Eating disorders a cry for attention

By Monty P. Satiadarma

JAKARTA (JP): Turn on your TV today and you are likely to see images of single, usually white (even if they are Asian), almost always thin females.

Flick through a glossy magazine's pages and you will be greeted with various women who are bound to be sleek and slim.

Some women may look at the images and want to be like this slender ideal of womanhood.

But take a look at another example. A few years ago the International Athletic Commission on Gymnastics became concerned about an international Olympic gymnast who suffered from anorexia nervosa, probably the most famous eating disorder.

The commission did extensive research and found the disorder resulted from her past eating habits to keep thin to compete.

As a gymnast she had to maintain her weight and her body proportion, and had been doing it since the age of about six.

Researchers concluded that restricting children from having proper meals that complied with their natural needs might cause them to suffer from anorexia nervosa when they reached adolescence and adulthood.

Another form of eating disorder, bulimia, affected Diana, Princess of Wales, who said the problem resulted from her stressful life.

Eating disorders became a greater concern to the public after Diana's admission and the death of singer Karen Carpenter after years of anorexia and bulimia.

Anorexia nervosa is a disruption in normal eating habits characterized by an all-consuming fear of becoming fat. One who suffers from it may lose more than 25 percent of his or her normal body weight, all the time denying that he or she is becoming thinner.

In short, people with anorexia can starve themselves to death. Most anorexics are women but there are growing numbers of men suffering from the disorder.

Bulimia is a cycle of uncontrolled binge eating followed by purging through vomiting or the use of laxative. In a severe form, eating sprees and purging may occur 10 or more times daily.

People suffering from bulimia often are of normal weight or are slightly overweight.

The physical effects however are damaging.

Frequent vomiting may cause tooth decay because the enamel erodes. A more dangerous possibility is kidney problems, and electrolyte imbalances as a consequence of the binge-purge eating habit can cause serious cardiac problems.

Multidimensional

Researchers are still conducting extensive studies to find the cause of the disorders. Most of them agree, however, that the sources are multidimensional, consisting of biological, psychological and social factors.

Deprivation of food during childhood is considered one of the leading causes. Many experts also conclude that the phenomenon stems from an effort at supreme self-control, whether in a physical sense or psychological sense.

These people tend to have low self-esteem and feel perpetual disappointment about their personal achievement, even though they may excel. They try to take command of their lives through food and their weight to achieve better personal control.

The DSM IV (Diagnostic and Statistical Manual of Mental Disorders - IV) classifies eating disorders as a form of mental disorder experienced mostly by adolescents, and some will continue through adult years.

In some cases the disorders may be lethal following the patient's decreasing health from an improper diet. In recent years, however, there has been an increased number of eating disorders experienced by children under 12 in Western countries.

In these cases, research found that children raised in a dysfunctional family or in a family where the parents were preoccupied with appearance and weight have a greater possibility of developing eating disorders.

Society as well as the mass media that emphasizes messages about the importance and the needs for being thin may support the growing number of eating disorders, including in children.

Lifestyle

What about Indonesia? Changes in eating patterns, particularly in Jakarta, are more related to lifestyle, while eating disorders may relate to depression and lack of attention.

As of today, while no exact information about eating disorders is available for Indonesia, especially Jakarta, there may be increased incidence of the problems in the rapidly changing society.

Symptoms of anorexia nervosa include drastic weight loss, fatigue, muscle weakness, complaints about being obese, seeking excuses for avoiding meals; the symptoms of bulimia consist of binge eating, secretive eating and bathroom visits after eating (to purge).

In both cases the people normally develop need for self- approval from other people. Depression, irritability and mood swings accompany the symptoms.

There is no doubt that people who suffer from this disorder are in a sense trying to kill themselves, and members of the family may experience distress, guilt and confusion in trying to help their loved ones.

In most cases, members of the family tend to force the patients to stop their behavior through direct confrontation.

They may give comments such as: "You look terrible", "You are ruining our family", "I'll help you fatten you up", "You've put on your weight, you look great", and so forth. The approach is actually counterproductive, because comments about appearance are a form of torture to a person with an eating disorder.

People with eating disorders have an acute awareness of their appearance. They are trying to gain composure while controlling others and themselves. Comments tend to cause patients deeper pain.

Physically trying to force the patients to stop their abnormal eating habits may deepen the suffering and add more pain.

In most cases, help from a professional is necessary. Professionals normally use reframing, thus allowing the persons to see things from different perspective.

As the patients feel unworthy, they need to be convinced that they are valuable and needed persons.

A person with an eating disorder has the best chance for recovery when he or she is surrounded by people that are loving and supportive.

There is no single treatment for such disorders. Treatment must involve individual, group and family therapy, support groups, medical and nutritional counselors. The approach must be based on a biopsychosocial approach together at once.

It is also important that the family gets support from community groups because they can share their difficulties and frustration. Unfortunately, there are few such groups at this time in Indonesia.

The writer is a family counselor based in Jakarta