Eating disorders are very complex, which is why they remain misunderstood across the world, more especially in developing countries like South Africa. An eating disorder is a serious mental health issue than can have grave effects if left untreated.
Main image: Marcel Heil – unsplash
Over the years, there have been misconceptions about eating disorders that have contributed to further misunderstanding of it. As a result, it’s still viewed as a class issue, which affects the middle and upper class; and white women who live in urban areas. But an eating disorder is a mental issue that does not choose race, gender, age or class.
In South Africa, there has been little research and writing on eating disorders. Hence, it remains an illness that is underdiagnosed or misdiagnosed.
Blacklight spoke to mental health practitioners from Akeso Montrose Manor (a treatment facility for eating disorders): Dewald Louw, Therapeutic Head; Counselling Psychologist Natascha Stallkam; and Clinical Psychologist Marlene van den Berg (Occupational Therapist) to gain more insight into the eating disorder issue in South Africa.
Do South Africans have a general understanding of eating disorders?
“No, eating disorders are generally misunderstood internationally as well in South Africa. The spectrum of eating disorders is complex to understand and can look different in different people. However, awareness of eating disorders is slowly improving, and we see an increase in South African admissions at our eating disorder clinic in Cape Town.”
What exactly is an eating disorder?
“It is a mental illness that negatively influences your relationship with food and your body to such an extent that it impacts your daily functioning. The most common eating disorders [in South Africa] is Binge Eating Disorder (BED). This involves bingeing episodes where an individual eats an unusual amount of food in a short period. This should be distinguished from normal overeating that is not pathological. Bingeing episodes are fuelled by negative emotions. The person reaches out to food as a way of self-soothing or comforting. They almost experience being out of control and going into a trance-like state during these episodes. As a result, individuals gain unwanted weight and feel intense feelings of guilt and shame after bingeing. Sadly, obesity is normalised in our society, and the diagnosis often goes undetected and untreated.
Other common eating disorders include Anorexia Nervosa (a significant fear of gaining weight and restricting food) and Bulimia Nervosa (involving unhealthy compensatory behaviours to manage weight, such as purging, using laxatives, excessive exercising etc.).”
“South Africans know suffering and pain, but we rarely learnt from our parents or other mentors how to deal with negative emotions. Vulnerability is seen as a “weakness” (especially for men), and it results in a build-up of unprocessed negative emotions. Food restricting or other eating disorder behaviours then become the coping mechanism to deal with or control difficult emotions.”
How true are the misconceptions about eating disorders?
“Eating disorders affect all races and ethnicities. However, certain population groups feel more comfortable seeking treatment. Black individuals are often still hesitant to attend to their mental health due to shame and stigma. But we have seen an increase in African women seeking help for their eating disorders recently, possibly due to an increased awareness surrounding the condition.
The research does indicate that women are more susceptible to eating disorders, possibly due to increased social pressure to look a certain way in society. Age plays a factor, and teenagers (young adults) are more susceptible to Anorexia Nervosa and Bulimia Nervosa: while Binge Eating Disorder is more prevalent in adults of all ages.
Can men have eating disorders?
“Men might suffer from Muscle Dysmorphia, which is a sub-type disorder characterised by the inability to see your own body accurately. These men often see themselves as less muscular than they are. This might lead to compensatory behaviour, such as extreme over-exercising and the use of illegal drugs to increase muscle size.”
What are the underlying psychological issues linked to eating disorders?
“It is rarely about the food; it is about the underlying feelings. Psychosocial stressors, such as poverty, inequality, discrimination etc., result in added anxiety and insecurities for South Africans. Individuals might then unconsciously develop an eating disorder in an attempt to have control or soothe themselves emotionally.
It is important to remember that an eating disorder is a mental illness. Our entire being is an integrated system. Often, when we are struggling in one area (emotionally), it will present itself in other areas, such as our sleeping or eating. Developing an eating disorder is related to aspects of anxiety, depression, trauma or childhood injuries as it becomes a way to cope and deal with our emotions. In this integrated system, we must understand, process and heal all aspects of our functioning and well-being as they are all related.”
What are the signs of a potential eating disorder which loved ones should look for?
“Loved ones should look out for changes in food and eating behaviour, secrecy and manipulation around eating or not eating, drastic changes in weight or changes in the individuals’ emotional state and anxiety levels. Families can also look out for compensatory behaviour like an increase in exercising or gymming or an increase in using the bathroom directly after meals. These are alarm lights that warrant caring attention and gentle support until the individual is willing to accept help.”
How do they intervene in a less threatening and invasive manner?
“This is again best guided through a therapeutic team. We carry so much of our own body and food beliefs with us. We all carry our own judgments and often our own randomly collected food and nutrition information. Not all of this is correct, and not all of this is helpful. As much as we want to support those we love: we often say and do the wrong things, as we do not know what the right thing to do would be. Let a clinician or healthcare professional with an eating disorder experience guide you on what to do and say so you can be more helpful in the healing process and beyond. Mostly, the way to intervene is to remind the individual that you love them and that you will support them to get help and to go through the process of recovery.”
How does a person with a problem reach out for support?
“Begin with honesty: share with loved ones if you have been engaging in behaviours that may be harmful to your health, e.g. over-exercising; restricting/fasting for long periods; eating large amounts of food in secret; or inducing vomiting after eating out of fear that you will gain weight. The thoughts driving these behaviours are the core of the problem. If you notice that you are terrified of gaining weight: obsessing about what you eat; how much you exercise; or are extremely focused on what your body looks like, it is important to seek the right support as soon as possible.”
When should people suffering from an eating disorder seek professional help?
People suffering from eating disorders rarely recover if they don’t receive professional help. Once you notice any impairment in your functioning, it is crucial to seek professional support.
Examples of impaired functioning include:
Frequent arguments with family members about food.
Struggling to concentrate at work/school due to long periods of not eating.
Loved ones expressing concern about how much weight you have lost or gained.
Withdrawing from your social life to restrict or binge food, compensate for food eaten or due to poor body image.
Medical issues resulting from malnutrition (e.g. decreased bone density), overeating (e.g. pain in joints) or effects of vomiting (e.g. tooth decay)
Lying and stealing to sustain the disordered eating habits.
Excessive feelings of guilt and shame regarding what you eat or what your body looks like.
Untreated eating disorders can ultimately result in death, often due to organ failure or other medical complications. According to research in recent years, eating disorders such as Anorexia Nervosa have the highest mortality rate of all mental illnesses.
What kind of professional help is there for people suffering from an eating disorder?
Eating disorders are mental illnesses and should be treated accordingly. While your doctor (general practitioner) may be able to identify that you have an eating disorder, it’s important to seek help from a mental healthcare professional (such as a psychologist or a psychiatrist) with experience in treating eating disorders, as well as consulting with a dietician.
Inpatient treatment at a psychiatric hospital has proven to be more effective in supporting patients to break the cycle and stop acting out. Akeso Montrose Manor, a private psychiatric hospital in Cape Town, specialises in treating eating disorders for adults and adolescents. A multi-disciplinary team consisting of nurses, psychologists, dietician, psychiatrist, occupational therapist and biokinetics provides intensive inpatient treatment to clients suffering from eating disorders.
What does the rehabilitation process entail?
”In the early stages of inpatient treatment, the focus is on medical stabilisation; introducing a balanced meal and exercise plan; providing you with information on eating disorders and helping you gain awareness of your specific eating disordered thoughts and behaviours. Later stages of the treatment involve family members, working through emotional difficulties and improvement of body image. You would also be prepared to continue your recovery as an outpatient by implementing a structured meal and exercise plan, identifying your professional and private support network and attending regular eating disorder support groups.
What can the state do in helping to treat mental health issues like eating disorders?
“There is a great need and urgency to prioritise mental health in South Africa. Given the immense burden of diseases associated with mental illness globally, it is time to reconsider public health policies in South Africa. The state needs to invest more resources in the treatment of mental illnesses like eating disorders. They also need to reduce the long waiting lists in public hospitals for psychologist or psychiatrist, and more mental health professionals need to be employed. For South Africans without access to medical aid, inpatient treatment for eating disorders should be made available.”
How do we break the stigma?
“The only way to break the stigma is for us to remove the shame. This is true for all illnesses or aspects that are stigmatised. Conversations, talks and open dialogues are the vehicles to reducing the secrecy and shame around eating disorders in our society.
Breaking the stigma increases help-seeking, and this is very important. Breaking the stigma is healing our own relationship with food and our bodies. Issues around body and food shaming should be called out in the open and talked about. We should be mindful of our own judgements and “diet rules” towards others and ourselves. Changing the narrative includes speaking about the illness, the recovery, the disorder, and also about our own unhealthy beliefs related to food, eating and body image.
For more information on eating disorders or to seek help go to montrosemanor.co.za
To seek professional help contact:
SADAG (The South African Depression and Anxiety Group)
24hr Suicide Crisis Helpline: 0800 12 13 14
Cipla 24hr Mental Health Helpline
0800 456 789
Cipla Whatsapp Chat Line
076 882 2775
Adcock Ingram Depression and Anxiety Helpline
0800 70 80 90
Lifeline – National Counselling
0861 322 322 (24 hours/ 7 days a week)