Eating Disorders and Treatment in Singapore

Eating disorders are a category of psychological conditions that manifest themselves in persistent and unhealthy relationships between body image, food, eating and exercise.

They usually develop in adolescence and young adulthood and are often associated with a whole host of distressing thoughts and emotions.

There is a common misconception that only women are prone to suffering from eating disorders – but this is untrue. Both men and women may suffer from eating disorders which can affect people of all body types regardless of their gender identity.

The Different Types of Eating Disorders

Anorexia Nervosa

An eating disorder characterised by weight loss (or lack of appropriate weight gain in children), unhealthy eating patterns, intense fear of gaining weight and significant body image concerns. This condition is extremely dangerous as it can lead to malnutrition, starvation, and death.

Bulimia Nervosa

Bulimia is characterised by a cycle of bingeing and purging, where the individual eats large amounts of food (larger than what most people would eat in a similar period of time) in a way that feels out of their control, and then engages in purging which involves self-induced vomiting, fasting, or excessive exercise. Individuals with Bulimia also tend to have significant body image concerns.

Binge-eating Disorder

Binge-eating disorder involves periods of consuming unusually large amounts of food in a discrete period of time, accompanied by a sense of loss of control over eating. Binge-eating episodes are commonly associated with difficult emotions such as guilt, disgust and shame.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Binge-eating disorder involves periods of consuming unusually large amounts of food in a discrete period of time, accompanied by a sense of loss of control over eating. Binge-eating episodes are commonly associated with difficult emotions such as guilt, disgust and shame.

One common misconception is that eating disorders are a lifestyle choice and are just a “passing phase”. This is not true – nobody chooses to have an eating disorder.

Unhealthy eating and exercise patterns can spiral out of control and become driven in ways that appear similar to an addiction.

Eating disorders can be very serious and dangerous conditions as they can directly affect physical health, as well as psychological and social functioning.

As they are commonly associated with a myriad of medical complications, eating disorders have one of the highest mortality rates amongst all psychiatric illnesses.

What Should I Look Out for?

While there are a variety of eating disorders, listed below are some of the more common signs and symptoms.

If you or one of your loved ones shows several of these symptoms, we strongly suggest seeing a professional for an assessment and treatment.

Some Symptoms and Warning Signs of Eating Disorders include:

Dramatic weight loss/gain or fluctuations in weight
Excessive and rigid exercise behaviours
Increased preoccupation with food, body weight and body shape (e.g. weighing self excessively)
Restrictive eating (e.g. skipping meals, choosing only “healthy” food)
Picky eating unresolved by late childhood
Binge-eating
Purging behaviours (self-induced vomiting and/or use of laxatives)
Non-specific gastrointestinal complaints (e.g. constipation, acid reflux etc)
Social withdrawal
Decreased mood and concentration
Hair loss
Feeling cold all the time
Feeling dizzy or faint
Loss of menses in females

Indicators for increased and urgent medical attention:

Irregular heart rate
Low weight
Low blood sugar
Low and/or postural drop in blood pressure
Hypothermia
Electrolyte imbalances

Are Eating Disorders Genetic?

Eating disorders are complex mental health conditions that impact individuals across all ages, genders, and socio-cultural backgrounds. Many people wonder if eating disorders are genetic, and research suggests that there is a strong genetic component to eating disorders like Anorexia Nervosa. This means that if you have a family history of eating disorders, you may be at higher risk of developing one yourself.

However, it is crucial to note that genetics is not the only factor contributing to an eating disorder’s development. Eating disorders are also influenced by environmental (interpersonal and social) and psychological factors such as stress, trauma, other comorbid mental health issues, past history of bullying, dieting and starvation, as well as cultural pressures. Therefore, it is important to note that genetics can increase the likelihood of developing an eating disorder, but that does not mean they will definitely result in the development of an eating disorder.

When Should I Seek Eating Disorder Treatment?

Ignoring the symptoms of an eating disorder is unlikely to result in spontaneous recovery. If you suspect you have an eating disorder you should seek professional help.

If your loved one is your child, you should strongly consider seeking out treatment by a specialist in a psychiatric clinic on their behalf. Studies have shown that early intervention is key as prompt and intensive treatment significantly improves the chances of recovery.

How Does Promises Healthcare Address Eating Disorders?

In our outpatient eating disorder treatment programme, our experienced psychologists and psychiatrists conduct thorough assessments of patients. Based on these assessments, patients may be referred to other healthcare professionals, such as dieticians or general practitioners, for comprehensive care. The specific therapies offered are tailored to each individual, taking into account factors such as the type and severity of the eating disorder, the patient’s age, and the level of support available.

We understand the importance of continuing care in the treatment of eating disorders. As such, our team is committed to providing ongoing support to aid with long-term recovery. We closely monitor patients’ progress, make necessary adjustments to the treatment plan, and offer guidance throughout the journey. Additionally, we emphasise the development of self-care strategies, coping mechanisms, and the cultivation of a supportive environment to foster lasting mental well-being beyond the treatment sessions.

At Promises Healthcare, our aim is to deliver comprehensive and compassionate eating disorder treatment. We are dedicated to helping individuals achieve lasting recovery, providing them with the necessary tools and support for a healthier relationship with food and body image.

What Does the Outpatient Eating Disorder Treatment Look Like?

As eating disorders affect both mind and body, treatment commonly involves a coordinated team of specialists – a GP or Specialist Doctor, a Psychologist, a Psychiatrist and a Dietician or Nutritionist.

First Visit:

A first visit with the clinical psychologist usually entails them making a detailed assessment of the presenting issues and taking relevant background history.

If you are the patient, you will be asked a number of questions about your eating habits, behaviours and other details, including your medical history.

If a child or adolescent is the patient, their parents will also be interviewed by a child psychologist skilled and experienced in evidence-based counselling and psychotherapies, comprehensive diagnostic and psycho-educational evaluations for kids. And the initial session may take 1.5 to 2 hours. If the patient has a caregiver, they may also be interviewed.

At the end of the first session, your psychologist will provide you with some information on your diagnosed condition, including some knowledge on how you can help manage your symptoms and behaviour.

Your psychologist will discuss some of the potential treatment options and plans. Depending on the assessment made by your clinician, they may recommend involving other specialists, such as a dietician or doctor in your treatment. They may also recommend either individual or family-based therapy.

Family-Based Treatment:

Based on the current research, Family-Based Treatment (FBT; sometimes also known as the “Maudsley Method”) is the most effective model of treatment for anorexia nervosa in children and adolescents. It has also been shown to be effective in the treatment of Bulimia Nervosa as well as ARFID.

FBT is a manualised treatment delivered by trained professionals. It differs from traditional treatments that involve waiting for the child to develop insight and motivation to get better. The problem with such traditional treatments is that they waste precious time and the physical consequences associated with malnutrition continue to affect the child’s health and development. Children and adolescents with eating disorders often lack the motivation to eat and get better. FBT can work around the resistance by leveraging on parents as agents of change and has been shown to be faster and more cost-effective compared to other treatments.

FBT requires active participation by parents and focuses on supporting and empowering parents to actively renourish their children until they resume normal development and are able to make appropriate food, eating and exercise choices.

In FBT, sessions are usually weekly at the start and then decrease in frequency, and the family is invited to attend every session together with the child. The child is also weighed and seen individually at the beginning of each session. The clinician will work with the family to discuss the impact of the eating disorder and help to understand the child’s fear and distress during meals. One of the initial sessions typically includes at least one family meal in the clinic room. This provides the clinician with an opportunity to observe the behaviours of each family member during a meal and to assist and guide parents in helping their child eat.

There are 3 distinct phases in FBT:

Phase 1: Due to the impact of starvation on the brain, the child is not able to make healthy and appropriate decisions surrounding eating at this point, hence parents are empowered to take charge of meals to help the child re-establish regular eating patterns. Physical exercise is limited at this stage.
Phase 2: This phase begins when most weight is restored and meals are going more smoothly. The child is gradually given more independence over their own eating and exercise.
Phase 3: The focus in the phase is to help the child develop a healthy and balanced life and to catch up on other developmental issues. Other comorbid mental health difficulties can also be addressed. The treatment ends with relapse prevention.

Enhanced Cognitive Behavioural Therapy (CBT-E):

Enhanced cognitive behavioural therapy is an evidence-based transdiagnostic treatment for a number of forms of eating disorders, including anorexia nervosa, bulimia nervosa and binge-eating disorder. It is primarily an outpatient treatment that is individualised and focuses on addressing the main trigger that is keeping the eating issue going.

There are 4 distinct stages in CBT-E:

Stage 1: Building an understanding of the eating problem and identifying the need for change. It also involves modifying and stabilising regular eating patterns.
Stage 2: Engagement, compliance and progress are reviewed, and plans are made for the next stage of treatment.
Stage 3: This stage focuses on the processes that are maintaining the eating problem. It is personalised and may involve addressing body image and extreme dietary restraint, as well as enhancing the ability to deal with daily events and mood.
Stage 4: The focus then shifts towards pre-empting and dealing with potential setbacks that can lead to relapse. A plan is developed to help maintain the changes obtained and to minimise the likelihood of relapse.

What Would the Fees be Like?

At Promises Healthcare, we understand the importance of transparency when it comes to fees for our services. As fees may vary depending on the specific treatment plan and duration, we encourage you to visit our Fees Page on our website for a comprehensive overview of the costs associated with our services.

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