Anorexia Nervosa cases rising in Kerala, seen mostly in women: Doctor explains reasons, quotes case study

The recent incident of an 18-year-old girl starving to death in Kerala's Kannur due to a condition called Anorexia Nervosa, an eating disorder, has stunned many. While the term 'anorexic' and 'anorexia' weren't too unfamiliar for us thanks to pop culture references, Western TV content and more, the fact that it can even lead to death wasn't something everyone was aware of. Its psychological implications, the need for timely medical intervention and the fact that it's not merely a case of 'someone trying a diet' have triggered social media discussions. Though the condition is still not commonly diagnosed among Kerala youngsters, it's apparently rising here as well, says Dr U Vivek, Consultant Psychiatrist at Renai Medicity Hospital in Kochi. He tells us more about its symptoms, who it affects mostly and more:

Who is it affecting?
"It was uncommon in Kerala and India and was considered a Western illness until recently. However, lately, the number of cases among youngsters in Kerala has also risen. I get to see at least three to five patients a month," says Dr Vivek. Apparently, it's seen most commonly among young women between the ages of 12 and 25 years in urban areas. There is limited research on why such eating disorders affect mostly women, though many factors like hormones, cultural differences and even brain activity are mentioned as possible reasons by Appollo24/7. Dr Vivek says Anorexia Nervosa is also commonly associated with a condition called 'Borderline Personality Disorder.' "It is characterised by mood swings, impulsivity, low stress tolerance, self harm, sensitivity to criticism and relationship issues," he explains.

Story of a 14-year-old patient
Dr Vivek narrates the example of one of his patients, a 14-year-old whose weight reduced from 42 kg to 21 kg in three months. "It was due to the reduction of food intake. She was worried that she was fat and her dress looked tight on her. In reality, she was painfully thin, her clothes hanging loosely off her frame," he recalls. The patient was hospitalised as her BP, pulse rate, and other vital parameters were deranged. She was treated by a team consisting of a psychiatrist, a psychologist, a dietician, a physician and nurses. "With initial nasogastric tube feeding and through small frequent meals along with medicine and counselling later, her weight and vitals stabilised," says the doctor. Apparently, she could be discharged after a few weeks of treatment at the hospital. After 6 months of treatment, she gained 35 kg. "Now, she is taking food on time, though at times she complains that she is too fat," says Dr Vivek. 

Why are the cases rising?
Over the last decade cases have increased drastically in Kerala due to exposure to social media, OTT content and more, explains the doctor. "Many youngsters are in search of the size zero figure they see on these platforms and crave it, though it’s unhealthy," he says. 

Treatment is challenging because...
Being one of those conditions that need doctors belonging to a multidisciplinary team to treat a patient, treating Anorexia Nervosa is a challenge, says Dr Vivek. "Often, patients need hospital admission as they should even be fed through nasogastric tubes. Their treatment team should include a psychiatrist, psychologist, pediatrician or physician, dietician and nurses. Admission and recovery would take at least a few weeks and if not adequately treated could lead even to death," he explains. Moreover, not many psychiatrists are trained in treating eating disorders. "Therefore, it’s essential that patients meet up with doctors trained in it and that doctors interact with such patients regularly," he says. 

What are the warning signs?
1) Loss of more than 5 kg a month 
2) Missing periods for more than three months
3) Contemplating self-harm, thinking of suicide 
4) A dull, emaciated look
5) Low BP and pulse
6) Drowsiness

How can family and friends help?
Parents and friends can help those who exhibit these symptoms by giving them small, frequent meals and giving pep talks. However, if symptoms don’t improve, they need immediate expert help from a mental health professional like a psychiatrist, says Dr Vivek. 

Symptoms of Anorexia Nervosa? 
Anorexia Nervosa is an eating disorder mostly seen in women, and if not treated on time, it could even lead to the death of a patient. Its symptoms include:
1) Extreme weight loss
2) Increased focus on appearance and the feeling that they are fat when they are actually skinny
3) Mood swings
4) Low blood pressure
Hair loss, stoppage of periods, overexercising, a tendency to follow extreme fad diets and fasting, tiredness, constipation, dry, blotchy skin, low blood pressure, mood swings, feeling depressed, excessive use of laxatives, diuretics and diet pills; denial of hunger, pushing food around the plate instead of eating it and feeling full despite not eating enough are some of the other symptoms of the condition.