1. What are the types of Eating Disorder?
Eating Disorders are a group of psychological conditions where sufferers have severe difficulties in their eating habits and behaviour. They include Anorexia Nervosa, Bulimia Nervosa, Binge-eating disorder and other types of eating disorder. About 1 in 15 females may be at risk of a ED but only a small proportion of these sufferers sought help with a psychiatric clinic in Singapore. Some patients seek help for other problems like depression but have ED as a coexisting problem which was picked up during our assessment.
2. Who suffers from certain EDs more? What is the demographic like and why?
In Singapore, young teenage school-going females are most likely to suffer from EDs like Anorexia. ED especially Anorexia can be perceived as a cultural phenomenon. In the past, we do not value thinness as much in our society. In fact, obesity was seen as a sign of wealth. However, as we become rapidly westernised and bombarded by the influence of western media, thinness and the emaciated look in females became idealised. Young girls are particularly vulnerable to these influences and they face more peer pressure from their friends in school and their social circles where everyone is trying to achieve the thin look.
3. Is the demographic changing? Any reasons for this change?
Although there are no recent local data to support this, from my clinical experience, more males are starting to suffer from ED. This is due to the fixation on masculinity in males these days, again influenced by western media. In male ED, the fixation is often on muscle definition and exercising instead of the obsession on thinness.
There are also an increase in the cases of orthorexia nervosa, a less common type of eating disorder where the individual is obsessed about eating "healthy" food and about exercising. This is again in contrast to Anorexia where the individual is pursuing thinness. Orthorexia can nevertheless lead to the same consequences as Anorexia if the individual eliminates too many types of food from his or her diet and ends up not eating and emaciated.
4. What are the main causes of ED in Singapore and do the causes differ across gender, cultural or racial lines?
The exact causes of ED is unknown and is likely to be multifactorial. There is likely to be a genetic link as it can run in the family. Neurotransmitters (brain chemicals) like serotonin have been implicated. Many ED patients also have psychological problems such as low self esteem, impulsive or perfectionistic personalities and troubled relationship. Social issues such as media influences and peer pressure to look thin also play a part in tipping a person over into ED.
5. What do you think of the rise in ED cases? How representative do you think the numbers of treated patients are of the actual group?
I believe many cases are not still not identified and treated. We are also not catching them early enough and they surface only when the youth is in a serious stage. In fact, even for anorexia which is the most well recognised ED, patients are often already in a very bad physical state when they first see a doctor. Patients with other ED like binge eating disorder may not even seek help at all as their family and friends may often just see their behaviour as gluttony. There is also a stigma to seeking treatment for psychiatric conditions which prevents people from seek help.
6. What are the most obvious signs that someone needs help - and how can loved ones intervene?
Early signs of ED are often hard to pick up for parents. If a parent noticed that their teenager is always preoccupied with being fat when they are not, are secretly vomiting their food out or having menstrual irregularities they should raise the red flag. Other symptoms that may be obvious are overexercising and using laxatives to control weight. As ED particularly Anorexia has high mortality (death) rate, if parents are concerned, it is best that they seek a consultation with a psychiatrist to check so that treatments can be started early.
7. How should one seek help?
Help is readily available. One can just call up our psychiatric clinics 64796456 to make an appointment for an assessment.
Those wishing to seek help from our restructured hospital, can call the SGH Eating Disorder Unit at 6326 6697.