For most, food is a source of nourishment, energy, and satisfaction. But for some, it is a cause of anxiety, guilt and conflict. Misha (name changed) always had an unhealthy relationship with food. Though slim, she never felt she was slim enough. It didn’t help that her mother kept putting her on a diet to find a ‘suitable boy’. But it took the birth of her baby for Misha’s relationship with food to become toxic. Obsessing over weight, she would eat uncontrollably, feel guilty and throw up to feel better. The days she was too tired to vomit, she abused laxatives to purge her system. She became withdrawn, subdued, and was eventually brought for treatment. She was diagnosed with bulimia nervosa, an eating disorder.
Eating disorders are serious psychiatric illnesses characterized by abnormal eating behavior, difficulties regulating body weight and body image disturbances. (Goldschmidt et al., 2016). No matter how attractive, thin or fit sufferers are, they believe they aren’t. They abuse food and punish themselves by over-exercising or other compensatory measures, sometimes until death.
There are three kinds of eating disorders:
Studies show that among sufferers, the brain circuitry merging taste perception, food reward value and cognitive-emotional associations with food is disrupted (Volkow et al., 2011). Genetics plays a role. Relentless dieting is also a risk factor.
Are we part of the problem?
Eating disorders are a combination of biological, psychological and sociocultural forces, triggered by magazines, films, fashion, and social media. Because of the messages that trickle down, even we become part of the problem. Aren’t we sometimes guilty of complimenting those who’ve lost weight, and advising those who’ve gained?
The late Princess Diana spoke openly about her struggles with Bulimia. Closer home, actors Jacqueline Fernandes and Richa Chadha have been candid about their eating disorders. And it’s not just celebrities. Indian studies show dysfunctional eating attitudes in 14-26% adolescents (Jiwani et al., 2013; Babu and Aroor, 2017). While the disease peaks in women aged 10-30 (Rohde et al., 2017), boys, older men and women, and very young children aren’t immune.
Depression, anxiety, self-harm and suicidality are prevalent among sufferers (Ulfvebrand et al., 2015). Left untreated, eating disorders can cause malnutrition, menstrual problems, severe cardiovascular problems and even brain damage. Individuals with anorexia and bulimia are five and 1.5 times, respectively, more likely to die than peers without eating disorders (Fichter et al., 2015).
Treatment is not about food, but addressing the biological component and issues of control, insecurity and inner struggles. Huge strides have been made in treatment to include anti-depressants and mood stabilisers and even hospitalisation in severe cases. Misha responded well to treatment and now leads a happy life. If you know anyone who might be suffering, urge them to seek help. Reduce your risk of developing an eating disorder by nurturing a healthy relationship with food, maintaining a healthy body image and giving yourself the best gift you can ever give: self-love.
The writer is a consultant psychiatrist at Jaslok Hospital