While death is the worst-case scenario, other complications are of major concern for both bulimics and anorexics, he said. Some recover after a single episode, some, like Hsu, have a fluctuating pattern of weight gain and relapse, and others experience a chronically deteriorating course of illness over many years.
Purging on a daily basis for more than three years, Hsu said the worst physical effect she has suffered is the decay of her teeth enamel from stomach bile. Girls she befriended in the group therapy, however, were not so lucky and suffer from chronic stomach pains or kidney problems.
A multi-disciplinary approach with psychiatric, medical, nutritional and family counseling support is the only way to treat the illness, said Chen, but it is both time-consuming and costly and it requires national recognition of the problem.
"They [Department of Health] recognize a problem with weight gain among the general population, but their anti-obesity campaigning does not include non-visible eating disorders, like bulimia or anorexia," he said. In terms of medical economics it is not a good subject. If the numbers are small then there is no funding, and you need programs in schools and hospitals to let people know where and how to get help.
Is there help?
There is no National Eating Disorder Association in Taiwan and likewise there are no public or private clinics. At present there are only two psychiatrists focusing their research and work on anorexia and bulimia, Chen and a female doctor at NTUH. Chen is currently talking with officials in the Bureau of Health Promotion and Protection under the Ministry of Health about establishing a national education program on eating disorders. Given the current lack of resources, however, most patients receive medication for an illness which he said requires psychiatric therapy not prescription drugs.
Hsu first learned the term "bulimia" when she researched it on the Internet. It wasn't until after several hospital visits and prescriptions for the anti-depression drug Prozac that she met Chen and began her psychotherapy sessions. "Three years ago, I felt I had lost the ability to live a normal life. Now I enjoy my job, I have friends and my family life has improved. I still make myself get sick, but I actually feel myself getting better," Hsu said.
Help and information can be obtained from the Mental Health department at any public or private hospital or by calling Taipei City Psychiatry Center (臺北市立療養院) at (02) 2726-3141 X 1119.
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