When Food Consumes You: Understanding Eating Disorders

Live to eat, or eat to live–which one are you?

According to the World Health Organisation (WHO); in 2019, 14 million people experienced eating disorders such as anorexia nervosa and bulimia. Much closer to home, in an article published by the Ministry of Health (MOH); between 2016 to 2020, there were an average of 300 patients per year receiving treatment for various eating disorders.

Essentially, eating disorders are a range of psychological conditions that manifest themselves in extreme, unhealthy eating patterns. Often, they start with an obsession with food, body weight, or body shape, which eventually develops into dangerous eating habits.

There is a common misconception that eating disorders are mostly diagnosed in women; but the truth is that they do not discriminate by age, race, gender, or sexuality. Unfortunately, in severe cases, eating disorders can cause serious long-term health consequences, including death, if left untreated. In fact, eating disorders are among the deadliest mental illnesses, second to opioid overdose.

However, there is hope. 

In this article, we hope to offer a basic guide to understanding eating disorders, where they come from, and how both individuals and their loved ones can cope with the illness. We have also invited three of our members: Yeow May, founder of Mind Garden Psychology; Caroline, founder of Calming Hearts Counselling; and Mandd, founder of Miracle of Minds, to share their thoughts and knowledge with us.

Signs and symptoms of an eating disorder

Eating disorders are defined by the American Psychiatric Association (APA) as “a behavioural cognition characterised by severe and persistent disturbance in eating behaviours and associated distressing thoughts and emotions.”

Here are the common mental and behavioural symptoms of eating disorders:

• Extreme preoccupation with food (e.g. calories, fat content, reading nutrition labels);
• Increased focus on healthy eating, weight loss, and body shape;
• Coming up with excuses to skip mealtimes or withdrawal from social activities involving food;
• Rigid rituals and routines surrounding food and exercise (generally being inflexible about what to eat and where);
• Over-exercising, or having a rigid exercise routine that seems inappropriate for the person’s age or activity level;
• Changes in eating habits, such as skipping meals or avoiding certain foods;
• Frequent comments about being “fat” or “flawed” in appearance;
• Use of laxatives, diuretics, diet pills, or induced vomiting to lose weight;
• Expressing depression, disgust, shame or guilt about eating habits; or
• Wearing bulky clothing or layers to hide their body shape.

Note: These symptoms are not mutually exclusive, and being diagnosed with an eating disorder requires a thorough assessment by a psychologist or psychiatrist.

What are the different types of eating disorders?

The DSM-5 (Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition) lists eating disorders under the category of “Feeding & Eating Disorders” and describes it as “characterised by a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food that significantly impairs physical health or psychosocial functioning.” Each type has unique risk factors, consequences, and treatments.

Note: An individual with an eating disorder can suffer from more than one of the following types of disorders:

Anorexia Nervosa: associated with partial or total abstinence from food (solids or liquids) because the individual believes any amount of food will cause weight gain. It is a potentially life-threatening disorder and individuals often perceive themselves as “fat” and have an intense fear of gaining weight.

As a result, they go to extreme efforts to lose weight (such as over-exercising or abusing laxatives), even if it significantly interferes with their health and daily life. These individuals are often underweight, although this is not always the case. You cannot determine if someone struggles with anorexia based on their body appearance alone.

Over time, individuals may suffer from health consequences such as brittle hair and nails, icy hands and feet, a weakened immune system, and permanent loss of bone mass.

Bulimia Nervosa: associated with being engaged in a cycle of binging and purging. Bingeing cycles start with the consumption of a large amount of food (in comparison to what is normally consumed) in a short period and are frequently emotionally induced. During a binge, the person usually feels out of control and cannot stop eating, even if they feel nauseous and experience severe discomfort.

The types of foods eaten during a binge can be any type, but most often occur with foods that the individual usually avoids (or are “forbidden”. Binges often occur at least weekly and are typically followed by what is called “compensatory behaviours” to prevent weight gain.

On the other hand, purging involves self-induced vomiting, excessive exercising, extreme fasting and laxative abuse. The idea is to rid themselves of the extra calories taken during a binge and as a way to compensate for the calories consumed and relieve gut discomfort.

Similarly, an individual must engage in purging behaviours at least once per week for three months to meet the criteria for diagnosis. Individuals with bulimia usually maintain a relatively typical weight rather than losing a large amount of weight. Over time, these individuals might experience dental problems (due to stomach acid from vomiting), swollen glands in the neck, or scarred knuckles from repeatedly inducing vomiting.

Binge-eating disorder: associated with binging excessively with periods of impulsive and non-stop eating–to the point of being uncomfortably full and even when they’re not hungry. The key difference is that binges are often not accompanied by purging or compensatory behaviours. It also does not include an individual’s perception of body shape and weight in diagnostic criteria.

Binge-eating disorder is one of the most common eating disorders, and it is usually triggered by an emotional event that causes the individual to turn to food as a means of comfort, the aftermath of which often results in guilt and self-loathing. Studies suggest that people with binge eating disorder may use overeating as a way to deal with uncomfortable emotions such as anger, sadness, stress, anxiety and boredom.

Typically, those affected are overweight or obese due to the binging episodes. To be officially diagnosed with binge eating disorder, the psychologist will consider if you have binged at least once a week over the past three months.

Is there a cause for eating disorders?

In short, the answer is no. Eating disorders are complex, multi-faceted disorders that arise from various biological, psychological, and social issues that vary from individual to individual. As Yeow May describes: “The presence of interpersonal difficulties within the family and/or with others, trauma and complex trauma, peer teasing/bullying, societal/cultural expectations; glamorisation and idealisation of thin bodies in the media.” can all result in the development of an eating disorder.

“Possible underlying reasons contributing to eating disorders include biological factors such as family history and genetic predisposition, and psychological factors including perfectionistic traits, over-reliance on validation from external others, poor body image, low self-esteem, and other anxiety and mood conditions.”

Mandd also adds: “Eating disorders can be caused by a multitude of factors, including certain genetic predispositions and medical conditions, the use of stimulants and substances such as caffeine, the influence of family, friends and colleagues, and individuals who have experienced trauma may all be more prone to developing an eating disorder.”

“It’s important to note that the presence of one or more of these risk factors does not guarantee the development of an eating disorder, but rather increases the likelihood of its onset. Additionally, multiple risk factors can interact and compound the risk of developing an eating disorder.”

Caroline shares her experience: “In my practice, I came across cases who are battling both depression and an eating disorder at the same time, and most of them have underlying psychological reasons such as:

• Low self-esteem;
• Lack of healthy coping mechanisms;
• History of abuse and trauma;
• Obsessive thinking; and
• Perfectionism

“And in all of them, there are unmet needs that drive the eating disorder such as not being seen or heard by their family, a sense of a lack of control, or being haunted by past trauma.”

In addition, the Journal of Affective Disorders has reported that people who have eating disorders may also struggle with other mental health conditions. The most common co-occurring mental health condition is depression and anxiety.

Treating eating disorders

According to the National Eating Disorders Association (NEDA), eating disorders have the highest mortality rate of any psychiatric illness. Long-term complications from an eating disorder include arrhythmia, sudden cardiac arrest, multi-organ failure, suicide, or even death.

Because eating disorders aren’t always obvious, they’re far more common than many of us realise. Treatment depends on your specific type of eating disorder; but in general, it typically includes a team approach such as nutrition education, psychotherapy and medication.

For psychotherapy, there are many evidence-based treatments that can support eating disorder recovery; the most well-known being Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), and Family-Based Treatment.

The goals of such treatment options are:

• Individual, group, or family psychotherapy. CBT may be recommended to help individuals learn how to recognise and change distorted or unhelpful thought patterns that lead to unhealthy eating patterns. Family therapy sessions can also help to rebuild the relationships that have been affected due to the disorder.
• Nutritional counselling. a nutritionist will work with the individual to learn proper nutrition and eating habits, or develop nutritious meal plans to restore or manage a person’s weight, especially if they have experienced significant weight changes. Studies suggest that combining nutritional counselling with CBT may significantly improve treatment outcomes.
• Medications. A doctor may recommend treatment with medications such as antidepressants, antipsychotics, or mood stabilisers to help treat an eating disorder or other conditions that may occur at the same time, such as depression or anxiety.

A therapist might also recommend individuals join group counselling or a support group to break down isolation and alienation (something that is commonly experienced by those affected by an eating disorder).

Mandd shares his insights from a hypnotherapy perspective: “Sessions can help to uncover the root cause of eating disorder symptoms at the subconscious level. By doing so, it becomes possible to clear any emotional baggage related to the disorder and help the person move forward.”

“Once the emotional baggage has been cleared, hypnotherapy can help to strengthen a person’s self-worth and self-esteem, promoting the development of a healthier lifestyle. The goal is to support the individual in establishing a more positive relationship with food and their body.”

Caroline shares her thoughts: “Counselling and psychotherapy can help someone with an eating disorder with evidence-based Cognitive Behavioural Therapy (CBT) that helps to identify the thought patterns and beliefs, or Acceptance and Commitment Therapy (ACT) where the focus is on changing your actions as opposed to thoughts and feelings.”

Yeow May: “Psychotherapy can assist persons with an eating disorder by exploring and understanding some of the reasons surrounding the behaviour; when we bring the less than conscious to a more conscious level (e.g. to exert some form of control in an otherwise uncontrollable situation(s)), it allows for improved awareness of unmet needs which can subsequently inform different ways of resolving the root cause(s).”

Supporting a loved one to seek treatment

Eating disorders can be debilitating for an individual, often manifesting in terms of serious health problems, depression and anxiety, social and relationship issues, and suicidal thoughts and behaviours.

If you’re worried about a loved one, it is important to know the signs and urge him or her to talk to a doctor.

Here are some things you can do to support a loved one’s recovery:

• Understand triggers: Major life changes can trigger those fighting an eating disorder; whether it be bullying, a family or relationship issue, job loss, or the death of a loved one. It isn’t uncommon for those with an eating disorder to find it hard to cope with stress and anxiety during the holidays as well.
• Make mealtimes as stress-free as possible. Instead of asking your loved one to “just eat”, emphasise the importance of living healthily by incorporating balanced meals into their diets, encouraging them to pick up a new hobby or engage in activities that bring them joy, and teaching them about moderation.
• Avoid blaming and listen without judgment. Resist the urge to advise or criticise. Even if you don’t understand what they are going through, it’s important to validate your loved one’s feelings.
• Take care of yourself. Don’t become so preoccupied with your loved one’s eating disorder that you neglect your own needs. Make sure you have your own support, such as a trusted friend, a support group, or your own therapist.

Mandd shares his advice: “Early detection of eating disorder symptoms, such as sudden and extreme changes in eating habits, is crucial for effective treatment. If you suspect that someone you know may be struggling with an eating disorder, listen to them without judgement and encourage them to seek help from a professional.

If a person is experiencing emotional trauma, such as bullying, it’s important to seek support from a professional counsellor, psychologist, psychotherapist, or hypnotherapist. They can provide the necessary care and guidance to help the individual overcome the challenges they are facing.

In cases where an eating disorder is at the extreme, such as in the case of anorexia, it’s important to seek medical attention first to ensure the person’s physical well-being is taken care of. Once the medical needs have been addressed, treatment for the underlying mental and emotional factors can begin.”

“It’s important to remember that seeking help early can greatly increase the chance of a successful recovery from an eating disorder. If you are living in the same house as someone with an eating disorder, consider making changes to a healthier lifestyle, because the environment will affect their eating habits as well. Encouraging a healthy and balanced approach to food and physical activity can help support their recovery.”

Yeow May also adds: “There can be a lot of shame and guilt associated with eating disorders; rather than judgmentally call them out, remember to approach them gently with kindness and compassion. It is also crucial to consistently foster safety and openness in the dialogue, to keep mealtimes as stress-free as possible, to assist them in reducing self-isolation and increase connectedness with others, and to encourage them to seek professional support when needed.”

For Caroline, support means: “Refrain from “talking sense” to them because eating disorders do not respond to logic. Instead, ask questions about their feelings, ask them how you can support them.”

“Stop any body talk and focus on their positive qualities.”

Important to note is that no one is to blame for an eating disorder. Eating disorders are not a choice.

Nourish to flourish. 

While seeking professional help is important, don’t ever underestimate your own role in recovery!

Research has shown that protective factors may lower your chance of getting an eating disorder. These include:

• high self-esteem;
• positive body image;
• being self-directed and assertive; and
• good social relationships.

Ultimately, there isn’t a quick fix when it comes to treating disorders, so be patient with yourself and listen to your body and feelings! Don’t neglect therapy or other components of your treatment (even if you’re doing better), and surround yourself with people who value you for who you are, not what you look like.

P.S. Eating disorders can often be isolating for those affected, but at their core, these individuals are often exceptionally intelligent and beautiful people just like you and me.

Sources

https://www.who.int/news-room/fact-sheets/detail/mental-disorders

https://www.moh.gov.sg/news-highlights/details/body-dysmorphic-and-eating-disorders

https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders

https://www.womenshealth.gov/mental-health/mental-health-conditions/eating-disorders/binge-eating-disorder#references

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085695/

https://www.mdpi.com/2072-6643/13/12/4490/htm

https://nedc.com.au/eating-disorders/eating-disorders-explained/risk-and-protective-factors/

Disclaimer: We would like to give a huge shoutout to Caroline, Mandd, and Yeow May for contributing to this article. At A Space Between, we offer therapists who are ready to fight alongside you through the ups and downs of overcoming an eating disorder. Use our Therapist Directory to find a therapist suitable for your needs today.

Caroline Ho started her career in the banking sector and a personal experience changed her perspective of what she wanted for her career. As your counsellor, her approach will be empathic and person-centered and will work with you to do manage the difficulties you are facing. She is also a Provisional Clinical Member of Singapore Association for Counselling.

To help his father with his alcohol addiction during the pandemic, Mandd Fernando rekindled his interest to pursue in-depth study in hypnosis and hypnotherapy. Since then, he has been using hypnosis and hypnotherapy to help people who are facing weight, anxiety, stress, panic attack and addiction issues.

Tan Yeow May is a clinical psychologist with over 8 years of experience working with adolescents and adults across a variety of Government and Community settings in Western Australia and Singapore. This includes individuals within in- and out-patient hospitals, rehabilitation centres, and in prison settings. she works primarily from dynamically oriented and attachment based approaches, where her focus is on addressing underlying issues that often mask as problematic symptoms. She believes in the value of attending to core issues and the context with which one’s distress develops, lest they remain under- or unprocessed, creating other problems that can manifest in various ways later in life.

Charmaine

A dreamer whose go-to motto is “Follow Your Heart”, Charmaine is currently embarking on obtaining her Masters’ of Counselling, hoping to eventually make a full-time career in supporting others in their mental health journey. She has always been awed by the beauty of the human psyche and writing remains to be her favourite form of expression. She enjoys reading and writing about trauma, and would like to encapsulate the silver linings of what it means to be an imperfectly perfect human being in all her pieces.