A new study, published in the Journal of Eating Disorders, has shed light on the increasing prevalence of two uncommon eating disorders among young adults in Pakistan. Sara Aleem Haqqi and Siddrah Irfan did a study on university students that looked at self-reported symptoms of pica and avoidant/restrictive food intake disorder (ARFID). The results were worrying. These conditions, though relatively rare globally, appear to be growing health concerns within the Pakistani context, linked to stress and impulsivity.
The disorders, introduced in the DSM-5, have historically been under-researched, especially in Pakistan, where mental health issues are often stigmatised. According to the study’s findings, 4.2% of the sample displayed symptoms of pica, a condition that is characterized by the consumption of non-food items like paper, clay, and stones. Meanwhile, 2.8% of the participants reported symptoms of ARFID, a disorder characterized by extreme food avoidance due to sensory sensitivities or fear of harmful consequences like choking.
One of the key takeaways from this research is the link between these disorders and impulsivity, alongside perceived stress as a mediating factor. The participants who displayed higher levels of impulsivity were more likely to report symptoms of both pica and ARFID. Stress, a well-established risk factor for mental health issues, played a significant role in exacerbating these behaviours, reinforcing the urgent need for further psychological interventions.
Pica is particularly dangerous due to the wide variety of non-edible items that individuals consume. In the study, 28 students reported symptoms of pica, with some consuming multiple non-food substances. While pica is typically associated with childhood or pregnancy, these findings point to its troubling presence among young adults, signalling the need for more research into its development and persistence beyond traditionally affected groups. The health risks of pica range from nutritional deficiencies to life-threatening complications such as gastrointestinal blockages.
ARFID, on the other hand, is an eating disorder that has gained attention for its complexity. The condition manifests in different forms, including a lack of interest in food, avoidance based on sensory preferences (texture, taste, or appearance), or restrictive eating driven by fears of adverse reactions. Though it shares some symptoms with other eating disorders, ARFID differs in that it is not associated with body image concerns. This makes it harder to diagnose, particularly in cultures where disordered eating behaviours may be dismissed or overlooked.
The researchers employed a comprehensive survey to collect data from 660 university students aged 18 to 25. Participants filled out questionnaires assessing their impulsivity, perceived stress, and eating behaviours. Interestingly, while ARFID is often thought to be more common in females, this study did not reveal significant gender differences in its prevalence. But ARFID symptoms were more varied, with most affected individuals exhibiting a combination of symptom clusters rather than just one.
Pakistan’s unique socio-cultural landscape might play a role in shaping the experiences of those with eating disorders. It was discovered that stress acted as a bridge between impulsivity and both pica and ARFID. This suggests that larger social pressures, like stress at school or expectations from family, could be major triggers. This adds weight to the argument that mental health interventions in Pakistan should focus on stress management as a core component of eating disorder treatment.
While the study focused on university students, the researchers have called for broader epidemiological studies to explore the prevalence of these disorders across different age groups and regions in Pakistan. The findings are a stark reminder that eating disorders are not confined to the Western world and that they can present in ways that do not always align with traditional expectations.
