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Dr. Frances Cheng
Psychiatrist

* This article was written for Shanghai Family's Ask the Pro feature.

Are you satisfied with how you look? Most of us would like to change a thing or two, but for some the desire to look like the billboards can become an obsession, with devastating affects.

Shanghai is a huge, cosmopolitan city with women of all ages and ethnicities facing a similar pressure of advertising billboards and magazine covers idealising what the perfect woman should look like. Add to that, the inevitable insecurities that arise for expat women when they relocate to a new place, and when hard-working husbands are frequently away for business, or spend a lot of time entertaining, and it’s not hard to see why body image issues and eating disorders are becoming more common.

Eating Disorders

The main types of eating disorders are anorexia nervosa (AN) and bulimia nervosa (BN). They affect about 1 in 200 adolescent and young women and are found less commonly amongst men. People with eating disorders have an extreme preoccupation with ideal body weight and shape and associated weight loss/control measures including excessive exercise, avoiding food that they think will make them fat, vomiting after meals, taking laxatives or diuretics, and taking appetite suppressants.

Patients with BN also experience an irresistible craving with food and experience recurrent episodes of binge eating and purging (periods of starvation, vomiting, laxatives, water pills and appetite suppressants). In fact, 30-50% of patients with BN previously had AN and since their weight can be normal, the physical symptoms are similar to anorexia but usually less severe.

In addition to the psychological stress associated with the pressure to keep the weight down these weight loss behaviors may lead to permanent physical damage, including tooth decay, hair loss, anaemia, hormonal imbalance, heart problems, renal stones, nervous system problems, and osteopaenia or osteoporosis (lack of bone density).

Unsurprisingly, many people with eating disorders also suffer from depression, obsessive-compulsive disorder (OCD), anxiety problems, and personality disorders. In some patients, external stress such as moving to a new environment or relationship problems, will worsen the symptoms. Patients with eating disorders might present in a variety of ways including thoughts or attempts of self-harm or suicide, depression, insomnia, or low self-esteem.

Treatment of eating disorders commonly includes personal or family therapy, antidepressants, and dietary advice, alongside treatment for physical problems. In extreme cases, in-patient treatment might be necessary.

The behaviors and physical complications of ED are often distressing to family members, causing tension, mistrust and anxiety. Mothers with eating disorders do influence their children as they are often preoccupied with food and body size and may impose strict diets and have unreasonable ideals about their children’s size or weight. Children also learn eating behavior from others, and pick up on how parents’ or siblings’ moods are affected by body image and food.

Surgical Extremes

The development of various medical procedures varying from botox injections to plastic surgery has allowed people to change they way they look in order to feel more attractive. Being uprooted from an environment and social network where one is familiar and comfortable to an unfamiliar setting, may induce or worsen prior insecurities.

In the majority of cases where people decide to have cosmetic work performed, there is no pathological element. However, in rare cases, where one minor procedure spirals into an endless pursuit to rectify physical imperfections, a possible diagnosis of body dysmorphic disorder or even delusional dysmorphophobia may exist. These people are obsessed usually with one or two physical aspects of their appearance which they find abnormal and distressing, leading to requests for medical consultations and rectification of the perceived problem areas. In these cases, while plastic surgery has not been found to relieve these obsessions, since new imperfections soon replace the old one, there is evidence that antidepressants and psychotherapy are effective.

Parenting Advice

As parents, it is very important to emphasize that being healthy is more desirable than being thin or a certain size.  Show acceptance and appreciation for your own body and if trying to change, doing so by adopting healthy habits.

The best way to stay in sync with your child is to maintain a constant interest in what is going on in their lives, in and out of school. Get to know your child’s friends and if possible their parents, as this is a natural way to let your child know that, while you are confident enough to allow them freedom and privacy, you would still be able tell if things were going awry.

Dr Frances Cheng is Member of the Royal College of Psychiatrists (UK) and Fellow of the Hong Kong College of Psychiatrists.