By Janine Shamos
When Jenny was 14, she and her mother went on a diet for Lent. When Lent ended, Jenny kept dieting. She died at the age of 25. Many of us have a love-hate relationship with food. We eat when we’re bored, may not eat when we’re sad, eat differently when we’re stressed. Can you eat when you’re hungry and stop when you’re satisfied? Do you eat foods that are right for you or do you insist on eating foods that may make you ill or put on weight? We’ve all heard of anorexia, bulimia and binge eating. But these illnesses are not just about food. Often they are a ‘survival mechanism’ to help people cope with their lives.
An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Common eating disorders include anorexia nervosa, bulimia nervosa and binge-eating disorder.
An intense fear of gaining weight, disruption in the way body weight is felt, and feeling out of control and dictated to by food are some characteristics of an eating disorder. While eating disorders have long been thought of as ‘white middle class’ the picture is changing. “Anorexia generally starts in the middle teenage years, and by the age of 15, can affect as many as one girl in every 150,” says Health24’s CyberShrink. Statistics also show that more and more bulimics are black teenagers and binge eating occurs in up to 30% of the population. “When we think ‘eating disorders’, we generally think of anorexia and bulimia,” says Johannesburg-based psychologist Lee-Ann Hartman. “But this doesn’t give us a full picture. There are a number of other unhealthy eating patterns and lifestyle choices that could also develop into eating disorders including eliminating whole food groups to lose weight, obsessive counting of kilojoules and grams of fat, an unnatural obsession with healthy foods, and extreme exercising to control weight and eating patterns.”
It’s not just females who suffer from eating disorders either. “Although males with eating disorders often exhibit the same signs and symptoms as females, they are less likely to be diagnosed with what is often considered a ‘female disorder’,” says Hartman. Males with eating disorders also experience a distorted sense of body image and other symptoms similar women. However they may also have muscle dysmorphia, a disorder characterised by an extreme concern with becoming more muscular. While girls with eating disorders generally want to lose weight, some boys want to gain weight or bulk up.
“I didn’t know what I was getting myself into and I never realised how far it would go,” says recovering anorexic, Tracy Stewart. Eating disorders are often misunderstood and stereotypes abound. Many people mistakenly believe that a person develops an eating disorder merely because of their need to attain a slim body. However, it seldom is that simple. Eating disorders are often underlined by complex psychological issues such as low self-esteem and a person’s need for control over their life. By taking control of their bodies and food intake, they feel more empowered. Offering counselling, information and referral to specialists and support groups through its toll-free helpline 0800 21 22 23, the South African Depression and Anxiety Group (SADAG) says those suffering from anorexia are often more likely to be perfectionists in all aspects of their lives than people without an eating disorder.
“If you ask an anorexic or bulimic girl why she misuses food the way she does, she will tell you that all she wants is to be thin. If she were thin then everything would be wonderful, yet this is patently untrue,” says Natalie Smith-Chandler who specialises in treating eating disorders. Anorexics are very thin but maintain that they are fat. Bulimics are usually a normal weight – for all the agony a bulimic endures, there is seldom a massive weight loss. “An eating disorder is more than just an unhealthy relationship with food. It might begin with unhealthy eating behaviours, but an eating disorder can become an ingrained form of control and power,” says Stewart who has been battling anorexia for 16 years. As a child, Tracy felt that she had no voice of her own. She felt imprisoned by her negative life circumstances, criticism and a destructive home life. “I spent most of my days living in fear of what people thought of me. These people were people who I thought cared for me and loved me, but I was often disappointed and hurt by their actions. I internalised everything that was going on in my family and the only certainty I had was my control over food.” Tracy says she was desperate for someone to notice the pain she was in, to notice how unhappy she was and how out of control she felt. “It wasn’t about the food. It was about the pain that I was experiencing in my life and I felt no one understood this.”
There are different types of eating disorders. The main three are anorexia, bulimia and binge-eating.
Anorexia is characterised by:
- Extreme thinness
- A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
- Lack of menstruation among girls and women
- Extremely restricted eating.
Many people with anorexia see themselves as overweight, even when they are clearly underweight. Eating, food and weight control become obsessions. People with anorexia typically weigh themselves repeatedly, portion food carefully and eat very small quantities of only certain foods. Some recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic or long-lasting form of anorexia, in which their health declines as they battle the illness. According to the American National Eating Disorders Association, anorexia has the highest death rate of all psychiatric disorders – up to 20% of anorexics starve themselves to death.
Bulimia is characterised by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behaviour that compensates for the overeating, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise or a combination of these behaviours. Unlike anorexia, people with bulimia usually maintain a healthy or normal weight, while some are slightly overweight. But like people with anorexia, they often fear gaining weight, want desperately to lose weight and are intensely unhappy with their body size and shape. Usually, bulimic behaviour is done secretly because it is often accompanied by feelings of disgust or shame.
With binge-eating disorder, a person loses control over their eating. Unlike bulimia, periods of binge-eating are not followed by purging, excessive exercise or fasting. As a result, people with binge-eating disorder often are overweight or obese. They also experience guilt, shame and distress about their binge-eating, which can lead to more binge-eating.
How are eating disorders treated?
Treating a person with an eating disorder means restoring the person to a healthy weight; treating the psychological issues related to the eating disorder, and reducing or eliminating behaviours or thoughts that lead to insufficient eating, as well as preventing relapse. Treatment often involves a combination of options and depends on the needs of the individual. Different forms of psychotherapy, including individual, group and family-based, can help address the psychological reasons for the illness. Cognitive Behavioural Therapy (CBT) helps a person focus on their current problems and how to solve them. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognise and change inaccurate beliefs, relate to others in more positive ways, and change behaviours accordingly. Some patients may also need to be hospitalised to treat problems caused by malnutrition or to ensure they eat enough if they are very underweight.
“There are good days and bad, and there are days where I feel like I’m going in circles trying to fight the anorexia,” says Stewart. Recovery from an eating disorder is a slow process and not something that happens overnight. Getting help is essential, however, there is also much that you can do for yourself. Stewart has a website that offers support, information and referral for sufferers and loved ones. Visit www.recoveryspace.org for more information. Helping a loved one with an eating disorder is a particularly difficult thing to do. But it is something that needs to be done as soon as possible. Recovery is a process and the journey is certainly not a smooth ride but with the care and support of those who show unconditional love, it is possible!
Some Warning Signs
- Spending a lot of time every day thinking about food – such as when, where and what you will eat
- Constantly weighing yourself, with the number on the scale determining your mood for the rest of the day
- Using laxatives, diet pills, self-induced vomiting or excessive exercise to keep your weight down
- Though it is important to achieve and maintain a healthy weight and minimise the intake of foods high in fat, salt and sugar, food should not take over your life
5 Eating Disorder Recovery Tips from Tracy Stewart
Here are some tips, courtesy of Tracy Stewart and RecoverySpace.org, a non-profit organisation dedicated to promoting recovery from eating disorders in South Africa:
- Don’t be afraid to ask for help. People are surprisingly supportive. Don’t feel ashamed for what you are going through. Rather forgive yourself and allow yourself to begin healing.
- Write in a journal. This is a great place to be yourself without any judgement and to understand where some of your feelings are stemming from. Be honest. The only way you can truly begin recovery is if you are honest, first with yourself and then with others. Hiding behaviours harms no one other than yourself.
- Give yourself time. Recovery is a process and there are stumbling blocks but that should not discourage you from the amazing steps you have taken towards healing.
- Discover what makes you feel good. I found that volunteering at an orphanage was a great way for me to gain perspective on life. The children allowed me to be in the present and I found myself thinking less about my eating disorder.
- Identify your triggers. If watching Fashion TV is going to create anxiety about your weight, don’t watch it. Ask people you trust to help you with this by telling them what makes you most vulnerable and eliminate these triggers from your environment. Throw away those magazines and photos that are holding you back.