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SINGAPORE: The end-of-the-year period, with invitations to gatherings and festive parties, is stressful for Jas, 31, who wanted to be known only by her first name.
That’s because you’ve struggled with an eating disorder for the past seven years, one that involves chewing food and spitting it out to avoid ingesting it.
The chain of gatherings for meals, especially during Christmas, New Years and Chinese New Years, can be a mental torment, he explained.
“Even before you get to the person’s home, you’d be planning days in advance: ‘If I eat turkey, I’ll just have the breast. Or if we order pizza, I’ll check how many calories are in that slice. Am I going to eat the tomato on the pizza and leave the crust behind? ‘”, Said.
READ: Comment: Eating Disorders Are About Emotional Pain, Not Food
“Eating out with people was also stressful because then I needed to plan how (to chew and spit),” she said, adding that it took a lot of practice to keep her behavior as low-key as possible.
“He did everything he could to avoid going out … When people had meetings, then they said they weren’t free,” said Jas, who works in education.
These days, he’s on the road to recovery, but the holiday season is still stressful. Faced with so many opportunities to eat, she said she has to “break a habit that she has had for so many years.”
His experiences of the holiday season are not uncommon.
Dr Ng Kah Wee, Director of the Eating Disorders Unit at Singapore General Hospital (SGH), noted that patients struggle more during the festive period for many reasons.
For one thing, people who binge can give in when they see a large amount of food, while those who restrict their food intake may have a hard time refusing social events or communal meals, added Dr. Ng.
Having more family gatherings can also exacerbate depression and anxiety among some patients, especially those already struggling with low self-esteem issues and distorted body image, he told CNA.
COVID-19 AND ITS EFFECT ON PEOPLE WITH EATING DISORDERS
The holiday season ends a year plagued by a pandemic that has put even more stress on those with such disorders.
Jas cited how the “breaker” period that began in April left her disorder unchecked as she was able to engage in unhealthy eating behaviors in the privacy of her own home.
“I also wanted to chew and spit because the food was so close that I could go to the refrigerator and do it. It was difficult for me, ”Jas said.
On the other hand, he also had to eat with his family more often than before, a dangerous situation given that they did not know about his eating disorder.
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Experts noted that COVID-19 has affected patients in other ways.
Closer supervision at home led to more anxiety and tension in patients, while the pandemic “abruptly stopped” habitual routines such as going to school or work, said SGH’s Dr. Ng.
“Some more unfortunate had lost their jobs, or perhaps this misfortune had befallen their parents. As a result, when anxiety and depression worsened, their eating became more erratic and purging behaviors increased, ”he explained.
He added that the pandemic and safe distancing restrictions prevented many patients from reverting to their previous ways of coping, such as hanging out with friends or watching movies.
“We saw patients who took maladaptive measures such as using alcohol, drugs and self-harm. Some patients even contemplated suicide when they were at the peak of their distress, ”Dr. Ng told CNA.
READ: Mental Health Services Disrupted During COVID-19 Pandemic, As Needs Increase: WHO
Dr. Courtney Davis of the KK Women’s and Children’s Hospital (KKH) added that COVID-19 also led to increased health concerns, leading to a worsening of eating disorder symptoms among some.
“Examples of aggravated symptoms include increased amounts of exercise and increased concern about dietary restrictions,” he said.
However, both doctors also noticed that some patients’ conditions improved amid the pandemic.
Dr. Ng said that a “small proportion” of them improved during the period of interruption due to closer parental supervision.
Parents were able to notice early mood swings and abnormal eating behaviors, and they got medical care for their children “in a timely manner,” he explained.
MORE CASES AMONG YOUNGER PATIENTS
In the Eating Disorders Unit at SGH, there were about 150 new cases in 2020. The average age of patients who presented for the first time was between 17 and 22 years. An overwhelming majority were female patients.
These figures are similar to those of previous years, SGH said.
However, KKH, which cares for younger patients, has seen an increase in cases.
Its Adolescent Medicine Service saw 96 new cases of patients with eating disorders in 2020, up from 80 in 2019.
In previous years, the service treated 50 to 70 new cases per year on average.
Dr. Davis said the hospital cannot establish the exact reason why cases have continued to rise, adding that research is ongoing in this area.
However, he noted that “better awareness of eating disorders has probably played a role in population growth.”
There has also been “increased complexity in a subset of cases,” Dr. Davis said.
“We are seeing more patients requiring medical admission at presentation compared to before. This trend suggests a greater severity of symptoms at presentation, ”he told CNA.
“We are also seeing younger patients. Approximately 20 percent of patients are under the age of 13 at the time of presentation. “
READ: The impact of COVID-19 on mental health needs to be managed as more people face stress and disorders: PM Lee
To reduce the number of eating disorder patients, SGH’s Dr. Ng cited several possible solutions.
In addition to helping young people develop their self-confidence and identity “in a healthy way,” teachers can be trained to identify those who may be at risk for developing such disorders.
Psychiatric disorders also need to be destigmatized, Dr. Ng said.
He added: “Encourage the general public to pay attention to their mental health and that of their loved ones, especially in this unprecedented testing period of a pandemic.”
