Q: How common are eating disorders?
Eating disorders, such as anorexia nervosa and bulimia nervosa, are common mental health conditions. They often begin during adolescence, although young children can also be affected, particularly during stressful transitions, such as starting a new school or being placed in a new class. These changes can be particularly challenging for children. For anorexia and bulimia, girls are up to 10 times more likely to be affected than boys. However, in the case of binge-eating disorders, the ratio between affected girls and boys may be closer to 1:1.
Globally, eating disorders are estimated to affect 5-9% for women and 2-3% for men.
Q: What are the types of eating disorders?
The three most common types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. A common feature of all these conditions is significant dissatisfaction with body image. Individuals with these disorders often become upset about perceived flaws in their body shape, such as feeling that their thighs, arms, or waist are not slim enough.
In anorexia nervosa, the individual experiences an intense fear of weight gain and consequently becomes underweight, or reach a weight that is significantly low for their age and sex. They severely restrict their food intake and may exercise excessively.
In bulimia nervosa, the person has episodes of binge-eating, where they feel a lack of control over their eating. This leads to feelings of guilt or disgust, which then result in purging (vomiting) or other compensatory behaviours like fasting or over-exercising. This pattern creates a vicious cycle of binge-eating and purging.
In binge-eating disorder, individuals also experience episodes of binge-eating, but there is no compensatory behaviour such as purging. As a result, they are often overweight.
Q: Is it true that purging after eating is always bulimia nervosa?
No, this is not always the case. In the “non-purging” subtype of bulimia nervosa, individuals may compensate for binge-eating by fasting or over-exercising instead of vomiting. Additionally, people with anorexia nervosa may also purge after meals.
Q: What are the risk factors?
Common risk factors for eating disorders include a family history of eating disorders, childhood trauma or neglect, personality traits such as perfectionism (more common in anorexia nervosa), and impulsivity (often seen in bulimia nervosa). Female gender is another significant risk factor. Some studies suggest that growing up in a family culture that emphasises external appearance may also increase the risk.
Q: How do I spot the signs in my child?
Unfortunately, individuals with eating disorders often hide their symptoms, and parents may not notice the condition until months later.
A child with an eating disorder may gradually lose weight by “eating healthily” or exercising more, and parents may initially praise these behaviours. Over time, however, the weight loss may become more drastic, raising concern.
Parents may also observe their child skipping meals with excuses like “I’ve already eaten at school.” At meal times, they may avoid “fear foods” such as carbohydrates (rice, noodles, or bread), fried foods, desserts, red meat, and other “fattening” items. When encouraged to eat, the child may become upset or even angry, causing distress for the family. Some parents may accommodate by preparing separate “eating disorder-approved” meals.
Children with eating disorders may also compare their food portions with others and insist that family members eat more than they do. They may become fixated on food, spending increased time cooking, baking, reading recipes, and watching food channels.
Excessive exercise is another warning sign. This can include anything from running and following workout videos to attending the gym, often with a rigid routine that continues regardless of weather or illness. Once the child’s weight becomes critically low, they may stop exercising. Instead, they may become lethargic and begin wearing layers of clothing to stay warm.
For those who purge, parents may notice vomit in the toilet or the use of slimming products like laxatives or slimming teas.
Boys with bulimia nervosa may present slightly differently. Their body image concerns may focus more on achieving a muscular physique. They may restrict their diet to lean meats and vegetables but binge on “unhealthy” foods during episodes of loss of control. They may over-exercise instead of purging, which can sometimes lead to sports injuries.
Q: Why is early treatment important?
Eating disorders are serious health conditions. Weight loss, over-exercising, and purging can result in severe health complications, affecting every organ in the body, including the brain, heart, bones, and skin. For instance, the heart, which is a muscle, can weaken, leading to a dangerously slow heart rate. Other complications include fainting episodes and seizures from low blood sugar (hypoglycemia) and electrolyte imbalances, as well as stomach tears from purging. Malnutrition can also lead to vitamin deficiencies and poor growth in children. Children with anorexia nervosa may not reach their full height potential, which can cause regret and self-esteem issues later in life. Additionally, eating disorders may lead to anxiety and depression.
Q: Where can I get help?
Children with eating disorders require medical attention from a psychiatrist or paediatrician who specialises in treating eating disorders. These specialists will work alongside psychologists, dieticians, family therapists, and physiotherapists to support recovery. These services are available in private clinics as well as in KK Women’s and Children’s Hospital.
Q: Why is it important to see a specialist in eating disorders?
Early treatment is important so any general psychiatrist or paediatricians can initiate treatment. However, as eating disorders are highly complex conditions, consulting a specialist with many years of experience working in an eating disorder treatment centre is preferable.
Get Help Today
Eating disorders are serious medical conditions that can stunt growth in children, endanger lives, and disrupt family harmony. It takes strength to seek help for yourself or a loved one, but early intervention is critical. Our team of psychiatrists and psychologists will work with you to develop an effective, respectful treatment plan. Regain the freedom to eat what you enjoy and learn to love your body again.
Dr. Victor Kwok
Senior Consultant Psychiatrist
Senior Consultant Psychiatrist
