When thin becomes an obsession

Posted on 25 December 2019

Eating disorders normally develop during adolescence or early adulthood. Navigate your way through this challenging time with advice from a Mediclinic psychologist.

Females are more vulnerable to eating disorders, due to pressure from social media and their peers. However, as Ronel Groenewald, a psychologist at Mediclinic Kimberley, explains, the jury is still out on the exact cause of any eating disorder. “They suspect a combination of biological, behavioural, and social factors,” she says. “Eating disorders often go together with other psychiatric problems such as anxiety disorders, depression and substance abuse.”

Groenewald believes that eating disorders are all about control issues. “The person feels out of control in a specific situation or amongst certain people,” she says. “They feel the only thing they can control is what or how much they eat. This distorted sense of control becomes an obsession and can lead to an eating disorder.”

Anorexia nervosa occurs when a person refuses to eat an adequate amount of calories to maintain and sustain normal body functions because of an intense and irrational fear of becoming fat. “Anorexia sufferers have a distorted body image and view themselves as overweight, even when they are dangerously underweight,” Groenewald says. “Being thin becomes an obsession and all efforts at rectifying their weight will be met with extreme hostility. It is estimated that one out of every 25 women will have anorexia in their lifetime – and most will deny they have an eating disorder.”

Signs that your teen might be suffering from anorexia include anxiety, depression, perfectionism and being highly self-critical, and dieting even when thin or emaciated. “Excessive or compulsive exercising, an intense fear of becoming fat, infrequent or cessation of menstruation and rapid weight loss are other symptoms,” Groenewald explains. “Concealing weight loss with loose clothing, avoiding meals, eating in secret and monitoring every bit of food are also warning signs.”

The primary aim of treatment for anorexia is to facilitate insight into the underlying cause of the eating disorder, bring normality into healthy eating habits and to stabilise normal weight. “In extreme cases, hospitalisation may be necessary and intravenous feeding may be required,” Groenewald says. “A multi-disciplinary approach is the most effective, comprising a physician, psychiatrist, psychologist, dietician and occupational therapist. Long-term antidepressant medication, behavioural therapy, psychotherapy and support groups can address underlying psychological issues.”

Bulimia sufferers fear weight gain and feel extremely unhappy with their bodies, says Groenewald. “They will repeatedly eat too much food in a short amount of time, which is called binge eating. Feeling disgusted, worried about weight gain and shame after overeating, people with bulimia will try to prevent weight gain by inducing vomiting or using laxatives, diet pills, diuretics, or enemas. After purging the food, they normally have a short period where they feel relieved. Only until they lose control again.”

Groenewald explains that doctors make a diagnosis of bulimia after a person has had two or more binge-purging episodes per week for at least three months. People with bulimia usually fluctuate within a normal weight range, although they may be overweight too. As many as one in every 25 females will have bulimia in their lifetime.

Warning signs that your teen might be suffering from bulimia include the abuse of laxatives and other treatments to prevent weight gain, mood swings and regularly spending time in the bathroom after eating, says Groenewald. Other symptoms include scarring on knuckles from inducing vomiting, damage to tooth enamel and an overemphasis on physical appearance.

It is thought that multiple factors contribute to the development of bulimia, including genetic, environmental, psychological, and cultural influences. “Some of the main causes include stressful transitions or life changes; a history of abuse or severe trauma; negative body image and poor self-esteem,” says Groenewald. “Remember, as with anorexia, bulimia is not about food, but about control and emotional turmoil.”

The initial phase of bulimia treatment involves breaking the harmful cycle the sufferer has learnt and restoring normal eating behaviours. “The second phase is all about improving negative thoughts while the third phase of bulimia treatment concentrates on recognising and changing irrational beliefs about weight, body shape, and dieting,” Groenewald explains. “The final phase of bulimia treatment focuses on healing from emotional issues that may have caused the eating disorder. The psychotherapy treatment of choice is Cognitive Behaviour Therapy (CBT).”

If you suspect your teen of an eating disorder, listen to the words they use and pay attention to their body language when food is being discussed. “Don’t expect the problem to just go away on its own – or that your child will outgrow the ‘phase’,” Groenewald says. “Get expert treatment and help – don’t try to handle it on your own.”



In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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