ANOREXIA AND BULIMIA: WHEN BEAUTY BONES LOSE THEIR BEAUTY

Demi Lovato, our Disney Star, has confessed, “‘Food is still the biggest challenge in my life and it controls — I don’t want to give it the power to say it controls my every thought, but it’s something that I’m constantly thinking about…Body image, what I’m going to eat next, what I wish I could be eating, what I wish I didn’t eat. It’s just constant…” 

Princess Diana revealed in one of her interviews, “The first time I was measured for my wedding dress, I was 29 inches around the waist. The day I got married, I was 23-and-a-half inches. I had shrunk into nothing from February to July.”

Portia de Rossi, an Australian-American model, actress and spouse of Ellen DeGeneres, has stated in her memoir, “Since I was a 12 year old girl taking pictures in my front yard to submit to modeling agencies, I’d never known a day where my weight wasn’t the determining factor for my self esteem. My weight was my mood, and the more effort I put into starving myself to get it to an acceptable level, the more satisfaction I would feel as restriction and the denial built into an incredible sense of accomplishment.”

These women along with many other celebrity figures have suffered from EATING DISORDERS. An eating disorder is a disturbed pattern of daily food intake (either eating too little or too much) along with high levels of unnecessary distress associated with body shape, size and weight. While Demi Lovato and Portia de Rossi suffered from Anorexia Nervosa (AN), Princess Diana was diagnosed with Bulima Nervosa. At the outset, it is important to note that even though the prevalence of eating disorders is higher in females than in males, we have witnessed several male celebrities to the likes of Eminem, Elton John, Russel Brand and others come forward to be open about their struggles with eating. Another common misconception better corrected at this point is that Eating Disorders are not the “disease of the rich”. Yes, it is through the stories of these high-profile celebrities that we have come to know of maladaptive eating behavior patterns. In fact, Princess Diana was one of the first prominent personalities to disclose her body image related issues which reportedly doubled the rate of women seeking treatment for Bulimia in the Great Britain. This came to be dubbed by the media as the “Diana Effect”. It may also be true that the work industry demands of maintaining a particular “body type” may play a major role in these models, actors, singers or royal family members in developing such disorders. Still, this is no reason why someone you know or love may not suffer from a similar condition.

Anorexia Nervosa

An individual is said to be suffering from Anorexia Nervosa (AN) when s/he shows the following three symptoms:

1.      Severely restricted eating which results in the person being 85% of the expected body weight for people their height, sex, age and physical health.

2.      Fat phobia: Intense and irrational fear of putting on weight.

3.      Disturbed self-perception of body shape and weight such that they view themselves as being fat even when in reality they are actually very thin—at times, dangerously thin.

What do I mean when I say “dangerously thin”?

It means that a person with anorexia may lose so much weight that they may actually be at the risk of dying from being underweight. In fact, research has found that out of all mental illnesses, the mortality rate is the highest for those suffering from eating disorders. This might be so because depriving our body of all vital nutrients to such a drastic extent often results in a number of physiological complications such as weakness and brittleness of bones, muscles, hair and nails; low blood pressure, slow breathing and pulse rate; lethargy and fatigue; heart and brain damage and the possibility of multiple organ failure. Although no longer applicable, earlier the criteria for assignment of this clinical diagnosis to women required that the patient stops menstruating completely. Nevertheless, a majority of women with AN don’t menstruate and experience infertility.

There are two major types of Anorexia Nervosa:

In the restricting type of AN, the individual doesn’t engage in binge eating. They simply refuse to eat or engage in excessively strenuous exercise schedules as a means of preventing weight gain.

However, in the binge eating/ purging type, the individual occasionally engages in binge eating of food items followed by means of ridding their bodies of these extra calories by either self-induced vomiting or use of laxatives and extreme exercising. Nevertheless, these individuals continue to remain significantly underweight as they may not necessarily consume a lot of food when they eat, but even such small amounts may make them feel as if they have binged.

An interestingly baffling quality of an individual with AN is that they fail to feel as if there is anything wrong with their eating habits or body image. They show extremely high self control and don’t experience hunger pangs. They often eat the little amount that they do due to force feeding from family and friends. They are less likely to be overweight in the past. Thus, their desire to reduce weight is often driven by an independent and erroneous evaluation of their own “fatness” rather than the need for seeking approval from others.

Bulimia Nervosa

The diagnosis for this disorder is given when an individual meets the following criteria:

1.      Eating excessive amounts of food containing about 3,400 calories within a time period as short as about 2 hours. This might be referred to as binge eating.

2.      Feeling absolute lack of control over eating while engaged in these binge sprees.

3.      Follow up compensatory purging behaviors like self induced vomiting, use of laxatives and diuretics, other medication, fasting or extreme exercising in order to prevent weight gain.

4.      Exhibiting this cycle of binge eating-purging at least once per week for a period of 3 months.

5.      Sole dependence of self esteem on body weight and shape.

6.      Binge eating-purging episodes shouldn’t exclusively occur at the time of meeting all the symptom requirements for anorexia.

An important fact to support the last point is that an individual with bulimia is almost always of the normal weight or slightly overweight which results in failure to make a diagnosis most of the time. In addition, these individuals are very well aware that their eating styles are maladaptive and so their ritualistic binge eating & purging is often kept a secret. Consequently, suicide rates are somewhat higher in this group than those with anorexia as a strong sense of embarrassment is felt by individuals with bulimia. Further, they have a fairly realistic perception of their body shape but are dissatisfied with whatever weight they are at. Their disorder usually is an off-shoot of some critical comments from a significant someone in their life or due to other stressful life situations like marital conflict. For instance, Princess Diana has reported an incident where Prince Charles held her love handles and called her chubby which led her secret journey into the depths of bulimia. Thus, differing from anorexia in important ways, sufferers of bulimia have often been overweight at some point in the past. Also, they are likely to experience strong hunger pangs which when combined with emotional instability may lead them to engage in impulsive eating.

Medical problems undoubtedly follow such erratic feeding patterns. Ipecac syrup used for inducing vomiting have severe toxic effects if taken regularly in large doses. Self induced vomiting also results in dental decay due to the high acidity of thrown up material. This binge-&-purge cycle often causes dehydration which may result in permanent gastrointestinal damage, fluid retention in hands and feet, and heart muscle & valve destruction or collapse.

These disorders compel us to spend a moment of introspection about how body image troubles lead to such severe mental disturbances in something as basic as feeding yourself. Stay tuned for upcoming posts on other related conditions stemming from bodily insecurities.

The Insecurities Underlying Our Love Handles

The Hindu Festival of Lights—Diwali—is just round the corner. And with Diwali come gifts, gatherings and of course, FOOD! From delicious ghee laden laddoos to deep-fried, savory namkeen; one will surely find themselves hogging on all the possible extra but yummy calories in their daily menus during this festive week. This ditto scenario is witnessed be it Diwali, Christmas, Eid, or any other festival.

Quick questions:

1. How many of you would hesitate before giving in to the urging demands of your sweet tooth?
2. How many of you would feel guilty & reprimand yourself after the festivities are over for having lost control over your diet?
3. How many of you wouldn’t even touch the fatty foods for the fear of turning into a fatty you?

My guess: Most of us, to varying degrees of course.

The ideal body type

The “ideal body type” is often a perfect hourglass figure for females and V shaped torso for males. This ideal, however, goes much beyond the idea of “fat is bad” to entail the requirements of fuller lips

and Kardashian hips for females and facial hair that can be flaunted during No-Shave-November for males. It demands fair, waxed-of-all-bodily-hair skin for females and tall, muscular, biceps-endowed frame for males. The list can go on. But two important notes to be made here:

First, the lists are heavily differentiated for the two sexes and any crossover between the two is more or less frowned upon (E.g. a “too tall” female can expect herself to be fired with a slew of mean comments).

Second, the list is so specific in its requirements that it fails to capture the uniqueness of all individuals. Consequently, it labels anyone who doesn’t fit in, as either fat or any other form of ugly. Ipso facto, my waist line of 30 is as imperfect (although a little less unacceptable) as someone else’s waist line of 36. Nevertheless, all of us are lesser creatures in front of that woman who is bestowed with the perfectly tiny waist of 24 inches.

How did this “hunger for the ideal body” manage to creep into our psyche?

The perfectness quotient enshrined by this ideal that as often showcased and praised in media is next to impossible yet aspirational. “Someone on the big screen was able to achieve it. So why can’t I?”—this is the logic that is often invoked by our minds when acceptance for what we are is already available scarcely in the society that we live in.

Most of the movies we watch portray stereotypically fat characters as having a stereotypically tragic story—one of low self confidence, gullibility and failure in matters of school, love and career (E.g. Think of Sweetu aka Delnaaz from Kal Ho Na Ho). In real life too, the “fat guys and gals” are reduced to nothing but a point of joke, criticism and rejection—no one wants to date or befriend a “fatty”, the “sit-on-you-and-kill-you” joke is a classic and a million other ways have been discovered to label them not good enough.

Time to rethink if this is really funny

It might be “just a joke” to you. Others along with your “fat or dark skinned friend” may even laugh with you, irrespective of really being comfortable with it. But a deeper consequence results at a psychological level when body shaming becomes a part of our everyday conversation. In psychology, reinforcer is a term used to denote positive and negative environmental responses that strengthen a particular behavior. Thus, unquestioned transmission of body shaming in everyday communication reinforces us to laugh at the next “fatty/ blackie” we see, reducing that person to nothing— embodying no talents or positives—beyond their undesirable body type.

 

Barbie (Left) v/s Emme Doll (Right)

Next, the availability of innumerable cosmetic surgery    procedures and beauty products essentially perpetuate the    idea that we are NOT OKAY the way we are and that there is always “something better” in store for us. Who would imagine that this all-time-optimistic-phrase could be twisted to play with our psyche and make us consumers (or aspiring consumers) of these so called enhancers?

In one study by Dittmar and colleagues (2006), it was  found that exposure to images of Barbie dolls (reflecting the 36-24-36 ideal) increased bodily dissatisfaction than exposure to Emme dolls (a doll with realistic bodily proportions) or neutral images, in girls as young as 5 and 6 years old! Imagine how seemingly harmless toys are so shaped to slyly corrupt our body image i.e. our own view about our own bodies!

Thus, these are some ideas that help explain the hesitance, guilt, self- deprecation, self- hatred and self- constriction that exists within most of us in varying degrees and very well reflect in the answers that you provided to yourself for the 3 questions I asked you at the beginning.

How to respect your body type?

1. Mirror, Mirror, on the Wall: All of us are aware or even guilty of using the many camera filters that are available. What makes you think that movie stars or even your friends at work may not be using these filters to look “better” than they already do? And even if a picture is #unfiltered, always remember that only the best of your moments find their way onto social media. So your bedroom mirror is where you want to find your true beauty—looking only at yourself, drawing no comparisons, especially with the Photo shopped media pages.
2. Care for a little history? : Among our ancestors, roundness of body was indeed a sign of wealth and attractiveness as indicated by various stone age figurines and paintings found all across the world. This is so because those times were marked by food shortages and so voluptuousness was indeed a beautiful feature. Thus, embrace your curves for they were not always a bad thing and who know, you may eventually be able to bring them back in vogue for time-appropriate reasons!
3. Body beyond beauty: Appreciate your body for the tool it has provided you to achieve your many aspirations than being simply wound up in figuring out how beautiful an instrument it is. For instance, value how your body helps you achieve little things like cycling to school or dancing in the rain or hug a loved one.
4. Is the “ideal” really beautiful? : What the ideal body type tends to bring along with it in terms of wealth, suitable romantic partners, self confidence, societal acceptance, and prestige may have more to do with it wrongfully being perceived as beautiful than it actually being beautiful. Maybe we care more about these by-products than about achieving the ideal itself. But since they all tend to more or less CO-OCCUR with the ideal body type that is described, we tend to wrongfully assume that the ideal body type CAUSES these by-products to occur. If causation was true, how do you explain the success of personalities like Barack Obama, Oprah Winfrey, Bhumi Pednekar and many others who don’t meet the “ideal” in certain obvious ways? Thus, breaking this incorrect linkage will go a long way in questioning the beauty stereotypes.

The above described methods can be handy in dealing with the milder body-related insecurities that most of us have. But, do you know that some individuals suffer from full-blown psychological illness categorized as EATING DISORDERS due to ill-formed body image? What are these and how they can be dealt with will be covered by a series of upcoming blog posts. Stay tuned!