SINGAPORE: The year-end period, with invites to gatherings and festive feasts, is a stressful one for 31-year-old Jas, who wanted to be known only by her first name.
That is because she has grappled with an eating disorder for the past seven years – one that involves chewing food and spitting it out, to avoid ingesting it.
The string of get-togethers for meals, especially during Christmas, New Year and Chinese New Year, can be a mental torment, she explained.
“Even before you reach the person’s house, you’d be planning days ahead: ‘If I eat turkey, I’ll just take the breast meat. Or if we’re ordering pizza, I’ll check how many calories are in that slice. Am I just going to eat the tomato on the pizza and leave the crust behind?'” she said.
“Eating out with people was also stressful because then I needed to plan how to (chew and spit),” she said, adding that it took a lot of practice to keep her behaviour as discreet as possible.
“I would try my best to avoid outings … When people had gatherings, then I’d say I wasn’t free,” said Jas, who works in education.
These days, she is on the road to recovery but the festive season is still stressful. In the face of so many opportunities to have a meal, she said she has to “undo a habit that has been with (her) for so many years".
Her experiences of the holiday season are not uncommon.
Dr Ng Kah Wee, director of the Eating Disorders Unit at Singapore General Hospital (SGH), noted that patients struggle more during the festive period for many reasons.
For one, people with binge urges may cave in when they see an abundance of food, while those who restrict their food intake may struggle with turning down social events or communal meals, Dr Ng added.
Having more family reunions may also exacerbate depression and anxiety among some patients, especially those who already battle issues of low self-esteem and body image distortion, she told CNA.
COVID-19 AND ITS EFFECT ON PEOPLE WITH EATING DISORDERS
The holiday season caps a pandemic-struck year that has put even more stress on those with such disorders.
Jas cited how the "circuit breaker" period that started in April caused her disorder to go unchecked, as she was able to engage in unhealthy eating behaviour in the privacy of her own home.
“I would also have the urge to chew and spit because food was so nearby, I could just go to the fridge and do it. It was difficult for me,” Jas said.
On the other hand, she also had to eat with her family more often than before – a dicey situation given that they did not know about her eating disorder.
Experts pointed out that COVID-19 has affected patients in other ways.
Closer supervision at home brought about more anxiety and tension for patients, while the pandemic “abruptly halted” usual routines such as going to school or work, said SGH’s Dr Ng.
“Some more unfortunate had lost their jobs, or perhaps this misfortune had befallen their parents. Correspondingly, when anxiety and depression became worse, their eating became more erratic and purging behaviours increased,” she explained.
She added that the pandemic and safe distancing restrictions prevented many patients from turning to their previous ways of coping, such as going out with friends or watching movies.
“We saw patients who adopted maladaptive measures such as turning to alcohol, drugs and self-harm. Some patients even contemplated suicide when they were at the peak of their distress,” Dr Ng told CNA.
Dr Courtney Davis of KK Women’s and Children’s Hospital (KKH) added that COVID-19 led to increased health worries as well, which triggered a worsening of eating disorder symptoms among some.
“Examples of aggravated symptoms include increased amounts of exercise and increased preoccupation with dietary restrictions,” she said.
However, both doctors also noted that some patients’ conditions improved amid the pandemic.
Dr Ng said a “small proportion” of them became better during the circuit breaker period because of closer parental supervision.
Parents were able to notice early changes in moods and abnormal eating behaviour, and got their child medical attention “in a timely manner”, she explained.
MORE CASES AMONG YOUNGER PATIENTS
At SGH’s Eating Disorder Unit, there were about 150 new cases in 2020. The average age of patients presenting for the first time was about 17 to 22 years. An overwhelming majority were female patients.
These numbers are similar to previous years’ figures, SGH said.
However, KKH – which attends to younger patients – has seen cases growing.
Its Adolescent Medicine Service saw 96 new cases of patients with eating disorders in 2020, compared to 80 in 2019.
In previous years, the service saw 50 to 70 new cases per year on average.
Dr Davis said the hospital is unable to establish the exact reason why cases have continued to rise, adding that research is ongoing in this area.
She noted though that “better awareness on eating disorders has likely played a part in the increase in numbers".
There has also been an “increased complexity in a subset of cases”, said Dr Davis.
“We are seeing more patients who require medical admission at presentation compared to before. This trend suggests an increased severity of symptoms at presentation,” she told CNA.
“We are also seeing younger patients. About 20 per cent of the patients are younger than 13 years old on presentation."
READ: COVID-19 impact on mental health must be managed, as more people face stress and disruption: PM Lee
To bring down the number of patients with eating disorders, SGH’s Dr Ng cited several possible solutions.
Apart from helping the young build their self-confidence and identity “in a healthy manner”, teachers can be trained to identify those who may be at risk of developing such disorders.
Psychiatric disorders must also be de-stigmatised, Dr Ng said.
She added: “Encourage the general public to pay attention to the mental health of themselves and their loved ones, especially in this unprecedented trying period of a pandemic.”