Written by Li Xin Rong (19-I4)
Designed by Martha Henrietta Soetedjo (20-U2)
When you think of eating disorders, what images and perceptions do you attach to it?
For most of us, set in our academically geared ways and blitzing along the railway tracks of life, eating disorders are a remote concept. We are unable to viscerally experience what it means to have an eating disorder, which is much more than simply having physiological frailness, such as being underweight.
For some of us, eating disorders may be an illness that has been romanticized by their portrayal in Western media and social media in general. However, films about eating disorders are not the best way to learn about what they entail.
Most films focus on anorexia nervosa and bulimia, but eating disorders are not limited to these two. Eating disorder experiences also vary very largely from person to person and may not have a clear denouement like films do. Just because a person with an eating disorder is restored back to a healthy weight does not mean his or her self-regard has improved. The person may still be battling with hatred towards food at this stage. Hence, the road to recovery is not marked by a single battle, but by small triumphs and continuous progress that can span the time of years.
Films about eating disorders tend to afflict a teenage female main character, despite the fact that eating disorders can affect anyone regardless of their gender, age or background. These teenage girls also tend to be glamorised as intelligent heroines with blatant angst, when most sufferers are often discreet and secretive about their problems. Such superficial depictions may be misleading and harmful to those who are vulnerable or those who are already anorexic.
While anorexia nervosa is the most common eating disorder, with typical sufferers looking abnormally thin, the illness does not begin with their physical frailty. The same goes for the other types of eating disorders. The illness is characterised by a recurring, negative loop of thoughts that obsess over one’s food intake.
Genetic predisposition, cultural factors and personality traits can give rise to eating disorders. For example, those exposed to thin ideals in their culture may experience perceived pressures to be thin. Personality traits such as neuroticism, perfectionism and impulsiveness are often linked to a higher risk of developing an eating disorder.
In the context of a Singaporean student, there are abundant stressors from the environment that can provide the opportunity for an eating disorder to develop.
Singaporean youths are amply exposed to western ideals of beauty, thinness and perfection. Such exposures shape our thoughts and create unrealistic standards for youths on what the beauty ideal is. This point has been belaboured many times, so here are the statistics.
Hospitals are seeing an alarming increase in the number of eating disorder cases, especially among teenage girls, where social acceptance is heavily tied to body image. A 2006 study showed that 7.4 percent of females in Singapore are at risk of developing an eating disorder, and according to adolescent specialist doctors from KK Women and Children’s Hospital, the number of cases of eating disorders are increasing every year.
Delving Deeper: Why Abnormal Eating Habits Develop and Why They Persist
Eating disorders are the deadliest of all mental disorders, particularly anorexia nervosa, with one in five either dying from complications associated with starvation (from damage to the heart, brain and other organs), or from suicide. Despite being severely emaciated, what prompts them to cling tenaciously to the ideal of unattainable thinness?
Tying back to the Singaporean context, it is too reductive to attribute the main cause of abnormal eating habits to being influenced by Western ideals of slimness. To this day, the most researchers and clinicians can conclude is that anorexia nervosa, the most common type of eating disorder, arises from various factors interacting with each other in a complex way. Some factors include feeling of a lack of control that could arise from failing grades, feelings of social isolation and helplessness, or anything that makes one perceive that they are inadequate.
These factors give birth to a lack of self-esteem. In the words of former eating disorders sufferers on a local YouTube channel, Our Grandfather Story, fanatically limiting the amount of food they ate became a source of “control” rather than wanting to weigh less. One of them described that “90 percent” of it was wanting to “fix [herself].”
This shows that controlling the amount of food they eat becomes an all-consuming source of self-esteem.
Sarah Rav, a medical student, who had recovered from anorexia nervosa in the past few years, spoke candidly of her experience in a Cleo article in July 2019. Before her diagnosis, though having dropped to a dangerously low weight of 30kg, becoming highly reclusive and anxious around meals outside where she couldn’t count her calorie intake, she revealed she was adamant about not having an eating disorder. Her goal had been “never to lose weight” but instead to be “healthy”. Describing herself as someone who “won’t stop until I’m the absolute best”, Sarah attributed the crux of her trigger to her highly perfectionistic tendencies.
The academic stress a student faces in Singapore’s academically competitive society does not help either. Eventually, the limit to starving oneself no longer becomes apparent. It is perhaps akin to filling a bottomless well with water, but never realising that the well, representing one’s unattainable standards, is bottomless.
The despair someone suffering from an eating disorder goes through can be incredibly debilitating. Since their thoughts are preoccupied with their food intake, eating meals is a stressful experience. Although people with eating disorders may strive for a sense of normalcy, that normalcy is warped for them until they recognise their own obsession over food and their radical self-regulation methods.
While it is unquestionably frustrating for those who are close to eating disorder sufferers, it is important to understand the psychological loop of thoughts going through their minds. Some people just think: “Why not just eat?” But for the person with an eating disorder, the preoccupation with food consumes all their energy and time, with feelings of inadequacy, self-hatred and discontentment drowning out most common sense. They come to associate the little damning, self-critical voice with their own identity – that is, their disorder and themselves are inextricable. In Singapore, eating disorders are treated in psychiatric settings by getting patients to acknowledge that the eating disorder and their own selves are two separate things. Being aware of such an unhealthy association allows them to progress along the road of recovery.
What can you do, as a family member, close friend or classmate?
You should treat them with kindness and understanding. Kindness and understanding form a triumphing influence over the despondency of their thoughts. You should ask them questions to try to understand what they are going through, and what type of support they want. It is very difficult for those without eating disorders to understand what they are going through, so do ask questions and try to put yourself in their shoes.
For anyone stewing in a bad mood for days- be it anger or sadness – the last things that would be welcomed are criticism and one-sided judgement.
While most caregivers of eating disorder patients – be they parents, siblings or medical professionals – prioritise establishing almost regimented food schedules to get them acquainted with normal eating habits again, many fail to address their psychological needs.
Eating disorders are classified under mental illnesses. Those who suffer from it require being introduced back to normalcy with gentleness and patience. Triggering intrinsic motivation to do so can come in the form of an objective party, who do not know about their eating disorder. Socialising with close friends from an objective party can be very healing for someone who has been isolated by mental illness for a long time (sufferers often withdraw from their friends to avoid meals with them, for example).
I believe it is important to associate mealtimes with a happy, care-free experience. Family members of eating disorder sufferers should perhaps try not to be forceful around mealtimes, but encourage them to take food of their own volition, while encouraging them to eat normal portion sizes.
By nudging them towards a healthy mindset towards food with understanding and empathy, the road to recovery will be a much more smooth-going and rewarding one.
In conclusion, eating disorders are a harrowing experience, and are capable of heavy repercussions on one’s physical and mental health. The road to recovery begins with the sufferer’s will to recognise their obsession, to strive towards a healthy standard of living, and to reject the illusion of control restricting their food intake gives them.
Those with eating disorders should channel their focus to happier and more mentally fulfilling tasks, so as to remove their focus on their bodies and their fixation over their version of perfection. They should also seek help from a loved or trusted one. Together, everyone as a family should practice self-compassion to best heal from an eating disorder.
Credits for the wording of certain eating disorder experiences, and statistics, go to “Fieldnotes of a Psychiatrist” by Professor Chong Siao Ann, a local psychiatrist and Vice Chairman Medical Board (Research), Institute of Mental Health.