The pursuit of thinness: an outcome study of anorexia nervosa.

INTRODUCTION: Anorexia nervosa (AN) is a growing problem among young female Singaporeans. We studied the demographics and follow-up data of AN patients referred to dietitians for nutritional intervention. METHODS: A retrospective nutritional notes review was done on 94 patients seen from 1992 to 2004. All patients were given nutritional intervention, which included individualised counselling for weight gain, personalised diet plan, correction of poor dietary intake and correction of perception towards healthy eating. We collected data on body mass index (BMI), patient demographics and outcome. RESULTS: 96 percent of the patients were female and 86.2 percent were Chinese. The median BMI at initial consultation was 14.7 kilogramme per square metre (range, 8.6-18.8 kilogramme per square metre). 76 percent were between 13 and 20 years old. 83 percent of the patients came back for follow-up appointments with the dietitians in addition to consultation with the psychiatrist. Overall, there was significant improvement in weight and BMI from an average 37 kg to 41 kg and 14.7 kilogramme per square metre to 16.4 kilogramme per square metre, respectively, between the fi rst and fi nal consultations (p-value is less than 0.001). The average duration of followup was about eight months. Among the patients on follow-up, 68 percent showed improvement with an average weight gain of 6 kg. Patients that improved had more outpatient follow-up sessions with the dietitians (4.2 consultations versus 1.6 consultations; p-value is less than 0.05), lower BMI at presentation (14.2 kilogramme per square metre versus 15.7 kilogramme per square metre; p-value is less than 0.01) and shorter duration of disease at presentation (one year versus three years; p-value is less than 0.05) compared with those who did not improve. Seven patients with the disease for more than two years did not show improvement with follow-up. CONCLUSION: We gained valuable understanding of the AN patients referred to our tertiary hospital for treatment, two-thirds of whom improved with adequate follow-up treatment. Patients that had suffered AN longer before seeking help appeared more resistant to improvement.

Youth suicide and parasuicide in Singapore.

INTRODUCTION: Suicide and parasuicide rates are important markers of the health of a nation. Suicide is a common cause of mortality in youth and parasuicide has its peak prevalence in adolescence and early adulthood. Both pose a tremendous burden to individuals, families and society. Historical and current studies on suicide and parasuicide in Singapore are reviewed and discussed in the light of available worldwide research. METHODS: Studies on suicide and parasuicide in Singapore were identified through a MEDLINE search (from 1979). Information from these studies were supplemented with relevant local monographs on suicide and parasuicide. RESULTS: Suicide is extremely rare in children under 10 years of age. Rates rise in the 10 to 14 years age group and increase markedly in the 15 to 19 years age group. The male to female ratio is about 2:1 for youths 10 to 14 years old and 1:1 for the 15 to 19 years age group. The historical preponderance of female suicide is much less clearly seen in recent years. Jumping from a height is the commonest method used, and mental illness and recent life stress are common causative factors. A peak in suicides in the young was found for June and October, and a trough for November and December. Parasuicide is extremely rare in children under 10 years of age. There was a peak in the months of October and November in the student population, corresponding to the examination months. Youths of Indian ethnicity were over-represented. CONCLUSIONS: Preventing suicide and parasuicide is of paramount importance, given the severe burden of such acts on individuals, families and society. Current studies on youth suicide in Singapore and a national study on parasuicide are urgently needed to increase our understanding of these phenomena.

Eating disorders in Singapore: a review.

INTRODUCTION: Anorexia nervosa, bulimia and binge-eating disorder are the three best recognised eating disorders. Eating disorders have been reported to affect some 1 to 3% of adolescent females in the West. Increasing reports from Asia suggest that it is no longer possible to view these illnesses as 'Western' diseases. Eating disorders are the third most common serious medical disorder in female adolescents, after asthma and depression. It poses a tremendous burden for individuals, families and society. Historical and current studies on eating disorders in Singapore are reviewed, and discussed in the light of available regional and worldwide research. METHODS: Studies on anorexia nervosa and bulimia in Singapore were identified through a MEDLINE search (from 1979). Information from these studies were supplemented with relevant local monographs on eating disorders. RESULTS: Reports of eating disorders have increased over recent years in the local literature. The psychopathology of eating disorders in Singapore is very similar to that described in the Western literature, and in the two main current classification systems. Body dissatisfaction is prevalent among Singaporean Chinese schoolgirls and female undergraduates, with rates not dissimilar to the West. There is a link between 'Westernisation' (based on English being spoken as the main language at home) and body dissatisfaction.

Muscle dysmorphia in a young Chinese male.

INTRODUCTION: To describe a young Chinese male with muscle dysmorphia, a recently proposed variant of body dysmorphic disorder. CLINICAL PICTURE: A 24-year-old Chinese male with a morbid fear of weight and muscle loss with associated compulsive weight training, avoidance behaviour, forced eating, depressed mood and disturbed body image. TREATMENT: Antidepressants and cognitive-behavioural psychotherapy. OUTCOME: Preoccupation with muscularity was reduced. CONCLUSIONS: Muscle dysmorphia has been reported in Western populations, mostly among body builders and anabolic steroid abusers. To our knowledge, this is the first case report originating from a non-Western population. The patient illustrates the nosological difficulty of this recent entity. It is likely to be a culture-bound phenomena associated with a Western concept of an ideal body shape for males.

Anorexia nervosa and bulimia--a Singapore perspective.

OBJECTIVE: To study the clinical characteristics of patients with anorexia nervosa and bulimia. METHOD: Fifty patients presenting to our department from 1991-1996 were identified and studied retrospectively. RESULTS: There was an increase in presentations for anorexia and bulimia over the period studied. The majority exhibited body image disturbance, morbid fear of fatness and compulsive efforts to lose weight, not dissimilar to that described in the Western literature. Significant transcultural differences were not found. Those with significant binge eating were more likely to present at a later age, have a higher BMI, menorrhoea, associated vomiting and/or laxative use, have prominent depressive symptoms and a history of self-harm. Compared to anorexics, bulimics were more likely to have relationship stresses and a history of self-harm. CONCLUSION: The clinical characteristics of anorexics and bulimics are more striking for their similarities rather than differences to that described in the West.