Eating Disorder

Eating Disorder - What it is

Eating disorders are mental health conditions that involve abnormal thoughts, behaviours or habits surrounding eating. The most common types of eating disorders include Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder.

Eating Disorder - Symptoms

Anorexia Nervosa

Intense fear of gaining weight
Distorted body image
Eating restrictively or starving self intentionally
May use additional techniques to control weight (i.e. excessive exercise or abuse of laxatives, enemas, or diuretics)
Tend to engage in behaviours that seem abnormal or compulsive to others (e.g. weighing self every day, calorie counting, avoiding meals or multiple types of food, checking the mirror frequently, weighing and portioning foods carefully, etc.)
Tend to have significantly low body weight in relation to height or developmental stage

Bulimia Nervosa

Intense fear of gaining weight
Distorted body image
Engage in repeated episodes of binge-eating (i.e. eating large amounts of food in limited time until uncomfortably full) and compensating via purging (i.e. vomiting), excessive exercising, or abusing laxatives, enemas, or diuretics
Tend to be within normal weight range in relation to height or developmental stage

Binge-Eating Disorder

Tend to experience out-of-control eating but not engage in compensatory behaviours
Tend to be overweight as a result of eating habits
May develop metabolic complications such as diabetes, hyperlipidaemia, obesity, and hypertension over time

Eating Disorder - How to prevent?

Eating Disorder - Causes and Risk Factors

Eating disorders are complex conditions that can arise from a range of behavioral, interpersonal, emotional, psychological, and social factors.

Psychological Factors

Low self-esteem
Feelings of inadequacy or lack of control in life
Depression, anxiety, anger, or loneliness

Interpersonal Factors

Troubled family and personal relationships
Difficulty expressing emotions and feelings
History of being teased or ridiculed based on size or weight
History of physical or sexual abuse

Social Factors

Cultural norms that value people based on their physical appearance
Cultural values that glorify thinness and obtaining the perfect body
Narrow definitions of beauty based on specific body weights and shapes
Influence of media on standards of beauty

Other Factors

Possible biochemical or biological factors (e.g. imbalance of chemicals in the brain that control hunger, appetite, and digestion)
Genetic factors (i.e. family history of eating disorders)

While there are no specific causes of eating disorders identified, studies have found that people with eating disorders tend to use food and the control of food to compensate for feelings and emotions that may be overwhelming for them. Dieting, bingeing, and purging can bring about different perceived benefits to individuals with eating disorders, such as a greater sense of control, feelings of comfort and relief from emotional distress, and increased self-esteem. These ‘benefits’ tend to make holding on to the eating disorders appealing to individuals, and they may therefore resist or delay treatment for their eating disorders. In doing so, individuals with eating disorders expose themselves to serious risks that can damage their physical and emotional health, self- esteem, and sense of competence and control.

It may not be possible to avoid developing an eating disorder. However, seeking professional help, taking control of and treating eating disorders early on when symptoms first appear can greatly increase the individual’s chances of recovery.

Eating Disorder - Diagnosis

Eating Disorder - Treatments

Building a Positive Body Image and Healthy Self-Esteem

Eating disorders cannot be treated solely using medications, if at all. Psychotherapy or counselling is the most effective and long-lasting treatment for individuals with eating disorders, coupled with careful attention paid to medical and nutritional needs. Family counselling may also be needed to support the individual’s recovery process.

Building a healthy self-esteem and a positive body image is one important way to build resilience against eating disorders. There are several ways one can achieve this. For some individuals, seeking professional help from a psychologist or a counsellor can further support their efforts to build a positive self-image and increase self-confidence.

10 Ways to Improve Self-Image

Appreciate all that your body can do and celebrate it
Keep a top 10 list of things you like about yourself (not linked to your weight or what you look like) and read it often
Remind yourself that ‘true beauty’ is not just about how you look physically
Look at yourself as a whole person, instead of focusing on specific body parts
Surround yourself with positive and supportive people
Shut down internal voices that shame you or your appearance
Wear clothes that are comfortable and that make you feel good about your body
View social and media messages with a critical eye and pay attention to how they make you feel about yourself
Do something nice for yourself – take a relaxing bath, make time for a nap, or find a peaceful place to relax
Use the time and energy that you might have spent worrying about food, calories, and your weight to do something to help others

Building Resilience

Learning and adopting healthy coping skills can also help individuals manage their emotions and responses to stressors better. This in turn reduces the necessity for the individual to turn to food or controlling food to cope with life’s challenges. Coping better can be done by improving skills in stress management, time management, decision-making, problem-solving, and lifestyle management.

Another way to improve one’s ability to cope is to build resilience – which refers to the process of adapting well to trauma, adversity, threats, or other significant sources of stress. One of the most important ways to build resilience is to have supportive and caring relationships in one’s life. Having a positive view of yourself is another important factor in building resilience. The following are specific strategies that one can use to build resilience:

10 Ways to Build Resilience

Maintain good relationships with close family members and friends, and help others
Avoid seeing crises as insurmountable problems
Accept that change is part of living
Set realistic goals, break them down into small achievable goals, and move toward your goals gradually
Take decisive actions instead of avoiding problems
Look for opportunities for self-discovery (e.g. think about specific ways you have grown from dealing with a difficult situation)
Nurture a positive view of yourself, and develop confidence in your ability to solve problems
Keep things in perspective – think long-term and avoid blowing things out of proportion
Maintain a hopeful outlook – visualize what you want instead of worrying about what you fear
Take care of your needs, your feelings, and your body

Information is adapted from National Eating Disorders Association (NEDA) (www.NationalEatingDisorders.org) and Johns Hopkins Medicine (www.hopkinsmedicine.org)

How Are Eating Disorders Treated at SGH?

SGH has a structured eating disorders treatment programme supported by a multi-disciplinary team comprising experienced psychiatrists, psychologists, social workers, family therapists, occupational therapists, dietitians, physiotherapists, art therapists, and clinical counsellors. The programme accepts patients aged 13 and above.

The team utilizes evidence-based treatment that is safe, effective, and scientifically proven. Treatment is individualized to the patient’s specific needs and recovery process. Treatment is intended to:
Help patients achieve a healthy and stable body weight;
Normalise the patient’s eating behaviors;
Work through conflicts and issues underlying and maintaining the eating disorders;
Assist the family in providing adequate support to the patient for recovery; and
Offer structured aftercare and prevent relapse.

All patients will receive a complete medical and psychiatric assessment as well as regular monitoring of their condition. A personalised and holistic treatment plan will be developed for the patient. The programme includes treatment at outpatient clinics as well as inpatient treatment.

Outpatient Treatment

Outpatient treatment comprises of:

Consultations with a designated psychiatrist for regular consultation and monitoring of the patient’s condition
Psychotherapy (for patients aged above 18)
Nutritional Therapy
Family Therapy
Family-based Therapy (for patients aged 18 and below)
Occupational Therapy
Art Therapy
Physiotherapy
Clinical counselling & case management

Inpatient Treatment

Inpatient treatment is intended for patients who require more intensive psychiatric nursing and medical care. The ward has 15 beds dedicated for medical stabilization of patients with eating disorders and/or general psychiatric issues such as management of mood and risk issues. It is designed to be a safe place for the patient to focus on their recovery, so there are specific rules and conditions in place to ensure the patient’s safety and wellbeing.

Inpatients will be expected to participate in inpatient groups run by members of the multi-disciplinary team that are carefully developed to support recovery from eating disorders. A specialized meal programme is also in place for patients with eating disorders with customized meal plans for each inpatient advised by the dietitians. Inpatients are also supported during their meal times.

Admission to our inpatient unit will need to be discussed and arranged by the doctor-in-charge. Admission may be necessary if you are:

Medically compromised as a result of extremely low body weight and/or symptoms of the eating disorders;
Psychologically unstable (e.g. suicidal or intensely resistant to treatment); or
Unable to cope with the eating disorder symptoms and/or are not responding to treatment as an outpatient

For more detailed information on SGH's Eating Disorders Programme and treatment approach, you can refer to this booklet: https://www.sgh.com.sg/patient-care/specialties-services/Eating-Disorders-Programme/Documents/Treating_Eating_Disorder.pdf.

Eating Disorder - Preparing for surgery

Eating Disorder - Post-surgery care

Eating Disorder - Other Information

Impacts of Eating Disorders

Eating disorders can have serious physical, psychological and social consequences on the individual. The following are just some of the impacts that eating disorders tend to have on individuals with eating disorders:

Physical Impacts

Permanent loss of bone mass
Delayed or permanently stunted growth
Weakened immune system
Fainting spells
Disruption of menstrual cycle or infertility
Damage to kidneys or liver
Inability to concentrate or think clearly
Irregular heartbeat or cardiac arrest
Death

Psychological Impacts

Mood disorders (depression, anxiety)
Obsessive thoughts and preoccupations
Compulsive behaviors
Fear of being out-of-control
Feelings of isolation and alienation

Social Impacts

Tensions within family, especially due to arguments about meals and eating behaviors
Damaged or destroyed friendships or romantic relationships
Reduced ability to perform or cope well in school or work

Frequently Asked Questions about Eating Disorders

1. Is having an eating disorder just a phase?

Dieting and paying additional attention to body image can be a phase for many individuals, but it can become a serious problem if it gets out of control. Identifying signs of an eating disorder early on and resolving them quickly is crucial for recovery. Warning signs of an eating disorder include frequent weighing, denial of hunger, avoidance of eating in public or situations where there is food, frequent trips to the bathroom (especially right after meals), mood shifts, fear of becoming fat, an excessive or rigid exercise regime, and binge or secretive eating.

2. When should I or my loved one with an eating disorder seek treatment?

If you see yourself or your loved one displaying warning signs of an eating disorder or already living with an eating disorder for a while, seek treatment as soon as possible to improve the chances of successful recovery and resolve any medical or psychological complications brought about by the eating disorder. Regularly attending appointments with the multi-disciplinary team and adhering to the treatment plans is crucial to the recovery process.

3. How would I know if I or my loved one is recovering from an eating disorder?

There are 3 key factors to look out for in the recovery of a patient with an eating disorder. One is physical recovery, where the patient’s body weight and nutritional status are restored to a healthy level and where any medical complications that resulted have been resolved. Another is behavioral recovery, where there are improvements in the patient’s behaviors related to food, eating, exercising, and engaging in social situations where meals are involved. The third is psychological recovery, where thoughts related to the eating disorder (such as fear of certain foods or bloating, body image issues, or significant obsession with healthy eating) are resolved or reduced.

4. What other resources can I read to find out more about managing eating disorders?

The following resources are highly recommended for anyone wishing to understand eating disorders better:

Eating Disorder Hope (https://www.eatingdisorderhope.com)
Help Your Teenager Beat an Eating Disorder (2nd Edition) (2015) by James Lock and Daniel Le Grange (Publisher: The Guildford Press)
Beating Your Eating Disorder: A Cognitive-Behavioral Self-Help Guide for Adult Sufferers and Their Carers (1st Edition) (2010) by Glenn Waller et al., (Publisher: Cambridge University Press)
The Intuitive Eating Workbook: Ten Principles for Nourishing a Healthy Relationship with Food (Illustrated Edition) (2017) by Evelyn Tribole and Elyse Resch (Publisher: New Harbinger)

For further reading, please download a copy of our leaflet: Eating Disorder.pdf

Overview

Article contributed by Psychiatry, Singapore General Hospital

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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