An Account of a Mother’s Battle with Childhood Anorexia in her Pre-Teen Daughter
Ten thousand and two hundred deaths (US) each year are the direct result of an eating disorder — that’s one death every 52 minutes. A grim statistic on a condition that is still considered a stigma and spoken in hushed tones in Asia due to a complex web of cultural nuances, misinformation, and the pressure to be thin. In fact, for a vast majority, anorexia is something associated with skinny models sashaying down the ramp, complete with a “fashionable” tag that renders it cool, strengthening stereotypes in the process. The fact that your child of single digits could be restricting or purging and slipping into a rabbit hole of darkness in pursuit of an obsession for perfection, exacerbated by unhealthy precedents shoved by the world she inhabits – could come as a surprise for many.
It did for me – three years back – when I came face to face with the devil that took over my child’s mind and pushed her to eat one morsel at a time or none at all.
A Deadly Discovery
Our daughter was around ten when we noticed that she was looking visibly thinner than her usual self. A multitude of GP visits and tests followed in an attempt to investigate the cause – may be a gut microbiome issue or something else related to the body? Nothing came up. As the shedding became more intense, the alarm bells sounded louder, yet the fact that it could be an eating disorder was a passing thought. After all, she was just a child! This is perhaps the biggest stumbling block with most parents – denial or just lack of awareness.
We finally had to wire our heads and consult an eating disorder specialist, who diagnosed her anorexia nervosa and placed the following blunt facts:
- Heart rate of fewer than 40 beats a minute;
- Loss of more than half of her intended weight;
- A walking time bomb which could go off any minute.
Immediate hospitalization followed as her life was in danger due to severe malnutrition. It was then that our lives changed as we got to understand the deadliness of the disease.
What is Anorexia Nervosa?
Anorexia nervosa (AN) is a life-threatening condition due to cardiovascular complications. It is characterized by abnormal eating behaviour and has the highest mortality rate of all psychiatric disorders. It has been associated with bradycardia (a heart rate of fewer than 60 beats per minute) (up to 95%), hypotension, mitral valve prolapses, and heart failure.
It’s a mental illness under the broader Eating Disorder (ED) family in which the central anxiety has to do with food and eating. I emphasize the word mental as it’s a disorder that affects thinking, mood, behavior and relationships – food is just the manifestation. There is enough evidence to believe that EDs have a lot to do with how our brains process information about the environment and the body. It is important to get this fact right and disassociate the stigma from the word “mental.”
EDs also come in the form of bulimia nervosa (BN), binge eating disorders (BED) and avoidant/restrictive food intake disorder (ARFID); and malnutrition in some form or other is a common denominator for which structured intervention is necessary. There are overlaps, and it is not surprising for patients to swing from one form to another.
The Burden of Appearance
It is estimated that 1.0% to 4.2% of women have suffered from anorexia in their lifetime, which has the highest fatality rate of any mental illness. However, it has to be pointed out that males are not immune from it, and studies show the increase in unhealthy weight loss which is fast catching up with men. The legitimate question would be to ask – “What causes an eating disorder?” It’s a complex answer to a simple question. EDs are disorders of the brain, and like cancer, asthma or schizophrenia, they result from a complex interaction of nature and nurture.
Dr Tracie Lazaroo, a clinical psychologist from Inner Light Psychological Services and LP Clinic, Singapore, says,
“Research has shown there is not one root cause for children developing an eating disorder. Some predisposing individual personality traits include, cognitive rigidity, a tendency to want to control their environment and what occurs around them, chronic worrying, pessimism, shyness, high avoidance, perfectionism, low levels of help seeking behaviour and impulsivity. Other social stressors that can include trauma such as childhood sexual abuse, exposure to violence or neglect, peer pressure or bullying. Additionally, exposure to social media without education on its negative effects can also increase the risk of developing an eating disorder. Studies have shown that social media has been a significant tool in influencing and encouraging children to place emphasis on the “ideal body” and “perfect appearance” through body objectification, making body comparisons and encouraging an unrealistic lifestyle surrounding fitness and striving for an unattainable, edited physical appearance”
The idealization of perfect body size is a narrative that is hard to escape from – media, diet culture, the wellness industry, weight stigma – all propagate it with a vengeance. At the young age of ten, my daughter succumbed to the narrative, as do millions of children worldwide, sometimes as young as age seven. A well-adjusted, carefree child who lived for her next meal, decided that she needed to lose weight to fit in and feel beautiful. While she could have been genetically pre-disposed, the external messages through social media; the casual conversations with friends, family, peers; the vilification of food (e.g., carbs are bad); the “health” narrative (e.g., dairy-free and gluten-free culture) – pulled the trigger.
The Trauma of Healing and Recovery
Unlike a physical illness, mental illness does not carry the badge of visible scars. When our daughter fell ill, it was hard even to convince ourselves that she needed urgent intervention as the thinking is that it will cure itself. After all, why on earth would it be so difficult for a child to eat – is that not what humans are conditioned to do? What we were oblivious to (at that time) was that malnutrition alters the pathways in the brain – patients can be fully functional yet have zero insight into their condition. The altered state of brain begs for immediate intervention and treatment.
“Given the various types of eating disorders and the complexity of the relationship the child may have with food, diagnostic procedures and treatment are usually tailored to the unique developmental, medical, nutritional and emotional needs of the child. Intervention typically involves work with a pediatrician, mental health professionals as well as the nutritionist. Generally, intervention begins with the restoration of nutritional health and weight. Medication may be recommended to help with mood stabilization and management of maladaptive urges (such as purging). Families and caregivers are then encouraged to attend family therapy where the family learns how to better communicate, understand the child’s triggers and how to better support the child during meal times.
On an individual level, the child may work with a trained psychologist on processing, understanding and making positive changes improving their self-esteem, interpersonal relationships, cognitive flexibility, mood regulation, and body image. Some therapeutic approaches may include cognitive-behavioural therapy, schema therapy, and individual psycho-dynamic therapy. Developing a self-awareness of one’s emotional triggers and responses and finding ways to build resilience and problem solve has been found to be beneficial in overcoming an eating disorder,” added Lazaroo.
The path to recovery led us a to new chapter of lives – one laced with turmoil, trauma and heartbreak. We took the Family-based treatment (FBT), also sometimes referred to as the Maudsley Method, which works on the principle that because of the Disorder’s ego-syntonic nature, decision-making on eating and physical activity lies with the parents. To say that it was harrowing would be an understatement. You see, the ED takes over the brain, which is almost akin to being exorcised, and a new personality emerges under the skin and bones of your loved one – who becomes hard to recognize. The voice of the ED is so strong that it will resist food at any cost – even the nullification of life. As the primary caregiver, the dining table became my home and battleground – the tantrums, the tears, the violence, the attempts at self-harm (very common with ED patients), the helplessness of trying to get her to eat, pretty much consumed my life and my own mental health took a severe beating. Three years into the recovery process, I can safely say that family support under the guidance of psychiatrists and psychologists is the strongest and most effective medicine in the cabinet.
How to Spot Tell-Tale Signs
A recent study conducted in the UK and Ireland found disturbing evidence that rates of anorexia among children may be increasing. The most concerning finding were that rates of anorexia among children, aged 12 and under, seem to have increased over the past decade.
Early detection makes a world of difference, as emphasized by Lazaroo, “Early detection is key in the successful management and recovery from an eating disorder. The signs can sometimes be subtle and may not develop into an eating disorder completely. Given this, awareness, non-judgement and open communication with children are essential in providing support as children need not meet criteria to benefit from having conversations surrounding food and body image.”
She also adds, “Some of the early warning signs of an eating disorder could include physical and behavioural issues such as throwing tantrums, aversions to tastes or textures of foods, excessive bowel movements or fear of abdominal discomfort. Indicators of a more pronounced condition can include actively refraining from eating during meals, significant reduction of food portions over a prolonged period of time, food avoidance behaviours during meal times such as spitting, hiding food, not completing meals consistently, significant weight loss or weight gain, engaging in excessive exercise, a delay of puberty (e.g., irregular or the absence of their periods) or digestive issues. Emotionally, children may become more irritable, socially withdrawn, fatigued and may experience significant mood swings.
Undoubtedly, the world is a challenging place to inhabit in more ways than one. The pressure on appearances has reached the young. It is important to let go of unconscious bias and mannerisms in talking about food and body image. As an adult, your action has the potential to influence a young mind – so every time you speak of squeezing your belly for the perfect photo, earn your meal by going for a run, embark on a diet, preach about healthy choices. Remember, there could be a young mind lurking who could be taking it out of context. However, it is in our hands to change the narrative and adopt a healthy stance towards food, appearance, inclusivity, and it starts with information and awareness.
“Recovery from an eating disorder may be a challenging, overwhelming and a stressful experience for both child and the family. Given this, it is important for families and caregivers to continue to practice compassion, patience and unconditional love towards the child and themselves throughout the recovery journey. There is life beyond an eating disorder and just like every other struggle in life, it is a journey of self-discovery, courage and finding your own definition of inner peace,” adds Lazaroo.
The Social and Economic Cost of Eating Disorders in the United States of America by the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED) and the Academy for Eating Disorders.
 The Renfrew Centre Foundation for Eating Disorders, Eating Disorders 101 Guide: A Summary of Issues, Statistics and Resources, 2003.
 Sullivan, P. (1995). American Journal of Psychiatry, 152 (7), 10731074.
[Scientists in the UK recently conducted an eight-month study to estimate how common new cases of anorexia were among young people aged 8-17.]