Often, patients or their caregivers ask me the difference between a person who is dieting and a person with an eating disorder.
In today’s health and diet-centric times, the distinction between the two is increasingly blurred.
In my experience, doctors’ diagnoses of an eating disorder are often challenged by patients who attribute their disordered eating habits to dieting. They make reference to the phenomenon of normative discontent body dissatisfaction (the widespread unhappiness amongst women and men with their weight and body image) to normalise their eating practices.
While a vast majority of people are mindful of their diet and exercise, a small minority are extreme in their approach, exhibiting disordered eating habits.
Dieting becomes a disorder when the symptoms and behaviours start to affect one’s function.
An eating disorder is a psychiatric condition whereby patients are preoccupied with their body image. Intense fear of weight gain, malnutrition, behaviours like fasting, binge-eating and self-induced vomiting are common telling symptoms which may have negative consequences on their physical and mental health.
The impact on physical health may include dehydration, low blood pressure, slowed heart rate, electrolyte abnormalities, fertility issues, hair loss, risk of collapse and even death for extreme cases.
Some patients may misuse substance such as alcohol and nicotine to curb their hunger pangs or numb their feelings and emotions. Psycho-stimulants – drugs that increase excitation, alertness, arousal and elevates mood – could also be misused to enhance their performance and energy levels in their chronically malnourished physical state.
Eating disorders often co-exist with other psychiatric conditions. Depression is the most commonly associated mental health condition among others such as anxiety, panic symptoms, obsession and compulsions.
As a result of the physical and mental implications of eating disorders, younger patients may withdraw from family and friends, deteriorate in academic performance or display school refusal behaviours. Older patients may struggle to cope with the demands of his or her job or fulfil one’s role as a spouse or parent.
The implications of eating disorders is not only limited to the patient, but may extend to the people around them. It can affect patients’ social relations by causing caregiver stress and burnout, marital conflict, estranged family ties, and may even influence family and friends to exhibit disordered eating habits.
The common types of eating disorders
The common types of eating disorders are Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder.
- Anorexia Nervosa
Patients with Anorexia Nervosa are more easily identified as they are often underweight and display behaviours such as restricting their diet, fasting and exercising excessively. They may engage in regular patterns of starvation followed by cycles of binging or purging behaviours such as self-induced vomiting, use of laxatives and diuretics (medicine that removes water from the body).
- Bulimia Nervosa
On the other hand, patients with Bulimia Nervosa can be missed as they are often of normal weight and may even appear to be eating adequate meals. Nevertheless, they are still preoccupied with body image concerns and have a distorted sense of body size and shape. They may also engage in unhealthy behaviours such as restricting their food intake, self-induced vomiting and excessive exercise. To be diagnosed with Bulimia Nervosa, a patient must have had regular binge episodes once a week for at least three months, together with compensatory behaviors such as fasting or excessive exercise.
- Binge-eating Disorder.
Patients with Binge-eating Disorder undergo periods of uncontrolled eating to the point of feeling uncomfortably full, with no compensatory behaviour (purging) after. Bingeing is often triggered by an emotional event which causes the patient to seek food for comfort, then suffering ramifications of guilt and self-loathing from over-eating.
The less common types of eating disorders
The less commonly known ones include Avoidant Restrictive Food Intake Feeding/Eating Disorder, Other Specified Feeding/Eating Disorder.
- Avoidant Food Intake Feeding/Eating Disorder
Patients with Avoidant Food Intake Feeding/Eating Disorder is characterised by a pervasive abnormal pattern of eating an extremely restricted range of foods without preoccupation with body image or weight loss. They are often very underweight with secondary medical complications such as anaemia and stunted growth. In contrast to other patients with other eating disorders, they may even try to gain weight, often unsuccessfully.
- Other Specified Feeding/Eating Disorder
Patients with Other Specified Feeding/Eating Disorder do not fall into the previously mentioned criteria, but exhibit disordered eating behaviours that result in socio-occupational dysfunction.
How and where to seek help?
Disordered behaviours such as starvation, bingeing and purging are often done in secret.
During Singapore’s stay-home phase of the circuit breaker, the close proximity between family members led to an observed increase in distress experienced by our patients. As such, it is important to learn the signs of eating disorders and encourage people around you who are exhibiting such disordered behaviour to seek help.
Patients are encouraged to involve their family members when receiving treatment as the process can be challenging and in some cases, long drawn. They will need to draw strength and support from their loved ones.
Younger patients who are still school-going should reach out to their school counsellor or form teacher. Most teachers will be able to provide some emotional support before directing them to the appropriate avenues for assessment. They can also form the bridge between the student and their parents, easing the often awkward yet essential communication process.
Older patients or caregivers can visit the family or primary care doctor at the polyclinics, who may then refer the patient to the respective public health institutes for further assessment.
The Eating Disorders Programme at Singapore General Hospital also provides a one-stop assessment for patients seeking help and treatment. You may contact us at firstname.lastname@example.org for enquiries and obtain an appointment at 63214377.
In event of emergencies, for example, if you are feeling physically unwell or having impulsive thoughts such as self-harm or suicide, visit the emergency department of any hospital and the doctors will be able to attend to your needs immediately. There are helplines to call in times of distress as well:
- Samaritans of Singapore: 1-767
- Singapore Association for Mental Health: 1800-283-7019
- Tinkle Friend (for primary-school-aged children): 1800-2744-788
The contributor is a Senior Consultant and Director of the Eating Disorders Programme at the Singapore General Hospital.