Anorexia nervosa: Dying to be thin

By Henrylito D. Tacio 

WHO doesn’t know of Snooky Serna, one of the most beautiful faces to come out from the Philippine cinema?  She was at the height of her career when she faded from the limelight because of her continuous bouts with anorexia.

Snooky was only 14 when she started having the problem.  Although she was making movies left and right, she was most of the time depressed.  She didn’t like the movies she was making and she detested her mother’s intrusion with her life.  In an interview with Totel de Jesus for a cover story of a magazine, the actress bared: “That time, I think I secretly hated my mom, even as I had always lived with her – for practically dominating my life, for dictating every decision I had to make, and when I was battling anorexia and depression, I realized I was my own worst enemy.”

Anorexia is a psychiatric disorder known as the “Golden Girl Syndrome” because it primarily hits rich, well educated Western women. The phenomenon was first documented in Japan in the 1960s.  Today, anorexia has spread to women of all socioeconomic and ethnic backgrounds in Seoul, Hong Kong and Singapore.

Cases also have been reported – though at much lower rates – in Taipei, Beijing and Shanghai. Anorexia has even surfaced among the affluent elite in countries where hunger remains a problem, including India, the Philippines, and Pakistan.

“Ten years ago, we saw only one or two anorexics each year,” says Dr. Sing Lee, a psychiatrist at The Chinese University of Hong Kong.  “Now, we see one new patient a month.  Many are hospitalized.”

According to the National Association of Anorexia Nervosa and Associate Disorders (ANAD) in the United States, anorexia nervosa literally means “loss of appetite.” However, the literal meaning is a misnomer. “A person with anorexia nervosa is hungry, but he or she denies the hunger because of an irrational fear of becoming fat,” it explains.

Anorexia nervosa is characterized by self-starvation, food preoccupation and rituals, compulsive exercising, and often an absence of a menstrual cycle. “If this goes uncontrolled and untreated, major damage can occur to various organs of the body, such as the kidney, intestinal tract, liver and even the heart,” says Dr. Asuncion Reloza, who practices pediatric cardiology at the Makati Medical Center.

The death of American pop singer Karen Carpenter at age 32 was attributed to heart failure following her eight-year battle with anorexia. Other famous victims, who managed to beat the self-starvation problem, include the late Princess Diana and Jane Fonda.

Anorexia nervosa usually begins in adolescence, occasionally earlier, and becomes less common in adults. The disorder runs from mild and transient or severe and long lasting.  “Anorexia nervosa is the third most common medical disorder in adolescents, and is more common in the young female teenager,” reports Dr. Reloza.

Because mild cases are not easily diagnosed, no one knows exactly how many people have anorexia nervosa or what percentage die of it.

The reason people get anorexia nervosa isn’t known.  Anorexics think they would be happier and more successful if they were thin. They want everything in their lives to be perfect. People who have this disorder are usually good students. They blame themselves if they don’t get perfect grades, or if other things in their lives are not going well.

“Appearance and figure have become very important in the minds of young people,” says Dr. Ken Ung Eng Khaen, a psychiatrist at Singapore’s National University  Hospital. “Thin is in, fat is out. This is interesting, because Asians are usually thinner and smaller-framed than Caucasians, but their aim now is to become even thinner.”

Another symptom of this eating disorder is excessive weight loss. When young women have increased concern with diet and body weight, chances are, they have anorexia nervosa. Even when emaciated, the person claims to feel fat, denies that anything is wrong, doesn’t complain about lack of appetite or weight loss, and usually resists treatment.

An anorexic’s image of her body is often so distorted that she may avoid looking at herself in the mirror or may exercise extensively. People with anorexia study diets and calories. They hoard, conceal, and deliberately waste food.

Some women who have anorexia nervosa binge and then purge by vomiting or taking laxatives and diuretics.  Others simply restrict the amount of food they eat.” Other girls at school started losing weight, and now they look great.  I want to keep up with them,” says Lea, who used to be anorexic.

Another symptom of anorexia is bulimia. Bulimia is characterized by recurring periods of binge eating where large amounts of foods are consumed in a short period of time.

The bulimic is aware that her eating is out of control and is fearful of not being able to stop eating. Bulimics are afraid of being fat and usually feel depressed and guilty after a binge.

Frequently, the binges are followed by purging, through self-induced vomiting. According to Dr. Meehan, half of those who are diagnosed anorexic turn bulimic.

“Filipino culture almost encourages bulimia among girls,” explains Dr. Maria Teresa Gustilo-Villasor, a clinical psychologist at Makati  Medical Center.   “Eating allows bulimics to comply with social expectations, while vomiting allows them to comply with their own ideals of beauty.”

Anorexics who become very thin tend to remain active, even pursuing vigorous exercise programs. Curiously enough, they don’t have symptoms of nutritional deficiencies and are surprisingly free of infections. Depression is common, and people who have this eating disorder frequently lie about how much they have eaten and conceal their vomiting and their peculiar dietary habits.

Women who suffer from anorexia nervosa stop having menstrual periods and lose interest in sex. Typically, they have a low heart rate, low blood pressure, low body temperature, and swelling of tissues caused by fluid accumulation (edema). If a person becomes seriously malnourished, every major organ system in the body is likely to be affected. Problems with the heart and with fluids and electrolytes (sodium, potassium, chloride) are the most dangerous.

“Treatment can save the life of someone with anorexia,” points out ANAD. “Friends, relatives, teachers, and physicians all play an important role in helping anorexics stay with a treatment program. Encouragement, caring, and persistence, as well as information about anorexia and its dangers, may be needed to convince the ill person to get help, stick with treatment, or try again.”

However, doctors admit that treatment of anorexia is difficult, because people with anorexia believe there is nothing wrong with them. Patients in the early stages of anorexia (less than six months or with just a small amount of weight loss) may be successfully treated without having to be admitted to the hospital. But for successful treatment, patients must want to change and must have family and friends to help them.

“Treatment for anorexia nervosa requires a concerted commitment toward virtual reprogramming of eating and living habits,” says Dr. Reloza. “Initial follow-ups require regular visits over a prolonged period of time. As much as 30 percent of the patients can relapse and another 30 may eventually become chronic or long-standing problems. Only a third is often completely cured.”

Treatment usually consists of two steps. The first is restoring normal body weight. The second is psychotherapy, often supplemented with drugs.

When weight loss has been rapid or severe, restoring body weight is crucial; such weight losses can be life threatening.  Experienced staff members in the hospital firmly but gently encourage the patient to eat. Rarely, the patient is fed intravenously or through a tube inserted in the nose and passed into the stomach.

“Treatment involves more than changing the person’s eating habits,” Dr. Ung says. “Anorexic patients often need counseling for a year or more so they can work on changing the feelings that are causing their eating problems. These feelings may be about their weight, their family problems or their problems with self-esteem.”

Some anorexic patients are helped by taking medicines that make them feel less depressed. These medicines, however, are prescribed by a doctor and are used along with counseling. — ###

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6 responses to “Anorexia nervosa: Dying to be thin

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  4. It’s always sad to hear of young people that suffer from eating disorders and really harm themselves. It’s always important as a loved one to keep on the look out for signs of any eating disorder. And to get involved in helping your loved one…

  5. It’s always sad to hear of young people that suffer from eating disorders and really harm themselves. It’s always important as a loved one to keep on the look out for signs of any eating disorder. And to get involved in helping your loved one…
    This is why the A&E show intervention is so important. It demonstrates how difficult addiction can be and uses a highly qualified team of specialists to address the core issues. The show really does a great job of showing what it takes to get on the road to recovery for some of the most difficult addictions and how it affects everyone involved. Check out http://www.aetv.com/intervention for more on the show. I’m working to help promote the show because I think that
    The issue of drug abuse and recovery is a topic American’s should be informed on. A new episode airs every Monday night at 9:00 PM

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