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More and more teens and pre-teens in Singapore, mostly girls, some of them as young as eight years, are falling prey to anorexia nervosa. This debilitating eating disorder, which was fairly uncommon in Asia just a couple of decades ago, is characterised by an obsessive preoccupation with being thin.
How can you tell if you or someone you know is suffering from anorexia? Doctors diagnose anorexia based on criteria defined in the Diagnostic and Statistical Manual of Disorders (DSM-IV) published by the American Psychiatric Association. These include:
- Body weight is less than what is required for their age and height
- Intense fear of gaining weight or becoming “fat” even though they are underweight
- Intense preoccupation with their body size and shape
- Undue influence of body weight or shape on self-evaluation
- Absence of three consecutive menstrual cycles in females
A multidisciplinary approach to treatment
In Singapore, the number of patients suffering from eating disorders like anorexia and bulimia has risen sharply in recent years, and doctors are taking a holistic approach to their treatment.
The Singapore General Hospital’s LIFE Centre has a dedicated Eating Disorders Programme. Its multidisciplinary team comprises of an art therapist, dietitians, medical social workers, occupational therapists, physiotherapists, psychiatrists, psychologists and a staff nurse, to deal with the physical and emotional aspects of the illness.
According to Dr Lee Huei Yen, Senior Consultant at the Department of Psychiatry and Director of the Eating Disorders Programme at SGH, eating disorders are becoming increasingly common in Singapore. “At SGH, we see about 11 new cases every month. Among psychiatric disorders, eating disorders have the highest mortality rate, with the rate for anorexia ranging from five to 15 per cent.”
Causes and triggers
Experts point to a number of causes for anorexia nervosa, including family history, personality traits such as perfectionism and low self-esteem, and social factors. Popular media is also partly to blame for the spurt in cases, with even children between eight and 12 years being bombarded with images of slim girls. In vulnerable people, Dr Lee notes that sometimes all it takes is a “trigger event”, which could be being teased about their weight, or stress related to school or work.”
An eight-year-long retrospective study on anorexia nervosa in Singapore, carried out by Dr Lee and three other doctors, and published in 2005, found comments from others, school and work stress to be the most common precipitating factors. The mean age of the onset of anorexia was 15.5 years and 25.4 per cent of patients were found to be suffering from depression.
Early treatment has been found to be very effective in cases of anorexia, with patients being able to recover and maintain their normal weight. If left untreated, however, the disorder can cause multiple health issues, which include osteoporosis, and heart, liver and kidney problems. It can also lead to changes in the brain matter which may affect the patient’s performance at school or at work.
“If a patient is severely malnourished and medically unstable, with a low heart rate and blood pressure, or if outpatient treatment fails, we then recommend hospitalisation,” Dr Lee stresses.
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