Body image a major factor in developing bulimia
When someone whose self-confidence is reliant on their physical appearance receives harmful comments on how they look, they could fall into a state of believing they are not good enough.

Body image is one of the greatest potential causes of developing eating disorders such as bulimia, according to clinical psychologist Thye Wen Yi.

Thye, who provides mental health therapy and counselling services, has a special interest in eating disorders.

“One of the biggest signs of an eating disorder is when the patient sees their body image as a defining factor of their self-esteem.

“There is a lot to do with how someone’s peers perceive them, so if they are constantly being told that they have to look a certain way to be liked as a person, they start to believe that their self-worth is nothing if they do not adhere to these standards,” she explains.

This can push people into doing detrimental things to their bodies because they believe it is the only way to be likeable as a person.

“It’s unhealthy to have to force yourself to conform to such standards, but to a lot of people, it can be a very huge part of their life,” says Thye.

Food is the fulcrum

It is not unusual for people to turn to food as a coping mechanism while dealing with emotions like stress and sadness.

However, in the case of bulimia, Thye shares that what may start as a coping mechanism eventually ends up being the reason for the patient’s struggles and relationship with food.

When food is used as an emotional coping mechanism, it can lead to overeating.

This can cause even more stress, which can lead to more overeating, thus initiating a vicious cycle of eating to relieve stress caused by overeating.

ALSO READ: Tips to manage emotional eating

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are two defining characteristics for bulimia.

“Firstly is the presence of binge-eating even when you are physically unable to continue eating, and secondly is the act of purging through compensatory behaviours,” explains Thye.

“The difference between binge-eating disorder and bulimia is that, in bulimia, the binge-eating is followed by compensating the guilt through taking laxatives, overexercising or forcing the food out through vomiting.”

Other mental health conditions can be associated with eating disorders as well, e.g. developing anxiety due to the lack of self-control from having an eating disorder, or depression caused by feeling worthless due to not knowing what to do about their condition and feeling helpless about it.

There is often also a physical stereotype associated with eating disorders like bulimia, i.e. a skinny, young girl or woman.

This may become a barrier if a person who has a eating disorder does not look like this stereotype.

“People with eating disorders may be told that their struggles are not that bad or that they don’t look like they struggle with food.

“This narrative can be very harmful, especially for someone who had to muster so much courage just to take the first step in finding professional help.

“It’s a stretch to expect everyone to be masters in mental health, but being able to lend an ear and be non-judgmental when a loved one needs to talk, can do wonders in building the courage needed for them to seek help,” says Thye.

She also emphasises the importance of consulting professional help and the dangers of self-diagnosis.

When a person is too aware of all the different types of disorders and symptoms from the internet, they may start to self-diagnose – a phenomenon known as medical student syndrome.

“The harm in this is that they’re convinced they have a disorder, but have no means of treating it, ultimately leading them into a downwards spiral of anxiety and fear.

“Professionals don’t only assess what sort of issues you may be facing, we work on treating your diagnoses with you,” she says.

Targeting the triggers

When it comes to treating eating disorders, Thye tends to implement behavioural strategies by looking into the psychological factors that trigger eating disorder symptoms. According to Thye, the self-esteem of people with eating disorders is typically defined by their perceived body image. — LOW BOON TAT/The Star

“If you believe that the people around you don’t like you for your appearance, we would work on self-esteem and confidence.

“And by targeting these factors, we also work on improving self-control and anxiety,” she explains.

Cognitive behavioural therapy (CBT), and acceptance and commitment therapy (ACT), are among the types of treatment she uses.

The cognitive aspect of CBT is where a patient’s core beliefs are challenged to reshape their mindset and behaviour into one that allows for growth.

ALSO READ: Change your negative thoughts and behaviours with CBT

For ACT, more focus is put into self-acceptance, and to embrace both the positives and negatives in the world.

Thye believes that personalising therapy based on symptoms, rather than targeting the disorder, is a better approach as it may not always be clear what disorder the patient has.

“For example, bulimia without the purging and compensatory behaviours is technically binge-eating disorder.

“However, unlike physical illnesses, the results are not always objective.

“If you take a blood test, you’ll be able to determine what problems exist based on the results of the blood test, but for mental health conditions where we use a variety of tools, assessments and self-report questionnaires, it’s not so simple.

“The patient may feel like a strong five for a specific assessment today, but only a two or three tomorrow, which is why I prefer assessing the client’s current condition based on whatever symptoms and behaviours they exhibit, instead of needing to strictly label them with a specific disorder,” she says.

Thye notes that even if a patient does not strictly follow the textbook definition of any one disorder, their symptoms as a whole are just as important and should not be overlooked.

Treatment and recovery is also a process that requires the patient’s continual efforts.

She says: “Mindsets and behavioural habits are always difficult to change completely, so what we can do is look into a patient’s relationship with food all over again to reshape the way they view food as a burden into one that is positive.

“Beyond the one hour of therapy, the patient has to put in the effort in implementing the practices and skills we share with them in their daily lives.

“It’s like driving without knowing where you’re going – we as professionals can serve as your map, but it is ultimately up to you as the driver to reach your destination.

“While we can’t say for certain that the patient will not relapse after recovery, what they can do is to reduce the chances of it developing again by learning to recognise and manage the triggers associated with the behaviour.”

A success story

Indeed, Thye shares the success story of a previous client who not only recovered from her eating disorder, but is also currently working as a nutritionist.

“I remember how unhealthy her relationship with food was, which stemmed from childhood and school experiences.

“She would go through a lot of binge-eating and purging, and had tremendous anxiety when it came to food.

“It took us about two years, but we managed to work through her struggles and developed better behavioural strategies,” she says.

“There is always light at the end of the tunnel.

“It’s truly inspiring to see that today, she is using her knowledge and experience to help others who are going through what she did, letting people know that they are not alone in the struggles that they face.”
Mind,Eating disorder,bulimia
This eating disorder is often triggered by a negative body image and emotional eating, among others.