Anorexia and bulimia: How these are rooted in mental disorders

A 15-year-old teenager came to meet me along with his very worried family. Let’s call him A. The family was worried because A had not been eating regularly and had been losing a lot of weight. Doctors were concerned about nutritional deficiencies and there was a concern that A would need to be hospitalised if this continued. However, even though significantly underweight, A was preoccupied with putting on weight and in fact even felt overweight as well.
B had also visited with similar preoccupations about weight gain. However, in this case, B had a normal body weight as per BMI benchmarks. Rather than restricting food entirely, B would engage in cycles of binging and purging. B would eat a lot over a span of a couple of hours, including a lot of junk food, and then because of the guilt and fear of putting on weight, would try and throw up. B would also engage in excessive exercise to compensate for this food consumed. While having regular body weight, B too experienced health related problems due to this binging-purging cycle.
These are two common presentations of eating disorders, Anorexia and Bulimia Nervosa. What were clinical conditions earlier associated with young girls, can now be seen across the gender spectrum. There are various vectors that impact individuals that can lead to the causation of such illnesses. Yes, biological factors do play a role in anorexia and bulimia. At the same time, we need to look at the psycho-social factors that play a significant role as well – everything from the individual’s thought processes, perceptions and coping resources to the family environment, the social milieu around the individual, social comparisons, ideals of perfectionism and portrayals in the media must be understood.
The treatment of eating disorders like anorexia and bulimia is also multidisciplinary. Medical interventions may be required both in the reduction of symptoms as well as to correct the acute nutritional deficiencies that patients experience. Psychotherapy is important to help people improve their body image, reduce their preoccupation with weight gain, work towards improving self-esteem and reducing comparisons, working through the guilt and shame that may further perpetuate such symptoms, inter-personal relationships and strengthening coping resources to deal with the stressors and challenges of everyday life.

In fact Cognitive Behavioural Therapy is recommended in most cases. This involves keeping to diet rules and fixed times, encouraging and developing creative thinking processes, noting down thoughts and emotions immediately after eating, problem-solving, relapse prevention and boosting the patient’s sense of self worth. Sometimes one has to conduct evidence-based modules, like showing how one pastry can lead to weight gain or not and how much.
Most importantly, however, we need to be cognisant of the role that media portrayals play in impacting the perceptions of young people towards the ideal body type and weight. For decades now, thinness has been associated with beauty in the media. And young people look up to celebrities as role models they watch on their screens and want to be like. The same applies nowadays in social media as well, where the world is portrayed through a myriad of filters and curated feeds – all of which tend to impact the self-esteem and body image of young impressionable minds.
This concern requires a two-pronged approach to be tackled – the media needs to take more responsibility in a healthier and more diverse portrayal of what is beautiful and attractive. At the same time, we need to inculcate media literacy within curricula to ensure that young people have the skills to dinguish between fact and filters, prioritise their emotional well-being and navigate through the barrage of media messages they are exposed to on an everyday basis.