THE HEALTH | SEPTEMBER , 2022

BY DR ROZANIZAM ZAKARIA

However , it was not until after the late 1970s , that the phenomenon of eating disorders that highlighted the nature of Anorexia Nervosa and Bulimia Nervosa became more apparent . This was most likely contributed by the public ’ s increased awareness about the disorder , especially after many cases involving public figures became known .

Unfortunately , in reality , eating disorders remain under-recognised and it is estimated that only 12 per cent of bulimia nervosa and 45 per cent of anorexia nervosa were detected at the primary care level .

A group of mental illnesses known as eating disorders include actual , lifethreatening illnesses with potentially deadly outcomes . The reality of these diseases go beyond their label , which emphasises the issue with eating .

It encompasses distressing feelings , thoughts , and actions related to food , size , and weight . Numerous biological , psychological , and societal factors are known to contribute to its occurrence . Eating disorders can genuinely afflict anyone of any gender , age , race , religion , or ethnicity , contrary to popular misconceptions that they mainly affect women of a particular socioeconomic class and demographic . According to estimates , up to 20 million women and 10 million men will experience eating disorders at some point in their lives .

Warning signs of these disorders can occur in the form of emotional and physical changes . Emotional signs include weight loss , dieting , and control of food become primary concerns .

The primary symptoms

The individuals affected would also manifest certain food rituals such as avoiding certain food or occasions related to eating activities . Obsession over appearance , body image , body checking , social withdrawals and extreme mood swings are other examples .

Due to problematic eating patterns , affected individuals may also manifest some physical changes such as noticeable weight fluctuations , gastrointestinal complaints , dizziness upon standing , and dental , skin , hair and nail health issues .

Many types of eating disorders are described in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ). This includes Anorexia Nervosa , Bulimia Nervosa , binge eating disorder and

Avoidant-Restrictive Food Intake Disorder ( ARFID ).

Among all of these , Anorexia Nervosa is likely the best-known eating disorder . It is primarily characterised by self-starvation .

The primary symptoms include inadequate food intake , a disturbance in the experience of body weight or shape , intense fear of weight gain , and an inability to appreciate the severity of the situation .

Anorexia Nervosa is probably widely known due to its potentially hazardous effect on its sufferers . In Anorexia Nervosa , the self-starvation cycle denies the body the essential nutrients it needs to function properly .

The body is therefore forced to slow down all of its processes to conserve energy , resulting in serious medical consequences . Other effects are ; dry hair , hair loss , fainting and fatigue , muscle loss , overall weakness , abnormally low heart rate , low blood pressure , risk of heart failure , severe dehydration , kidney failure and osteoporosis or osteopenia ( reduction in bone density ).

Risk of other psychological comorbidities

Bulimia Nervosa , on the other hand , is predominantly characterised by binge eating and compensatory behaviors . Compensatory behaviors include anything aimed at reversing the effects of the binge , such as vomiting , laxative abuse and excessive exercise .

Concern with body weight and shape and feeling out of control during the binges are also symptoms . Most people struggling with bulimia appear to be of average weight .

Knowing that we cannot tell if someone is struggling with an eating disorder based on weight alone is vital . Like anorexia nervosa , the recurrent binge-and-purge cycles of bulimia nervosa can affect the entire digestive system and lead to electrolyte and chemical imbalances in the body that affect the heart and other major organs .

One health consequence of Bulimia Nervosa is electrolyte imbalance leading to an irregular heartbeat and possible heart failure and death . Other potential health consequences are gastric rupture during periods of binging , inflammation and possible rupture of the oesophagus from frequent vomiting , tooth decay and

staining from the stomach acids released during vomiting , chronic irregular bowel movements and constipation as a result of laxative abuse , and calluses on hands and knuckles from self-induced vomiting .

Apart from eating disorders alone , those affected are also at higher risk of other psychological comorbidities . One in two eating disorder patients abused alcohol or illicit drugs , a rate five times higher than the general population .

Treatment and recovery

Besides that , they are also at higher risk of mood disorders such as depression and other mood disorders that co-occur with eating disorders quite frequently . Up to 69 per cent of patients with anorexia and 33 per cent with bulimia have a coexisting diagnosis of obsessive-compulsive disorder .

Numerous hypotheses offer probable explanations for the origins of eating disorders . The root causes in real life are complex . When it comes to aetiology , genetics is a factor because affected siblings have a 6 – 10 per cent higher risk of developing the disorder than the general population , which has a 1-2 per cent risk .

Several studies have also emphasised social aspects of food , body image , and weight problems , such as family dynamics . The development of the disease is significantly influenced by family and relationship factors too . Rigidity , lack of conflict resolution , and disturbed relationships with pathological patterns of overprotective and controlling parents are known to enhance the risk .

Eating disorder treatment and recovery involves intervention , professional treatment , and ongoing support . Early diagnosis and intervention significantly enhance recovery .

Following the intervention , professional treatment should be the first step ; eating disorders require the care of a trained professional with expertise in the treatment of eating disorders .

Ongoing support from friends and family is vital . These are complex illnesses , and compassionate support throughout the treatment process is essential . – The Health

Dr Rozanizam Zakaria is Psychiatrist and Assistant Professor in Psychiatry at International Islamic University Malaysia ( IIUM )