Two days ago, I paid my sister a visit. She candidly told me she has a history of bulimia. I know she had an episode of trichotillomania when she was a child, but I never knew about the Bulimia until now.
Prior to that, I gently asked my first-degree cousin to confirm what I had suspected for ages. “Did he have bigorexia when he was a teen?” His answer was “yes”.
Eating Disorders and Body Dysmorphic Disorder runs in my family. We have a shared genetic truth, and it sucks big time.
So that I can tell you more about it, I have to hide my sister and cousin’s identities. Nobody likes to expose their most private ills and my relatives are no exception. (Well, I blog about my Anorexia, but that’s another story.) Let’s call my sister “Pip” and my cousin “Ram”.
Case Number One: “Pip”
I visited Pip recently because something was gnawing at me. She has been always concerned with her appearance. She is ever critical of my skin and my hair and my clothes ever since I remember. And she a little obsessed with her skin. Particularly, she wants it to be porcelain white. I mentally filed this preoccupation under “normal behavior” until something set my shrink alarm off.
Pip loves to swim. But lately, she stopped doing it. I asked her why and all she could say was she was morbidly afraid of getting dark. I probed deeper and I found out her level of anxiety about her skin is already pathological. Fully aware that Body Dysmorphic Disorder (BDD) and Anorexia are highly related, I got down to work and checked my diagnostics.
Here is a summary of what I found out. I emphasized what applies to my sister and what convinced me that she needs help.
Pip’s signs and symptoms:
- She cannot stop thinking how flawed her skin is. What her thoughts are about her skin have no objective basis whatsoever. Her skin looks fine.
- She is utterly convinced that people think her skin is dark, ugly and full of pockmarks. Again, this has no objective basis. Sometimes she has slight blemishes, but blows them out of proportion. In her mind, her skin looks gross.
- Because of her belief that her skin is ugly, Pip stopped practicing sports. She admits that she gets so anxious when she swimming (because of the sun exposure), that she could not swim anymore. Pip used to jog too. But not anymore.
- I know my sister as extroverted. She loves to socialize. She used to talk to other people a lot. But lately, she doesn’t want to make new friends or connect with old friends. She has shut herself off from them.
- She habitually compares her skin to the skin of other people, including perfect strangers.
- If Anorexics do “Body Checking”, Pip does “Skin checking”. She spends a lot of time in the bathroom mirror, checking her reflection for skin abnormalities. In public though, she avoids mirrors like the plague. (She is already anxious in public, skin checking at strange places adds to her unease.)
- She feels very slighted when people comment about her skin. If an Anorexic cringes at the mere mention of weight, Pip cringes whenever anybody comments about her skin ─ seemingly positive or negative comments upset her. She is either not fair enough or she is being too paranoid about her complexion. It is like stepping on eggshells when people talk derma around her.
- The most alarming sign I detected was something subtle, something slight. It was the absence of light in her house. When I visited her, it was cloudy and rainy. But her curtains were down, the shades were drawn. She said she was afraid of the sun getting to her. Something crept up my spine when she said that. It is as if my sister has chosen a dark corner to hide. The shrink in me firmly said, “This does not look good.”
Pip and I grew up in a Chinoy household. My father was a second generation Chinese-Filipino; my Ammah (Grandmother) and Angkong (Grandfather) were immigrants from Fujian, China. But my father is not the biological child of my Ammah. He was an “anak sa labas” (a love child) of my grandfather and an unknown Filipina woman, possibly from Surigao. Angkong was seaman by trade, family lore dictates that he had girlfriends in every port, so the question of my father’s lineage never got answered. Anyway, my father’s skin is dark. This is why his Chinoy friend all call him “Oh-e”, simply translated as “the black one”. All his life, my father made fun of his dark skin. He never hid his being an “anak sa labas”, his being “ampon” (adopted). But whenever he referred to himself, he derided his being half-blood. Half-blood Chinese versus pure-blood Chinese. Dark colored versus yellowish white. In his brain, his skin was an indication of his inferiority, and he passed down this thought form to my sister.
The problem with this passing down is that there was something else passed down there aside form skin inferiority. It was not just skin, it was the inferiority per se. My sister’s dark skin became the symbol of her inferiority, it became the physical proof that she was flawed. Damaged. Wrong. Unworthy. Of course my sister had very low self-esteem from the get go! Up to now, she feels people judge her lowly. She thinks that people look at her, notice her skin and see her as unacceptable. A dark shadow.
Recently, her beliefs are running amok. I could hazard to say, they are ruining her life. But, her obsession is serving serve a purpose: It is relieving her of stress. As long as she has a preoccupation, she could dodge the pain she is in at the current moment. Because it’s too personal, I will not discuss my sister’s stress contributors. Likewise, Pip has deep seated issues on self-esteem, self-worth and confidence. Obviously, they are too close to the bone for this blog.
Leading Eating Disorder researcher Dr. Cynthia Bulik likens genetics to a loaded gun, while environmental factors act as trigger. Together, these two elements set off Anorexia and Body Dysmorphic disorder.
For my sister, she was predisposed to Body Dysmorphism. It is in our genes. Her temperament is the same as mine. She is prone to anxiety and sensitive to criticism (meaning, we feel things intensely, and we feel them in a quicker rate that the average person). People like us tend to be very moody and quite impulsive. And yes, emotionally vulnerable.
If she wasn’t bullied when she was young…if she wasn’t harassed by my father because of her skin…if my dad was not an “anak sa labas” or called “Oh-e”…if….if…if…the ifs are endless as her agony. Because she can never be white enough (nor I thin enough.)
Case Number Two: Ram
It began innocently enough: with a desire to look good. With Arnold Schwarzenegger in mind, my cousin got into body-building. He was in his early twenties when began pumping iron after work with his friends. Ram got admiring glances for his sculpted chest, arms and abs. This would make any man feel like a real man. Of course, it made my cousin feel very, very good. But what began as exercise ended up as an obsession. Trying to gain as much muscle, Ram took dietary supplements and tweaked his diet. He also spent so much time working out that it was already taking up a huge chunk of his time. Gradually, he became overly conscious about his weight and musculature. He constantly checked himself in the mirror. During his most intense moments, he hardly had any time to do anything else aside from working out, planning his meals, and thinking about his muscles.
At one point, Ram’s workout routine became so punishing, he was in constant pain. It was during this time that he began to feel that something was not quite right. Because he took a lot of supplements and ate a special diet, Ram also had a hard time explain himself to “outsiders” or people who did not go to the gym.
My cousin is a very social person. He also lived in a family compound where he shared his meals with his cousins, uncles, aunts, and nuclear family members. They kept on asking about his “diet”, and they kept on talking about his weight. When more and more of his kin started commenting how abnormally big he already looked like, Ram felt uneasy. When friends who were “outsiders” echoed the same comments, Ram really felt uneasy. Nonetheless, it took some time to convince himself that this was the case. What finally hit the mark were indications of dietary supplement induced liver damage. When his health became affected, he finally told himself, “No, no, no.”
In retrospect, what prevented Ram’s spiral towards full blown Bigorexia was social support. Before he got swallowed by the disease, his friends and family intervened. And in a big way, so did life. At the same time he started letting go of weightlifting, Ram’s family situation changed. Drastically. Again, this is too personal to discuss on this blog, but the gist is, he needed to hop on a plane and get a job abroad.
It runs in the family. I am not the only one crazy. But aside from sharing the genetic predisposition to eating disorders and body dysmorphism, is there something else we have in common? Family beliefs? Cultural norms?
Vaguely and unscientifically, I answer that question.
All three of us are children of middle-class families of Chinese-Filipino descent. Our culture values obedience above all. From early age, we are told never to lose “face”. Never to disobey our parents. Never talk back. Never question our elders. We have a term called “phai se”, it means “shame”. (Roughly, the Filipino equivalent “phai se” is “hiya”.) From childhood, we have been drilled not to be a source of shame for our families. “Do not be the daughter or son that will bring phai se to the clan. Be mindful of your parents and elders loosing face because of your actions.” As Chinoys, me, my sister and my cousin were taught to keep our emotions to ourselves. “Don’t act out.” In the process, we had a hard time telling our parents our hurts. For me and Pip unfortunately, mom and dad’s actions were the source of our pain. We could not tell them they were hurting us. This is phai se. So Pip and I hurled our troubles to our bodies. We made our bodies the enemy.
Here, I have to acknowledge that our being of the middle-class freed us from worrying about “real problems”. Like not having the opportunity to go to school. Or having little to eat. Funny thing is, we had so much to eat, so many opportunities to choose, but we ended up picking on ourselves. Our bodies ─ my fat, Pip’s skin, Ram’s muscles ─ they were acceptable targets in our community, our social class. There are some other finer mechanics, some flawed beliefs about masculinity and femininity at large that led to our downfall. But I would hazard to argue that the focus on outward appearance, the pressure to be thin, to be fair, to be a well-built ─ these were all misguided attempts on independence, self-assurance, and growing up.
Now that the three of us are in middle age, the challenge is to grow up. Ram seems to be doing quite well in the present moment. But me and Pip, we are still right smack in the middle of the struggle. We are fighting our biology and our badly learned habits and it is oh so hard.
A memory floats to the surface.
When I was six years old, my mother’s father (Guakong) died because of a stomach ulcer. I vaguely remember my Guakong but for the fact that he was deathly thin.
Deathly thin…
Deathly thin…
He died of a stomach ulcer…
