Most people look forward to taking a break from the usual daily routine and enjoying a meal. But, for anyone with an eating disorder, it is a time of dread and anguish. Even though they may have been thinking about food all the time, the ‘voice’ inside their head makes them feel guilt and a sense of shame for wanting to eat. They live in a world where eating would mean a loss of control or an overwhelming act that goes against their perceived body image or deep-seated beliefs about their food, weight and appearance. Thinness equates to happiness – yet there is never, ever “thin enough”.
According to Dr Felicity Marcus, a specialist psychiatrist who practices in Johannesburg, “The questions many people ask about those with eating disorders reflect how little we actually know about the patients and their conditions. Unfortunately, society still tends to react with a judgmental approach to mental illnesses in general and to the mental illnesses that cause eating disorders in particular.”
Because of this, there are many misconceptions about eating disorders. “It’s quite commonly believed that a person with an eating disorder avoids food because they want to be thin. However, most often this is not the case. The avoidance of food is more likely to be a symptom of more complex issues.” Dr Marcus refers to ‘the iceberg effect’ – i.e. the eating disorder is the tip of the iceberg (the bit that we can see), but what the person is experiencing underneath is what keeps the iceberg (the eating disorder) going.
The underlying issue may be some form of emotional suffering. “An emotional injury may arise from emotional deprivation, abandonment, social isolation, abuse – something that causes a feeling of failure,” explains Dr Graham Alexander, Consultant Psychologist at the Cape Town Bariatric Surgery Clinic, who specialises in the treatment of eating disorders. “The focus on either starving, bingeing, or purging is a means of soothing away the underlying pain. It’s much like an alcoholic: the drink reduces the pain of the emotional trauma that the alcoholic experiences.”
Although we have been aware of eating disorders for decades, the first global analysis of studies on the problem was only conducted in 2023. It showed that the conditions are more common among girls, older adolescents, and people with higher body mass.
Among South Africans, approximately one in six girls demonstrates attitudes and behaviours which could indicate a risk of an eating disorder. Over 40% of teenagers in South Africa are ‘highly dissatisfied’ with their bodies.
Interestingly, comments Dr Alexander, a report done many years ago in South Africa suggests that the incidence of disordered eating amongst Black female adolescents may be higher than among their Caucasian counterparts. Dr Alexander says, “I wonder if that ratio has not broadened even more now, what with greater urbanisation and access to Western media.”
Dr Alexander cautions against the use of psychiatric medication as a first measure for treating anorexia among adolescent sufferers, since “there is still no evidence of the value of psych medication.” Instead, he advocates schema therapy for the treatment of Anorexia Nervosa. This approach acknowledges that the sufferer uses the eating disorder to insulate emotional pain. “In schema therapy, we are looking to make redundant the eating disorder by replacing this temporary fix with healthy ways to self-care by addressing unresolved emotional pain and building qualities to lead a confident and autonomous existence.”
Both Dr Alexander and Dr Marcus endorse the benefits of working with a multidisciplinary team: a dietician and a GP at minimum, and possibly also a psychologist or psychiatrist. “A team approach is always best due to the complexity and nature of the illness,” concludes Dr Marcus.
Impact on a child’s schooling
Information provided by Cape Town Torah High: Indications that suggest the possibility of an eating disorder: withdrawal from socialising, a fixation on food, comments about their own or other people’s bodies, restrictive eating, bringing home full lunch boxes, emotional distress/ anxiety/ depression.
A child’s schooling may suffer, e.g. poor concentration or lack of focus; malnourishment which impacts quality of sleep and so negatively affects academic success; inability to participate in physical activities such as sport.
Advice for parents
• Show empathy
• Create a non-judgmental environment to encourage your teen to share their feelings
• Consult a paediatrician and a mental health professional, e.g. a counsellor specialisting in eating disorders
• Work with the treatment team (paediatrician, therapist, dietician, etc.) and the school counsellor.
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