Eating into one’s sense of self worth

Bollywood actress Richa Chadha’s recent revelation about her struggle with bulimia nervosa, an eating disorder characterised by binge-eating followed by purging, has shed light on an important health issue.
Eating into one’s sense of self worth
Eating into one’s sense of self worth (Illustration by Varghese Kallada)


However, while Richa termed eating disorders as one of the best kept secrets of the film industry, experts say that it is fairly noticeable, especially among younger women and teenagers. An estimated 10 million people are diagnosed with bulimia nervosa every year in India. Experts say that the numbers have been steadily rising in the last five years or more, indicating a socio-cultural change.
Psychological condition:
By the international classification of diseases, bulimia is a psychological condition, says Dr Lakshmi Vijayakumar, psychiatrist, World Health Organisation, Consultant and founder of Sneha, a suicide prevention helpline. She adds that like other psychological conditions, such as depression and schizophrenia, there is some biological basis to it. She says, “The genesis is multi-factorial and is a combination of biological, psychological and social pressures. In most cases that we are witnessing, it is a combination of bulimia and anorexia characterised by low weight, fear of gaining weight, a strong desire to be thin and food restrictions.”
Dr Lakshmi adds that compared to 10-15 years ago, there has been a steady rise of cases. “It is three to four times now than a decade ago. And, this is not just in India or the US, but also in Africa, where being buxom is considered beautiful,” she says.
Dr Krithika Ravindran, Cosmetic Surgeon and Age Management Consultant, says that anorexia nervosa can be evident as a person is visibly thin, but bulimia doesn’t manifest through a typical body type. “They are not denying themselves food, but then they even resort to using laxatives, apart from vomiting to bring it out of the system,” she says.
Bulimia is a deep-rooted psychological condition, and if left untreated, can trigger a whole set of physiological problems. Dr Krithika points out that frequent purging or vomiting can damage the oesophagus and lead to ulcers. “In some cases, it can lead to reflux problems like heartburn and Gastroesophageal Reflux Disease (GERD), a digestive disease in which stomach acid or bile irritates the lining of the food pipe. Other implications include an imbalance of ghrelin, the hunger hormone, and an adverse effect on tooth enamel. Also, when we study a bulimic’s brain, there is an imbalance of neurotransmitters, which transmit signals from one neuron to the other.” 
With long duration bulimia, heart and kidney problems become apparent. Kidneys are stressed due to the dehydration and electrolyte imbalance. “There is a possibility of heart problems, like arrhythmia (or irregular heart beat), once again because of erratic potassium levels, which can even lead to death,” says Dr Sheela Nambiar, Gynaecologist, Fitness and Lifestyle Consultant. 
Parental support is critical in addressing the issue, says Sumathi Chandrasekharan, a clinical psychologist. “When there is a conflict between how the teen looks and how she perceives herself, it should be addressed immediately,” she adds. Treatment depends on how soon the problem is addressed, say experts. 
“Most often, many are just on anti-depressants,” adds Dr Krithika, adding that it takes a lot more to come out of it. “If treated early it can be reversed. In at least 50 per cent of these cases, there are other co-morbid psychological conditions like depression and anxiety,” says Dr Lakshmi.
Points to ponder
  • Tooth decay due to constant purging is a likely fall-out.
  • Digestive problems, like injury to the oesophagus, even tearing and bleeding.
  • Bleeding in the stool is also common due to injury to the rectum.
  • Young women with bulimia could develop irregular periods, anovulation and infertility. 
  • Likely to develop osteoporosis as a result of lowered oestrogen.
  • With long-term bulimia, risk of developing heart and kidney problems.

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