by Dr. Marilyn G. Chotem – April 2, 2007
Bi-monthly "Adaptations" Column in the Lifestyles & Culture section of
The Canadian Immigrant Magazine.
It is an incomprehensible tragedy of our time that many women and girls have an obsession with food restriction and weight loss, which can lead to ill health or even death. In affluent North America, choosing starvation flies in the face of the abundance of the Western world. For immigrants and refugees fleeing from poverty-stricken countries to Canada for a better, more prosperous life, it can seem unthinkable. But it’s not impossible that your daughter or even wife may succumb to an eating disorder in this environment.
Eating disorders often begin in adolescence. Adolescence is a time of experimentation and rebellion. It is a time of forming one’s identity. Who am I and how am I unique or special? These are important questions. Part of the question of identity is image. Girls become very image conscious in adolescence. Fashion is important, as is makeup and body size. It doesn’t help that the fashion industry portrays emaciated models as the beauty ideal. Young women who may have fragile self-esteem can be vulnerable to these cultural icons.
Females with eating disorder issues tend to be unassertive and people pleasing. Issues of control, perfectionism, self-esteem and coping are also common to individuals with eating disorders. They may have been raised in chaotic homes or suffered sexual abuse. They may have experienced emotional neglect or, alternatively, have overly controlling parents. Disordered eating may be a way of coping with intense anxiety, high expectations, uncomfortable feelings or unmet dependency needs. Immigrant females fall prey to these problems for similar reasons, such as high family standards, perfectionism, desire to fit in with the prevailing cultural standards and so on.
There are two main types of eating disorders. Those with anorexia nervosa have the following symptoms:
To lose weight, they may restrict food intake, exercise excessively, abuse laxatives and stimulants, or purge.
Bulimia nervosa is less obvious because bulimics are often at a normal weight. Bulimia is characterized by recurrent episodes of binge eating (out-of-control eating in excess of what most people would eat in a time period), followed by behaviours such as restricting food, excessive exercising or purging.
There are also variations of eating disorders that do not fit exactly into either of these two definitions.
While recovery from eating disorders is possible, they are often chronic conditions, and like other addictions, tend to get worse before they get better. The best treatment is a combination of medical monitoring, nutritional counselling, psychotherapy, self-help groups, such as Anorexics Bulimics Overeaters Anonymous (ABOA), and even inpatient or residential treatment. Medications can be helpful for impulse control, anxiety, distorted and rigid cognitions (thought patterns) and depressed mood.
Depression is as likely a result as a cause of eating disorders. With anorexia, the starvation produces a loss of energy, depressed mood and social withdrawal. People with bulimia tend to become depressed because of the self-perceived, shameful secret that keeps them emotionally isolated, and the failed attempts to control the behaviours.
If you or someone you know is suffering from an eating disorder, don’t be ashamed to seek help. Check with your local immigrant settlement agency or family doctor for advice on where to turn for help. The National Eating Disorder Information Centre provides information and resources on eating disorders; see www.nedic.ca for a list of eating disorder clinics in your area. In B.C., there is also the Eating Disorder Resource Centre of B.C., located at B.C. Children’s Hospital.
Dr. Marilyn G. Chotem, Ed.D., is a registered psychologist #773 with a private practice in North Vancouver. Of Russian-Jewish heritage, Chotem was born in Seattle, Washington, and moved to Canada in 1974.