THIN OR MAYBE NOT QUITE?

Ah! I wish was thin enough. If I lose a few pounds, I’ll look attractive . Ughh! these bulky thighs and paunch make me look so ugly. Ah girl, you’ve gained so much weight than the last time I saw you! Oh no, just give me half a bite or maybe not!

We must’ve all said these statements to ourselves or heard them at some point in our lives , in movies and shows! What might seem to be seemingly harmless statements and insecurities which we often subject ourselves too or are subjected to by those around us and the unrealistic  societal standards .

Which brings me to an important condition-“Anorexia Nervosa”.  A word and  a condition which might be seemingly unheard of in earlier decades is becoming increasingly popular at an alarming rate.

WHAT IS IT?

It is an Eating Disorder characterized by the following features-

• Intense fear of becoming obese which does not decrease even if body becomes thin and underweight
• Body Image Disturbance in which person is unable to perceive their own body size accurately
• Refusal to maintain the body weight above a minimum normal
• Significant weight loss , usually more than 25% of original weight
• Amenorrhoea
• Imposes dietary restrictions on self
• Peculiar patterns of handling food- cutting them into small pieces, hiding food , increased chewing time etc
• Engage in vigorous exercises
• Preoccupation with food- a lot of time spent in collecting recipes and cooking for significant others
• Depressive symptoms and Obsessive Compulsive Personality traits are common
• Fine lanugo hair all over the body
• Poor sexual adjustment
• Conflicts about being a women
• Can be accompanied by episodes of Binge Eating followed by intense guilt and attempts to remove the eaten food by laxative , purgative abuse and periods of starvation.
• Often feel fatigued and exhausted
• Take appetite supressants
• It is more common in females and the common age of onset is adolescent years. The risk of developing the eating disorder is higher in actors,models,dancers, athletes etc in the professions where appearance is important

EFFECTS-

This disorder affects the Physical , Mental, Social , Occupational  & Emotional well being & functioning. More often than not, these effects are often undermined and go unnoticed  until  they become severe.

In untreated cases, Weight loss becomes marked  (BMI – 17.5 or less) and death may occur  due to –

• Hypokalaemia (due to self induced vomiting)
• Dehydration
• Malnutrition

Congestive cardiac failure (due to anaemia)

TREATMENT

PHARMACOLOGICAL TREATMENTS

In case you see someone showcasing the above symptoms , it is necessary to direct them to an appropriate source for help as earlier the treatment starts , better is the prognosis. In certain cases , Hospitalization and Pharmacological agents under supervision of a psychiatrist may be required –

• Antipsychotics
• Anti depressants
• To correct any nutritional deficiencies which maybe present appropriate medications
• Healthy weight gain

NON PHARMACOLOGICAL TREATMENTS

• Cognitive Behaviour therapy  & Dialectical  Behaviour Therapy – they focus on modifying negative thoughts , behaviours and emotional responses and acceptance of self.
• Support Groups & Group Therapy – It focuses not on an individual but includes several members which helps them realise they are not alone in their struggles and  at the same time instils in them feelings of hope & universality . the members share their own experiences and also hear and learn from others experiences and provide emotional support.
• Individual & Family Counselling – Appropriate counselling can help solve the various intrapersonal (anxiety, unrealistic expectations , flawed ideas , cognitive distortions etc) and  interpersonal issues (family conflicts , unhealthy and toxic relationship problems etc) .
• Healthy Eating Habits– A healthy balanced diet (as advised by a professional) to promote healthy weight gain. Initially the meals should be supervised to ensure that the person is being compliant. Eating together as a family will also help in bonding and  spending quality time together.

Their favorite dishes can be made to encourage them to eat & gradually they can also be asked to participate more actively in their meal planning -making lists and planning meals for the entire week well in advance so that they’re more likely to stick to them & also gradually include them in cooking if it excites them

• Self -Coping Strategies– As someone who has been at war with themselves acknowledging , embracing and getting on track of recovery is in itself a reminder of immense courage.
• Starting your day with at least five   positive affirmations  in front of the mirror
• Journaling– penning down your thoughts, feelings, triggers will help you organize your emotions better
• Start by expressing yourself in ways you are comfortable with singing, dancing, poetry etc. Do more of things that make you feel good.
• Gratitude Journal– for showing you all things you are thankful for.
• Acceptance of yourself and working on your self esteem.

 REFERENCES

AK AHUJA TEXTBOOK OF PSYCHIATRY