Trigger warning: Eating disorders, sexual abuse, body dysmorphia
Srishti (name changed), 24, loves exploring new dishes and cuisines. Although she was a picky eater as a child, she tried to savour all varieties of food as she grew up.
“In 2022, I was going through a very difficult phase in my personal life which got me into severe anxiety…I started starving myself until my brain told me that I needed to eat or I would collapse, and even then I chose to not touch food but drink coffee and take a nap. I was living alone and despite having a cook making me fresh meals, I used to throw all of it in the dustbin and order food, only to eat a small portion and throw the rest of it away,” she told Financial Express.com.
There were days when she used to “stress eat” until she was full and then forcefully vomited it out.
“This went on for a good six months until one day I lost consciousness while at work. I was taken to the hospital and I had developed low blood pressure along with low haemoglobin. I was hospitalized for a week and given continuous glucose. It was difficult for me to even get out of bed and stand straight for ten minutes. I saw the changes in my body – my skin had lost its shine, my hair density had reduced and I was looking visibly weak,” she said.
In December 2022, Srishti was diagnosed with Anorexia Nervosa, a serious mental illness characterised by self-starvation and weight loss resulting in low weight for height and age. According to the American Psychiatric Association, Anorexia has the highest mortality of any psychiatric diagnosis other than opioid use disorder and can be a very serious condition.
“Things started getting worse. I did not feel like getting out of bed or going to work. I started losing my appetite and inclining towards smoking multiple times a day… Post diagnosis, I was given a balanced chart regarding the food which I need to follow,” she told Financial Express.com.
She also informed that after having a difficult relationship with food for a long time, it was difficult for her to finish the quantity of food that was kept on her plate.
“Often I used to eat half of it and struggle to finish the rest of it. On days when I could finish the entire meal, I used to feel bloated and restless. I complained of not getting enough sleep because of excessive food intake but the portion was as given keeping in mind my age, height and weight,” she revealed.
According to the American Psychiatric Association, dieting behavior in anorexia nervosa is driven by an intense fear of gaining weight or becoming fat. Some persons with anorexia nervosa also intermittently binge eat and or purge by vomiting or laxative misuse, it added.
In the beginning, it was difficult for her to follow a healthy lifestyle and a balanced diet, however, she informed that it has become a part of her routine now. After getting proper treatment, she has rebuilt her relationship with food and her body.
“It has been 10 months of me protecting and doing what is best for my body and I have only seen good results,” she said.
What are eating disorders?
Eating disorders are serious psychiatric conditions that often lead to disturbed eating behaviour. According to the American Psychiatric Association, eating disorders are associated with distressing thoughts and emotions.
There are several types of eating disorders like anorexia nervosa, bulimia nervosa, binge eating disorder, Avoidant Restrictive Food Intake Disorder (AFRID), other specified feeding and eating disorder, and pica and rumination disorder.
Globally, eating disorders affect at least nine percent of the population. According to a 2019 study published in The American Journal of Clinical Nutrition, the global rate of eating disorder prevalence doubled from 3.4 per cent of the population to 7.8 per cent between 2000 and 2018.
“Eating disorders are a group of mental health conditions that involve significant disturbances in eating behavior and related thoughts and feelings. They are often characterized by an obsession with food, weight, or body image. Eating disorders can have serious physical and emotional consequences, and they can be difficult to overcome,” Dr Shambhavi Jaiman, Consultant Psychiatrist, Department of Mental health and Behavioural Sciences, Fortis Healthcare told Financial Express.com.
According to Dr. Jaiman, eating disorders can be caused by a combination of genetic and environmental factors.
“People with a family history of eating disorders are at increased risk, as are people who have experienced trauma or abuse. Other risk factors include perfectionism, low self-esteem, and exposure to unrealistic body image standards,” she informed.
‘I love food but I have these episodes where I cannot eat for days’
Chris, 23, has a complicated relationship with food. Diagnosed with Autism a year ago, they struggle with the texture and smell of food.
“I love food but I have these episodes where I cannot eat for days. I have had multiple instances of starving and staring at food but being unable to eat it because it’s overstimulating and nauseating. It does not help that I live with complex Post-traumatic stress disorder (PTSD). I haven’t been able to identify specific triggers but yes, there is a pattern,” they told Financial Express.com.
Almost two years ago, Chris was diagnosed with Avoidant restrictive food intake disorder (ARFID), an eating disorder that is characterised by highly selective eating habits, disturbed feeding patterns or both.
“Although I have lived with ARFID most of my life, I hadn’t found the words to articulate it or the agency to address it until recently…I tend to have these episodes when I am severely stressed or triggered by flashbacks of abuse or even body dysmorphia. I’m a non-binary person assigned female at birth so of course my relationship with my body is complicated too. I have not confided in my family but friends are extremely helpful. Having this community of people who understand my neurodivergence and hold space for me is truly beautiful. I have had friends stay on video calls while I eat. I have friends who send me juices and keep track of my comfort textures. It is nice to feel seen,” they shared with Financial Express.com.
They also shared that although things are better at the moment, they don’t know how long this will last.
“I have had three meals a day for the past two weeks and it’s a major win. I don’t know how long it will last but I’m cherishing it while I can. Living alone and learning to cook has also reconfigured my relationship with food. Using my own hands to make myself a meal somehow grounds me and makes me less alienated by food,” they revealed.
According to ANAD, a nonprofit organisation in the United States that provides services to anyone struggling with an eating disorder, people struggling with ARFID might experience significant weight loss, nutritional deficiencies, dependence on nutritional supplements, or interference with their psychosocial functioning. Moreover, several studies suggest that people with autism are more at risk of developing eating disorders like ARFID.
“I have had mental health issues but I’m definitely in a much better place now. I underwent CPT for my PTSD. I no longer meet the diagnostic criteria for PTSD. The treatment went well. With eating disorder, it is impossible to find the right treatment or diagnosis or support groups. I have been hunting for an ED support group but I haven’t found anything Indian. Even when there is conversations surrounding EDs, it is usually just about anorexia or bulimia,” they told Financial Express.com.
People don’t even know what ARFID is or how to be there for a loved one who has ARFID, they added.
Chris also shared that they has never received any medical help for ARFID. “I have been in therapy for other reasons. The diagnosis was a byproduct of that…Most autistic people have ARFID. However, when someone gets diagnosed with these, the eating disorder is rarely addressed or taken seriously because there are more pressing things to address thereby leaving it undiagnosed and untreated,” Chris said.
It is also noteworthy that people with eating disorders are also more prone to developing smoking habits. “Most of us smoke to suppress appetite leading to various other health concerns,” they added.
According to a report by Ohio State University, individuals with eating disorders (ED) report higher rates of smoking than individuals without eating disorders. Nicotine is an appetite suppression which may lead some individuals to use it to control eating behaviors, it added.
‘Statistics on eating disorders in India are not up to date’
Although eating disorders affect people worldwide, in India, eating disorders are largely underreported. According to a 2023 review paper in Acta Neurophysiologica journal, topics like eating habits and body dissatisfaction are not studied in the Indian context.
“Even though every third client comes in with challenges about how they view their bodies, eating disorders are underreported due to the shame attached to it.However, a study done by Srinivasan TN, et al (1995) using a sample of 210 medical students in Chennai and using the Eating AttitudeTest found that 14.8% of the sample group had symptoms resembling an eating disorder. A following study confirmed that 0.4% of North Indians have symptoms resembling Bulimia(Bhugra et al, 2000),” Aanandita Vaghani, a counselor and mental health behavioral therapist told Financial Express.com. In 2021, Vaghani founded a mental health counselling company, UnFix.
According to Vaghani, the reason for underreporting symptoms of eating disorders is that many in India see their symptoms to be more physical than psychological, and are therefore likely to seek help to address their concerns through a purely physical lens. This can lead to over-dieting behaviors, therefore worsening the issue, she added.
Meanwhile, Dr. Jaiman revealed that due to the stigma associated with eating disorders, which prevents many people from seeking help, the statistics on eating disorders in India are not up to date.
However, global statistics suggest that one in 14 people may have a predisposition to developing an eating disorder.
She also revealed that teens are the most susceptible population to all kinds of eating disorders. “Some people have reported cases as early as 7 years of age, but research suggests that the most common age range for onset is 12 to 14 years,” she added.
‘People may not realise their eating behaviour is unhealthy’
Many people with eating disorders are not able to identify the signs and symptoms of their condition. “This is often because eating disorders are characterized by distorted thoughts about food, body image, and weight. As a result, people with eating disorders may not realize that their eating behaviors are unhealthy or even dangerous,” Dr. Jaiman told Financial Express.com.
She also informed that even when people with eating disorders do seek help, they may not initially present with a history of their condition. This is because eating disorders are often accompanied by other mental health conditions, such as depression and anxiety. When people seek help for these other conditions, their eating disorders may go undiagnosed.
“Healthcare professionals can play a vital role in identifying and diagnosing eating disorders. When talking to patients about their mental and physical health, it is important to ask about their eating habits and body image. If a healthcare professional suspects that a patient may have an eating disorder, they should refer them to a specialist for further evaluation and treatment,” she emphasised.
Most people with eating disorders do not come forward and disclose their condition. This is because eating disorders are often accompanied by significant physical and mental health problems.
For example, people with anorexia may restrict their food intake to the point of malnutrition, which can lead to weakness, fatigue, and other medical complications. People with bulimia may purge fréquemment, which can also lead to malnutrition and other medical problems, Dr. Jaiman said.
In addition, eating disorders are often associated with mental health conditions such as depression and anxiety. As a result, people with eating disorders may not be aware that they have a problem, or they may be too embarrassed or ashamed to seek help.
The awareness of eating disorders is very low, especially when compared to mental health conditions such as depression and anxiety. This can make it difficult to diagnose and treat eating disorders, as people may not realize that they have a problem.
“When someone comes to us with a history that suggests an eating disorder, we may need to watch and wait for symptoms to develop before making a diagnosis. This can be frustrating for both the patient and the healthcare professional, but it is important to be patient and understanding,” she told Financial Express.com.
‘Treatment for eating disorders can be challenging’
People with eating disorders often have distorted thoughts about food, body image, and weight. This can make it difficult for them to understand that they have a problem, even when they are experiencing significant physical and mental health consequences.
“Treatment for eating disorders can be challenging, but it is possible to recover. It is important to create a supportive environment for the patient and to involve them in the decision-making process,” Dr. Jaiman highlighted.
However, it is important to seek help as undiagnosed and untreated eating disorder can have a severe physical and psychological consequences. “For disorders like Anorexia, an individual can have multiple physical and psychological consequences, including other mental health disorders. However, the most significant consequence of anorexia is death, which can occur by suicide or due to physical health complications,” she informed.
According to Dr. Jaiman, people with anorexia and purging disorders are at a higher risk of developing comorbid conditions such as depression, anxiety, and psychosis. They are also at a higher risk of suicide.
“Physical comorbidities are more common in people with eating disorders due to nutritional deficiencies. These deficiencies can lead to significant problems with the heart, immune system, and other organs. This can make people with eating disorders more susceptible to illness and death. In addition, people with eating disorders are at a higher risk of suicide than people with other mental health conditions,” she added.
In case of AFRID, avoidance or restriction is not based on body image or weight concerns, but rather on sensory sensitivities, fear of aversive consequences, or lack of interest in food. ARFID is less severe than anorexia and bulimia, but it can still lead to significant health problems, she revealed.
Moreover, Dr. Jaiman also highlighted that whether or not eating disorders are treatable depends on a number of factors, including the person’s history and family history. “In some cases, eating disorders may be chronic and require lifelong management. However, many people are able to recover fully with the right treatment,” she added.
Stigma and lack of awareness continue to remain major problems
One of the most difficult aspects of eating disorders is that the affected individual may not realise or accept that they have a problem. In some cases, people are frightened, disgusted and ashamed to seek help.
“Stigma and lack of awareness are major problems in the treatment of eating disorders. The more people talk about eating disorders, the less stigma there will be. There is a scarcity of well-equipped clinicians who specialize in eating disorders. Even psychiatrists may not have the necessary knowledge and skills to treat eating disorders effectively. It is important to have a team of professionals, including a psychiatrist, psychologist, nutritionist, and general physician, involved in the treatment of eating disorders,” Dr. Jaiman emphasised.
As individuals with eating disorders find it difficult to seek or accept help, it is extremely important for their family or loved ones to be supportive and patient.
“While encouraging a loved one to seek treatment, it is essential to be prepared for negative reactions to seek professional help. It is essential, therefore, that you pick a time that is private, and free of distraction when initiating the conversation. You may explain your concern, be patient and supportive, and avoid commenting on their appearance or weight which may exacerbate the challenge,” Vaghani told Financial Express.com.
It is important to remember that eating disorders are treatable. With the right help, people with eating disorders can recover and live full and healthy lives.
Dr. Jaiman also emphasised that there is a need to recognize that eating problems in teens can be more than just tantrums or pickiness. Addressing eating disorders early is important, because the later they are diagnosed, the more difficult they are to treat, she added.
If you are concerned that someone you know may have an eating disorder, it is important to seek professional help. A psychologist or psychiatrist can assess the situation and provide the appropriate treatment, Dr. Jaiman said.
DISCLAIMER: If you or someone you know is struggling with their mental health or in distress contact the Vandrevala Foundation’s helpline (+91-9999666555) which is available in 11 languages including English and can be accessed via telephone or WhatsApp 24×7. You can also contact Fortis Hospital’s National Helpline number 91-8376804102 which is available 24×7. You can also contact the Government Mental Health Rehabilitation Helpline ‘KIRAN’ at 18005990019 which is available 24×7.
