Body image disturbance is a rather broad umbrella term that consists of several dimensions, including affective, cognitive, behavioural, and perceptual components. Body dissatisfaction is more common in adolescence and young adults, reports indicating prevalence in girls and women more than boys and men. Thus, body dissatisfaction or negative body focused self-perception may create a myriad of problems.

A negative body image can bring about eating disturbances, such as anorexia nervosa or bulimia nervosa. These are problems that gradually build over time. If you worry about looking fat, it may lead to an excess in diet and exercise. Chronic dieting may lead to binge eating, which can precipitate purging (vomiting). Not only does having a negative, "fat-phobic" body image predispose you to disturbed patterns of eating, but having an eating disorder undermines your body image. People with eating disorders not only hate their body shape and weight, but their eating problem traps them in a vicious, unhealthy cycle. The hatred towards their body and feelings of guilt, depression, and self-loathing just keeps diminishing the quality of their life and the ability to control their eating behaviour.

For good health and longevity, individuals with eating disorders must eventually gain control over their problematic eating behaviours. But they must also re-learn to think and feel differently about their physical attributes so that their feelings about their weight or shape no longer define their self-worth. Without repairing their body image, they risk returning to the same repetitive patterns of self-starvation or binges and purges. Although a negative body image is a core aspect of their problems.

By: Dr Joydeep Das

Clinical Psychologist

Consultant MIND India

Ask Dr Sangeeta Goswami

Question: Is Eating Disorders treatable, if so what are the treatments available?

Answer: Eating disorders are complex illnesses. While we do not definitively know what causes them, some theories exist. It appears that 50% to 80% of the risk for developing an eating disorder is genetic, but genes alone do not predict who will develop an eating disorder. It is often said that "genes load the gun, but environment pulls the trigger." Hence it can also an element of learned behaviour. The management of eating disorders is a collaborative approach, where clinical psychologist, psychiatrist and psychiatric social workers play a very crucial role. Treatments mainly are both psychotherapeutic counselling and psychopharmacological but varies from patient to patient in symptoms severity and their effectiveness.

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