I was recently watching the latest season of Heartstopper on Netflix. One of the protagonists, Charlie, was confronted by his boyfriend Nick about his eating habits. As his boyfriend, Nick was concerned about Charlie avoiding food and feeling tired all the time. This was something new. Charlie felt put on the spot and decided to avoid the topic. The later episodes navigate Charlie’s experience of being diagnosed with Anorexia Nervosa and how he deals with the challenges that come with it.
Obtaining precise data on the prevalence of eating disorders in India can be challenging. However, the National Mental Health Survey conducted in 2015 suggests that these disorders affect approximately 2% to 2.4% of the Indian population. Additionally, other surveys carried out by licensed therapists report a prevalence rate of 2% to 3%, with women experiencing these disorders at a higher rate. A 2018 study examining the prevalence of ED in the student population of Mysore, in the southern state of Karnataka, revealed that 26.06% of participants were prone to ED due to their abnormal eating attitudes.
In a country like India, where many people tend to dismiss mental health issues, the prevalence of eating disorders such as anorexia nervosa and bulimia is often overlooked. A report in the Pune Mirror, published in August 2018, quoted Dr. Udipi Gauthamadas, a Chennai-based neuro-behavioral medicine expert specializing in treating eating disorders. He stated, “Various studies of Indian schoolchildren have shown that disturbed eating attitudes and behaviors affect about 25% to 40% of adolescent girls and around 20% of adolescent boys.”
In this article, we are going to look at anorexia nervosa and the way it presents itself.
What Are Eating Disorders?
Eating disorders are behavioral conditions that are marked by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological and social function. Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and eating disorder, pica and rumination disorder.
Taken together, eating disorders affect up to 5% of the population, most often develop in adolescence and young adulthood. Several, especially anorexia nervosa and bulimia nervosa are more common in women. It may be more common for those who take part in sports and activities that focus on body shape and size. This can include modeling, dancing, and other athletic areas.
Eating disorders don’t happen overnight; they can develop over the course of a few months or a few years. Like with any mental health condition, eating disorders, begin differently for each person. For some, it may be losing a few pounds and enjoying the way their body looks with less weight, for others it may be finding comfort in food, and still, for others, it may begin due to depression, stressful triggers, or trauma.
Signs to look out for in others:
- Preoccupation with food, weight, or shape
- Worry about consequences of eating certain foods
- Binge eating
- Restrictive eating
- Avoidance of certain foods
- Compulsive exercise
- Existing mental health conditions
Eating disorders often co-occur with other psychiatric disorders, especially mood and anxiety disorders, obsessive-compulsive disorder, and alcohol and substance use disorders. Ambivalence towards treatment, denial of a problem with eating and weight, or anxiety about changing eating patterns is not uncommon. With proper medical care, however, those with eating disorders can resume healthy eating habits, and recover their emotional and psychological health.
Anorexia Nervosa
People with anorexia have an intense fear of gaining weight. You may have a distorted view that you are fat even when you are dangerously thin. To avoid weight gain, you may restrict your food intake, which can severely impact your health. Anorexia can lead to malnutrition, affecting the brain and increasing the risk of serious health issues or death. It has the second-highest death rate among mental illnesses, following opioid overdoses, often due to heart problems or suicide.
With anorexia, you may use abnormal eating habits to cope with stress, anxiety, and low self-esteem. Limiting food may give you a sense of control over your life.
Anorexia can take over a person’s life and is not simply about food or appearance; it involves changes in the brain. However, with proper treatment, people can regain a healthy weight, develop better eating habits, and reduce the serious complications of this illness.
Anorexia has two subtypes:
- Restrictor type. People with this type of anorexia severely limit how much food they eat. This often includes foods high in carbohydrates and fats.
- Bulimic (binging and purging) type. People with bulimia eat too much food and then make themselves throw up. They may take large amounts of laxatives or other methods to clear their bowels.
Physical Symptoms To Watch Out For:
- Extreme weight loss or not making expected weight gains based on age.
- Feeling very tired and weak.
- Frequent dizziness or fainting.
- Having a hard time passing stool and having stomach pain.
- Not able to stand the cold, or feeling cold when others feel fine.
- Swelling of the arms or legs
- Stress fractures or reduced bone mass.
- Irregular heart rhythms, low blood pressure and dehydration.
- Wearing away of the teeth and calluses on your knuckles from causing yourself to vomit.
- Never feeling hungry or feeling hungry and getting full right away after eating a very small portion.
- If you’re female and not taking a contraceptive, you may not have menstrual periods.
- Your fingers may look blue and you may have dry skin.
- You may notice a change in your skin color, such as yellowing of the skin.
- You may have hair that thins, breaks or falls out.
Emotional And Behavioural Symptoms To Watch Out For:
- Excessive exercise. This includes exercising when you’re injured, instead of doing something you value or enjoy, or exercising to such a degree of intensity that it’s notably different from the people around you.
- Fear of weight gain. This may manifest as anxiety about gaining weight, which can lead to constantly weighing or measuring your body.
- Focus on appearance. This includes checking in the mirror for perceived flaws and wearing multiple layers of clothing to hide certain areas of your body.
- Concern about being overweight. This includes concerns about being fat or having parts of the body that are fat.
- Emotional changes. You may experience a lack of emotion or feel emotionally flat. This can lead to social withdrawal, irritability, anger, and decreased interest in sexual activity.
- Trouble sleeping. This also is known as insomnia.
- Self-Harm Thoughts. You might consider self-harm or have thoughts about suicide, or you may even attempt suicide.
Psychological And Societal Causes Of Eating Disorders
Eating disorders often arise from a complex interplay of psychological vulnerabilities and societal pressures. Body image dissatisfaction is one of the most significant psychological contributors. Many individuals struggle with unrealistic expectations about their appearance. This is often driven by the desire for thinness or muscularity.
A study by Stice et al. revealed that adolescent girls who internalize the “thin ideal” are at a greater risk of developing disordered eating behaviors. These pressures can come from peers, family, or even the media, which frequently promotes an unattainable standard of beauty through edited photos, filters, and advertisements.
Media influence amplifies societal pressures to conform to beauty ideals. Social media platforms like Instagram and TikTok can be particularly harmful, as they constantly expose users to curated images of “perfect” bodies. One study found that young women who spent more time on Instagram reported higher levels of body dissatisfaction and increased engagement in unhealthy eating behaviors.
Family dynamics and childhood trauma are also important factors. Families that emphasize appearance or have a history of weight-related teasing can contribute to unhealthy relationships with food. Additionally, individuals with traumatic experiences, such as abuse, may use eating behaviors as a way to regain control over their lives.
These factors combined often create a toxic environment where individuals may turn to disordered eating as a means of coping, validating their self-worth, or trying to conform to societal expectations.
How To Help A Loved One
A core feature of anorexia is that people with the eating disorder usually don’t see how serious their symptoms are. If you know someone with anorexia, it’s important to take action, even if you think it might be too much. Getting help early usually leads to better results. If you’re worried about a friend or family member, encourage them to talk to a doctor. As a parent or caregiver who has concerns about their child’s eating habits, weight, or body image, discuss your worries with their doctor.
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