Justin Thomas says that parents need to be aware that adolescents can misuse Ramadan to embark on excessive and unhealthy weight loss
Why obsession can turn into a dangerous disorder
Research exploring religion and mental health typically suggests that there is something protective about religious belief and practice. In general, higher levels of religious commitment seem to be related to lower rates of mental health problems. Hundreds of studies have explored this relationship and, from substance-related disorders such as addiction to mood disorders such as depression, religious commitment tends to be associated with better mental health status. There is at least one disorder that breaks this rule.
Anorexia nervosa, unlike other disorders, appears to be associated with higher levels of religious commitment. Research shows higher rates of religious commitment and affiliation among patients diagnosed with anorexia compared to control groups. Similarly among the general population, higher levels of eating disorder symptoms seem to be associated with higher levels of religious commitment.
The idea of a connection between anorexia and religiosity is nothing new. When exploring the history and evolution of the disorder, most writers discuss the concept of "holy anorexia" as a forerunner to the modern psychiatric condition. The earliest case reports of self-starvation tend to implicate excessive religiosity as a defining feature. It's like the ancients reasoned: if gluttony is one of the seven deadly sins, then its corresponding heavenly virtue must be abstinence.
Prolonged abstinence in the form of excessive dietary restraint was the modus operandi of the so-called "holy anorexics". The most famous, Catherine of Siena, died at the age of 33 as a result of her brutal regime of self-induced vomiting and self- starvation. Commenting on the holy anorexics in her book, Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease, Joan Jacobs Brumberg writes: "In the earlier era control of appetite was linked to piety and belief; the modern anorexic strives for perfection in terms of society's ideal of physical rather than spiritual beauty."
However, the connection between anorexia and religious ideas perhaps has not totally vanished. For sure, the links between dietary restraint and religious terminology still exist even in our most secular societies. In advertisements, for example, low-fat foods are often associated with saintly behaviour, while the consumption of fatty foods is frequently cast as a delightfully wicked act of self-indulgence. One slimming club in Britain took this idea a step further and offered its members a diet called "the original sin a day slimming plan", where slimmers are allowed a limited number of "sins" (high-calorie foods) each day.
Our own research in the UAE suggests that the relationship between eating disorders and religiosity persists. There is also a UAE case study that describes how the boundaries between religious practice and dietary restraint can get dangerously blurred.
In this account of her own illness, Samira Al Romaithi traces her final descent into anorexia to the holy month of Ramadan. She writes: "I abused the good intentions behind the holy month and will forever be ashamed. It was an anorexic's dream come true. I could go all day without eating a thing, have my dose of exercise by horse-riding and then at iftar eat only the little set of safe foods I had prescribed for myself: a green apple, a 90-calorie cereal bar and a glass of orange juice."
I use the term Ramadanorexia to refer to a particularly unhealthy and excessive form of dietary restraint that begins in the holy month and persists long after it has ended. Ramadan is a time for fasting and for breaking the fast; it's not a time of quasi self-starvation.
The fact that some adolescents might misuse Ramadan to embark on excessive and unhealthy weight loss or shape-change aspirations should be a serious cause for parental concern. Although the exact nature of the relationship between eating disorders and religiosity requires further research, there is little doubt that the obsession for thinness and muscularity can lead to excessive behaviours among some vulnerable young men and women.
Dr Justin Thomas is an associate professor at Zayed University
On Twitter: @DrJustinThomas