Disorders don’t discriminate

Clothing house Nolita ran an advertising campaign against anorexia to show the reality of the illness. (Alberto Pizzoli/AFP)

Clothing house Nolita ran an advertising campaign against anorexia to show the reality of the illness. (Alberto Pizzoli/AFP)


Eating disorders are illnesses that anyone can get, have little to do with vanity and can have lifelong after-effects.

Anorexia nervosa, bulimia nervosa and binge-eating disorder are silent diseases that harm a person’s physical health, their ability to function in daily life and their relationships with family and friends. Anorexia nervosa has the highest death rate of all mental health conditions.

Christopher Paul Szabo, head of the University of the Witwatersrand’s psychiatry department and of the clinical department at Charlotte Maxeke Johannesburg Academic Hospital, said there was a disconnect between average body sizes and types in real life versus the ideals portrayed in the media, including social media platforms.

“This potentially creates incorrect perceptions that being underweight, meaning below healthy norms, is desirable and contributes to the unhealthy attitudes and behaviours around weight, food, dieting and body image that are central to eating disorders,” he said.

Szabo, who is also a member of the South African Society of Psychiatrists, said the causes of eating disorders were complex and their treatment was specific to each individual. Although body image concerns were central, eating disorders were “powerful indicators of distress that goes beyond food and body issues alone.
Every sufferer has an individual story.”

Broadly defined as an unhealthy preoccupation with eating, food, weight, exercise and body image — together with behaviours such as restriction of intake, excessive exercise, binge eating or purging — eating disorders are most prevalent in teenage and young adult women.

But there are increasing concerns for pre-teens, with the physical changes of puberty such as increased body fat and girls maturing at younger ages, together with social pressures for “thinness” and dieting, creating a risk for eating disorders to develop.

And, Szabo said, the stereotype of eating disorders being limited to young women was also changing — teenage boys and young men are increasingly at risk because of pressures to achieve perceived ideal male body types, usually involving exercise to lose weight and build muscle.

This could lead to excessive exercise and use of nutritional supplements (or anabolic steroids, or both) to replace healthy eating habits.

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Szabo said his research since the 1990s had found that eating disorders affected all races and weren’t limited to urban or “Western” settings. This mirrored findings in other African countries and other societies undergoing social and political changes.

He said it was important for families, schools and medical professionals to be aware that eating disorders were possible in all cultures, socioeconomic groups and races, so that symptoms weren’t dismissed or misdiagnosed.

The root causes of eating disorders are complex but are often linked to the pressures of contemporary life and culture, “with the body as the vehicle for expression of conflicts of identity”, Szabo said, adding that “the causes are best understood as an interaction between the individual and their environment”.

Perfectionism is a personality trait associated with eating disorders but not exclusively so and, combined with a preoccupation with diet and exercise regimens, should be an early warning signal.

The role of parents and family in the development of eating disorders has been a highly controversial topic, but Szabo said no specific causal relationship had been identified.

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Families should, however, pay as much attention to healthy father-daughter relationships as to the relationship of mother and daughters. Unrealistic expectations of high achievement or perfection from either parent were associated with a child’s feelings of guilt and shame that could potentially lead to expression in eating disorders.

Further possible precipitants of eating disorders can be linked to stresses such as changes in family circumstances, abusive situations (either directly or witnessing abuse), or pressures to perform in school or sport, leading to feelings of a lack of control or disrupting the sufferer’s sense of self-esteem and self-worth.

The area of eating and body becomes the one place where the sufferer feels in control over their emotions and circumstances.

Szabo said treatment might require the help of a specialist in eating disorders but the family physician was often the starting point.

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Eating disorders are treated with a combination of psychotherapy, usually also involving therapy sessions for the family, as well as dietary counselling. Medication may be prescribed to treat related symptoms such as sleeping problems, anxiety or mood disorders.

Treatment for anorexia and, in certain circumstances bulimia nervosa, could include being admitted to hospital, with a focus on nutrition counselling and weight restoration, which has been proven to aid improvement in overall psychological and emotional health.

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