Silent disorder

Anorexia and bulimia are illnesses to watch out for

Fifteen-year-old Sonia, a chubby, smart girl full of enthusiasm, moved to Dubai some time back. On moving to the new environment she could not cope with the sudden changes. Having left friends behind she was lonely. She felt isolated in her new school.

Added to it was her parents' demand to do well and also to lose weight. She withdrew into a shell, ceased to eat and continued in a state of not being hungry. At first, her pale face and falling weight did not give away the warning signals. She lost weight beyond limit.

It took some time for her parents to realise that Sonia was suffering from anorexia – an eating disorder. This was because of the sudden changes and demands on her which she was unable to handle. In some cases, the beginning of anorexia is related to trauma in the family.

Abuse, death of someone close or even depression can trigger off this psychological disorder. In teenagers, bullying at school, being overweight and wanting to reduce, peer pressure and low self-esteem are at times found to be the causes leading to eating disorders.

Anorexia usually develops over a period of time. It often seems to start with a person refusing to eat, but what is unusual for a person who develops anorexia is that she continues in the state of being in hunger and refuses to stop intense dieting and get back to normal eating patterns.

Anorexics refuse to maintain body weight. Some have an intense fear of gaining weight or becoming fat even though underweight. A person claims to feel fat even when obviously underweight. Anorexia has no organic, metabolic or genetic cause. It is not just to do with food, but is part of an emotional system that is maladaptive, whereby the coping skills of the person to the problems of life becomes difficult to bear.

It affects every aspect of the sufferer's life. The anorexic usually withdraws into isolation. Self starvation demands enormous emotional energy and concentration and for a teenager having withdrawn from ordinary social interchange means that her social development is affected at a time when there is so much to be acquired in life. Most of them become steadily thinner and more unwell.

Starvation progressively leads to the body ceasing to function properly. In young girls, the serious signs of this condition is the reduction and eventual stopping of menstruation or the failure to establish menstruation at all. In more advance stages here can be hair loss, a permanent feeling of being cold and unseen development of the thinning of the bones, a precursor to osteoporosis. Physical weakness, constipation and anaemia are all the natural results of chronic starvation.

Bulimia is the eating disorder in which only the pattern of behaviour is different. A person may go into compulsive eating followed by compulsive vomiting and purging. It could carry on unnoticed which can cause permanent damage to the digestive system.

"An anorexic has the sense of constantly repressing and denying the bad of herself to become more acceptable, whereas the bulimic is engaged in the most violent fight with the hateful part of herself that she cannot tame, they are not able to cope with their problems in the right way," says R. McCarthy, clinical psychologist, Counselling and Development Clinic, Dubai.

At the clinic, they provide information, help and support for people with eating disorders, in particular anorexia and bulimia nervosa. "In the treatment, we work with the medical team which has nutritionists and dieticians and with the help of the patient's family try to find solutions. Sometimes, in severe cases, the patient needs hospitalisation," says Dr McCarthy.

Symptoms of anorexia and bulimia can be noticed when:

* A person makes excuses for not being hungry.
* Obsession with one's weight (weighs himself many times a day).
* Complains of being fat even though underweight.
* Withdraws into isolation.
* In teenage girls, reduction and eventual stoppage of menstruation.
* Hair loss, thinning of bones, physical weakness and anaemia are the natural consequence of starvation.

"Having an eating disorder involves hating and attacking your body. Getting rid of it involves learning not to do that, and instead accepting and taking care of your body. If you can sort out where all the hating came from, you will have more freedom to choose whether you want to continue like that.

Use your supporter to discuss these things and also to compare somebody else's experience with your own," says Julia Buckroyd, in her book Anorexia and Bulimia: The Element Guide.