“She seems like the average teenager but she’s 5’ 10” and sickly thin at 50 kg. What everyone doesn’t know is that she won’t eat more because she is afraid to eat. She is scared of what will happen if she gains weight. She feels that all the love and adulation she gets right now, because of her being thin, will all go away.”
Restricting food intake or purging after excessive binging are ways that some individuals control their weight and through weight their emotions. The pressure to be thin, and ‘thin meaning pretty’, goes back to the Ice Age Era perhaps. Whether we look at it from the lens of culture (thin girls are more sought after for marriage) or whether we look at it from the lens of media; being thin is the way to be! However, there is hardly any focus on ‘fitness’. It is no wonder that Eating disorders, such as Anorexia Nervosa and Bulimia Nervosa, are quite common among adolescents and adults. They are marked by severe dysfunctional eating patterns and behaviour and are characterised by a warped perception of body shape and weight. Unless treated, these eating disorders that typically begin in adolescence, continue into adulthood and impact every aspect of an adult’s life, whether in the ability to form or sustain relationships or at the work place. And while certain aspects, like purging or use of laxatives may reduce or disappear in 20’s and 30’s, other aspects like food restriction and excessive exercise persist.
Individuals who suffer from Anorexia Nervosa refuse to maintain even an acceptable low body weight because they are afraid of gaining weight (even though underweight) or spoiling the size or shape of their bodies. The onset of Anorexia Nervosa typically occurs in adolescents who range in the ages 14 to 18. It is 10 times more common in females than in males, though it rarely occurs in females over age 40. The trigger for the onset is usually a stressful situation they experience in their early life.
Bulimia Nervosa also usually begins in late adolescence or early adult life. In Bulimia Nervosa, individuals get habituated to binge eating. Then, to prevent weight gain or changed body shape or size, they then try to offset the binge eating by improper compensatory behaviours. These behaviours include fasting or excessive exercise, self-medicating through the use of laxatives or other medication and/or purging (self-induced vomiting). Only those individuals who do binge eating followed by inappropriate compensatory behaviours on an average of at least twice a week for 3 months are diagnosed with the condition of Bulimia Nervosa.
While there could be many causes for developing eating disorders, the most typical cause is an unhealthy self-image. An unhealthy self-image can be formed, for example, by unhealthy relationships with parents and peers in the neighbours and at school. In some cases, the atmosphere at the adolescents’ home is conflictual with constant fights, leading to arguing, shouting or hitting. In other cases, the family exerts pressure on being fit and being overweight is met with taunts and scorn. Even in school sometimes, adolescents are not able to form healthy friendships at school because of their low academic achievements, and/or sports or co-curricular presence is poor. In such situations, adolescents feel judged, misunderstood and do not feel comfortable to share their feelings or emotions with either their parents, teachers or peers. Such adolescents blame themselves, feel helpless, like a disappointment to their parents and a burden on them which make them more susceptible to blaming themselves and, therefore, developing an unhealthy self-image. They start to find solace in controlling their emotions through their own body by harming or punishing themselves by controlling their food intake/ purging/ using laxatives/ excessive exercise. Whether through purging or restricting food intake they are able to feel in control and are able to regulate their emotions (feeling upset when one overeats but feeling happy after purging or feeling happy to restrict food intake) and gain some control of the situation.
While it is important to be mentally and physically fit, the teens and part of 20’s are particularly hard for certain individuals due to hormonal and bodily changes. The focus must be on being ‘fit’ rather than being on ‘thin’. Inculcating healthy food habits does not mean eating only healthy food. In fact, promoting a healthy body image is more successful when one eats everything in a balanced manner with an appropriate amount of exercise.
If you have had or know someone who struggles with his/her self-image and uses these techniques to loose/maintain weight, regulate emotions, then therapy can be an effective path to recovery for that individual. A combination of Individual work and Family work is recommended. Through the process of individual therapy, clients are taught to separate their emotions from situations so that they can experience themselves separate from difficult situations, and develop a healthy image of themselves. Family work facilitates a space where all family members can express their hurt and anger towards each other in a safe, non-judgmental manner. Expression then is not about blame but about understanding another person’s perspective. Gradually, healing and strengthening the core of the family helps everyone feel accepted and loved which eliminates the need to express through unhealthy patterns of control food intake.
