BEIRUT: In the psychiatric wing at one of Lebanon’s prominent hospitals, Nadine sits. It’s past lunchtime, and the nurse comes in with a tray of food, insisting she eat. Nadine stares blankly at the plate of salmon, rice and vegetables.
“They annoy me,” says Nadine, not her real name, while shuffling the plates around on the tray. A look of pain appears on her face as she looks at the piece of fish, as if she considers it a form of punishment.
Recently diagnosed with anorexia, Nadine’s battle with recovery has just begun, and she has a long way to go.
“First I was suffering from chronic depression and from an obsessive compulsive disorder, and anorexia was a disease caused by my depression,” Nadine says slowly.
“But anorexia became a serious problem because I became a severe case. So now there are two problems, the depression and the anorexia,” Nadine says, her words echoing in the empty ward.
“We have a family of eating disorders, the best known being anorexia nervosa, binge eating disorders and bulimia,” said Jeremy Alfrod, a clinical psychologist and cognitive behavioral therapist.
According to Alfrod, also the founder of the nonprofit Middle East Eating Disorders Association, there are other kinds of eating disorders that people aren’t aware of. For instance, there is orthorexia, in which patients become obsessively preoccupied with eating healthy foods, eventually morphing into anorexia.
Speaking over the phone, psychiatrist and addiction specialist Dr. Dany Khalaf summarized anorexia as “the distortion of self-perception, obsession about being thin and fear of food.”
For those seeking treatment, the first step in recovery is to acknowledge they have the disease.
“I took the decision according to my own will,” Nadine says. “The changes have only been minimal. I do now know that I have a problem, that I have a sickness and that I am not okay.”
Nadine made the decision to check herself in after she traveled to Dubai in March.
“After my parents noticed that I had lost a lot of weight, the drama and tension in the house began to increase,” she explains.
Brushing off comments at home came easy, but she began to doubt herself when friends in Dubai said the rapid weight loss could be due to cancer or severe disease.
Experts say the onset of anorexia is not sudden; its effects do not manifest themselves overnight, but by way of difficulties and stressful situations in a person’s life.
Within the eating disorder family, anorexia is the most complicated.
“It’s the deadliest of all mental health disorders and people don’t usually know that,” Alfrod said.
Having spent most of her life working in the Gulf, where she was overwhelmed by her responsibilities, Nadine’s breakdown was not necessarilysurprising.
Her job as an equity analyst didn’t make things easier. On the contrary, Nadine used to work for around 16 hours a day. This led to deterioration in her health and an endless cycle of severe depression.
“I worked in Beirut for one year and then moved to Dubai for four years. Then I moved to Qatar, to Doha.” she explains, never making eye contact. “Then I quit my job in October 2013.”
The control she lacked over her work life she tried to make up for with food.
“Anorexia is an eating disorder in which the person starves himself,” said Maya Haddad, head dietitian at the Mount Lebanon Hospital psychiatry department. “Anorexics use their food to control their feelings.”
Haddad said a person was in danger when their body mass index measured under 17.
“Not everyone suffering from anorexia needs to be admitted to the hospital,” she added. “But when their BMI is under 17, they need to go [have their health monitored].” A regular person’s BMI ranges between 18.5 and 24.9.
Diagnosed anorexics such as Nadine often exercise to burn more calories and say they do not appreciate food.
“They don’t eat because they want to,” Haddad explained. “They eat because they need to take the [necessary] medication.”
While for many, food can be both an art, combining flavors, and integral for survival, for those suffering from anorexia, the opposite is true.
With a BMI of 15, Nadine is indifferent about food and everything else. “It is very difficult for me to re-accept food. It hurts me physically and emotionally. People ask me, ‘Why don’t you eat?’ Well, it’s not that easy.”
Although there is no specific medical treatment to cure anorexia, with time it can be treated.
“Many studies have shown that some medications can have a positive effect; however none have proven specific for anorexia nervosa,” Khalaf said. “Yet, the earlier diagnosis and treatment are, the better the prognosis would be.”
As for Alford, he said anorexics needed to know they were in control of the situation and their treatment. “It’s very important for them to know that they’re in control during the entire process and that they’re in control of their choices.”
But the chief factor inhibiting treatment for people suffering from medical disorders, and for health workers administering treatment, is a lack of awareness. In Lebanon, the dearth of facilities for patients suffering from eating disorders is another issue.
Nevertheless, those undergoing treatment represent a spark of hope for others. Nadine has found refuge in art and painting. “The drawings express the inner struggle, which words can’t relay.”
“During my years working, I got so sucked into my career and work addiction,” Nadine says. “When you become weak, you forget that there are people around you who do truly care about your presence, even when you have lost hope in your own self.”