Reporters / LIU, YU-CHIEH, WU, JIN-YU

Eating disorders (飲食障礙) are considered common psychological diseases. Some of the causes include genetic inheritance, family and psychological influences, and social-cultural influences which produce psychological stress and emotional ups and downs that may affect people’s eating habits.

Most experts agree that eating disorders are complicated illnesses that stem not from a single cause, but from complex interaction of biological, psychological, and environment factors.

Lana, a model from Russia, said that she has an eating disorder because of pressures in life. When she moved from Northern Russia to Moscow at the age of 11, the new environment and school made her very uncomfortable. This, coupled with her fixation that being thin is the norm, she began to eat very little at the age of 15. But she also recalled that there were actually some warning signs before this.

“I think it’s all connected. I had these problems since I was 5 years old when my mom told me not to eat food that all the other kids would eat, like chips or candies – not to mention drinking coke,” Lana said. Since then she has meticulously watched what she ate.

Three main categories of eating disorders

According to data released by the Ministry of Health and Welfare, there are three main categories of eating disorders: anorexia (厭食症), bulimia (暴食症), and binge eating disorder or BED(嗜食症).

“Most of the anorexia and bulimia patients are perfectionists,” psychiatrist Frank Kuan-Yu Chen (陳冠宇) explained. He added that anorexia and bulimia are close in mentality among the patients, both of which are generally caused by strict ideals for body shapes.

Anorexia is characterized by eating less to become thin, while bulimia is mostly the feeling of a compulsory behavior, which is to purge after binge eating by going on a strict diet, using laxatives, or vomiting.Despite this, the intake of calories is normal, so the person’s weight will generally be average. “But this way of eating is not normal,” Chen commented. On the other hand, binge eating disorder is different from anorexia and bulimia, since it doesn’t involve avoiding food or purging. Rather, a person with this illness will eat a lot in a short period of time, so most of this type of patients are obese.

Treatment of eating disorders

Chen said that bulimia and BED can be treated easily, while anorexia is the most difficult one. Patients with bulimia and BED are usually treated with anti-depressant. If the medication does not achieve ideal results, cognitive behavioral therapy can be used, which has patients record their eating habits and correct their wrong concept.

“Anorexia is the most troublesome one,” Chen stated. He added that anorexia currently does not have any drugs to treat, and the top priority for patients with anorexia is to undergo nutritional rehabilitation and then receive psychological treatment, because they are in a state of undernutrition.

Moreover, Chen said that there are two types of nutritional rehabilitation treatment. One is hospitalization, and the other is done at home, with the supervision of the patient’s family and nutritional professionals. Patients also receive psychotherapy after weight recovery.

Adriana Rabre, a dietitian, explained that nutritional education is based on helping the patients to better understand eating disorder, while designing a specific nutritional plan to help patients maintain healthy eating habits. “It is also important to help patients change their attitude by providing them with proper eating plans, and to promote the importance of being healthy,” Adriana Rabre said.

Plight of anorexia patients

In addition, patients with anorexia usually find themselves relapsing and feel as if they have an incurable condition. Many people with anorexia don’t even know they have anorexia at first, and might ignore the symptoms and prolong seeking treatment.

Sia, a model from Russia, also has anorexia. She said, “I have had it for many, many years. I have been aware of having it for just a couple of years but I’ve actually only been treating it for just a few months.” Her initial treatment was not entirely due to anorexia, but rather because of depression.

Chen added that patients with anorexia have a very wide age range. Moreover, there is no indicator, so even doctors have difficulty detecting such disease. “I don’t think a lot of psychiatrists fully understand the existence of anorexia,” he explained. In fact, many patients with anorexia will go to the Psychiatry Department(精神科) because of emotional distress. But psychiatrists are not able to specifically help them, as they believe just that the patients haven’t eaten enough and rather than help them with this psychological illness, the psychiatrists may refer them to doctors or physicians in the Gastroenterology Department(腸胃科).

Adriana Rabre also underscored that patients must realize they have an eating disorder so that treatment can be performed. She usually encourages patients in face to face counselling, reminding them that everything will be fine. “If a patient does his part and has a good attitude, the rehabilitation or treatment process will be less complicated,” she stressed.

Psychiatrists agreed that the most difficult part to treat people with anorexia is the patient’s own willpower. Chen mentioned that many patients give up during the halfway point of treatment, plus the mentality of wanting to be thin or the influence of the external environment always exist, so it is difficult to change the patients’ mental state, and anorexia is sure to reoccur.

Eating disorders affect people’s eating habits and entire life       

“Eating disorder affects all stages of my life, absolutely every single part of it,” Sia said. Worst of all, sometimes the situation exacerbates when she was unaware of it.

Being on a diet is an indispensable part in many people’s lives. Eating disorders not only affect people physiologically, but also have the deepest impact on their mental state.

“Bulimia has left me with decreased concentration, lack of self-confidence, tendency to self- mutilate, daytime sleepiness, and nighttime insomnia,” said Yi-Jua Wang, a college student. “I don’t dare go out and meet my friends,” added Yu-Xuan Chen, also a college student.

Many people with eating disorders stated that the disease has seriously affected their lives. Moreover, they dare not tell their family and friends, have no motivation to live and learn, have no confidence in themselves, do not know how to overcome the problem, so they often feel helpless in battling their illness.

Say yes to your imperfect shape

Many people have prejudices and misconceptions about eating disorders, and even people close to them may verbally insult them, which is likely to be the last straw that crushes those with eating disorders. Charity, a freshman majoring in Communications Management at Shih Hsin University, said that once a friend didn’t understand the concept of eating disorders, so he was very unforgiving to her, which in turn hurt her badly. He was likely dissatisfied and said, ”We don’t have to eat this, you will go make yourself vomit anyway.”

Wang stressed,“I also have high self-esteem! You may ask how much I want to eat, but do not insult me for it. That hurts my self-esteem. After all, I am not gluttonous!”

Because of the prejudice against people with eating disorders, there are many people who are afraid to seek medical help. “At first, I was afraid to see a doctor because I thought that if I was a teenager, the doctor would notify my parents,” Charity recalled. She also said that sometimes she really needed someone to help her along the way. Thus, it’s important to find a doctor who is empathetic.

Sia said that there is no shame in not being afraid to go to see a doctor and seeking professional help. “I really believe that every person should have therapy with a psychologist. It’s just like going to see a dentist a couple of times a year,”she said.

Therefore, the understanding and companionship of people around the patients is also very important. “It is pertinent to advise the parents to support and encourage their sons or daughters to improve their dietary habits,” Adriana Rabre said. “I hope that people around those who are in this situation can be more patient and give them more warmth,” Charity added.

However, Chen also commented that as times change, more and more people are open to the idea of going to the Psychiatric Department. Hopefully, those affected by mental ailments will be able to seek recovery.

Many people with eating disorders are still working hard to find meaning within their lives. Sia believed that it is important to find one’s priorities in life and maintain a healthy lifestyle. 

“I first left a toxic relationship which I was stuck in for almost six months; then I quit smoking, and started to be interested in sports. I also become more active, which led me to pay more attention to my eating disorder,” Sia said.

As seeing is believing, Lana shared her experience of seeing a girl who looked gaunt. “It’s like watching the worst horror movie,” she stressed. This experience has since become a constant reminder for her not to fall into that girl’s situation.

People who struggled with eating disorders but since recovered say that learning to live with their imperfections is the best medicine. “Love yourself, or else no one will,” Lana said. “I would recommend people to stop comparing themselves with others. We are all different and there’s no such thing as having a perfect looking body,” Sia reiterated. Everyone has their own flaws, even the “perfect” model will wear a mask of confidence. “And after a while, you will notice how beautiful you are even with all the imperfections,” she said. Learning to love, accept oneself and stay healthy is indeed a must.