"At 39 kilograms, I am the most confident. I think I'm the most beautiful at this weight, and whenever my friends know I've lost a few pounds, they always cast envious eyes." Azi said. But where does this magic number, "thirty-nine", come from?

Written by: Dr. Ho Jinxing, School of Mental Health, Castle Peak Hospital

The more you learn about people with anorexia, the more you will be able to understand the difficulties they encounter in building self-esteem and why weight control has become an important achievement – in order to gain a sense of independence. (Schematic diagram/profile picture)

Azi is 17 years old and a Secondary 6 female student preparing for the diploma examination. Her mother was very strict with Azi when she was a child, and she was very demanding of her performance in her studies and interest classes; Dad didn't ask much from Azi, just wanted her to be happy and healthy. And whenever Azi shares her troubles, Dad always shares his life principles and encourages Azi to make big things small and stay positive.

Sadly, Azi's mother died when she was seven years old due to a recurrence of breast cancer. Although no one will supervise her studies now, she also hopes in her heart that her mother can feel comforted in the spirit of heaven, and hopes that she can do everything in front of others for a hundred points, so she puts a lot of pressure on herself.

Azi's mother was very strict with Azi when she was a child, and she was very demanding of her performance in her studies and interest classes; Dad didn't ask much from Azi, just wanted her to be happy and healthy. (Profile picture)

Azi was also particularly strong when her mother died. She remembers holding back tears at that time, and rarely mentioned her mother to her father, because she felt that her father had always "endured". Just when Azi was in the mourning period, she happened to fall out with her elementary school classmates again and was boycotted. Since then, she has been particularly sensitive to the evaluation that others give her.

Azi is a patient with anorexia. People with anorexia often have an extreme fear of obesity and want to stay thin and lose weight by dieting, vomiting, excessive exercise and even taking medication. Ah Zi, who is 1.57 meters tall, originally weighed 48 kilograms and had a body mass index (BMI) of 19. Although her ideal weight was 39kg, she was already as low as 34kg when she was admitted to the hospital. Not only is the body weak, the liver is dysfunctional, and menstruation has stopped for a while. "I felt like I was out of control," she said. Now I'm so thin that I can't see myself in the mirror. But I'm scared, I'm afraid that if I take one bite, I will lose control and then eat more."

"Why are you aiming for thirty-nine kilograms instead of thirty-eight or forty?" I asked curiously. Azi thought for a while, but could not give a clear explanation.

A patient with anorexia is like an onion. To truly understand the causes of anorexia in every patient, it is necessary to start from many aspects, including their own values, personality, family background, upbringing, relationships, and the patient's perception and expectations of himself and others. The more you learn about people with anorexia, the more you will be able to understand the difficulties they encounter in building their self-esteem and why weight control has become an important achievement for them – in order to achieve a sense of independence.

When learning about Azi's case, Azi mentioned one of her closest friends - Ah Ting. Ah Ting is her middle school classmate and a teammate on the school dance team. Ah Zi described Ah Ting as more popular and flattering than herself, and was also the main dance of the dance team. Ah Ting also has requirements for her figure, and often shares weight loss experience with Ah Zi; Sometimes she also touches Azi's arm and stomach and says that she has excess meat, often encouraging Azi to lose weight.

I don't know if you have tried to imitate the way people around you speak, look and move unconsciously? In addition to our words and actions, perhaps our values, things and topics are also influenced by the people around us. So I asked Ah Zi, "What do you think of your friendship with Ah Ting?" Do you think your relationship is equal?"

"Actually, I think I'm a little jealous of Ah Ting." Azi said in a low voice after deep thought. It turns out that sometimes Azi hears Ah Ting's evaluation of her appearance, and there will be a lot of pressure in her heart. Although she is superior to Ah Ting in other aspects such as grades, she often has a feeling that she is being compared.

"Then do you know how much Ah Ting weighs in kilograms?"

"I don't know about kilograms, but she seems to have said that it was eighty... Eighty-six pounds."

"Wait a minute." I immediately took out my phone to convert. After pressing the keyboard a few times, I saw that the phone said: thirty-nine kilograms. I suddenly realized, looking at Azi's eyes, Azi also seemed to understand something.

Through psychotherapies such as cognitive behavioral therapy and Maudsley Adult Anorexia Nervosa Treatment (MANTRA), patients with anorexia can better understand the personal and environmental factors that make up their anorexia. By discovering their strengths, values and self-image, as well as trying to look beyond diet, with the involvement of family members and medications, patients have the opportunity to escape anorexia and embark on a healthier and happier life path than ever before.

Aoyama Hospital. (Profile photo/Photo by Zheng Zifeng)

"Hong Kong 01" "01 Clinic" in collaboration with the School of Mental Health of Castle Peak Hospital publishes a column written by medical staff every other Tuesday entitled "Pen Heart Clear".

"Clear" means to let the water settle and then become clear. May you quietly savor every little story, see the subtleties, understand the hearts of yourself and others, and see things and feelings more clearly. See clearly, know how to cherish, may this column calm your emotional waves and enjoy the quiet of the years. I hope you will share this experience with the people you care about, so that you can have another partner on the road to a better life.

The details of the story have been modified to protect patient privacy.

Seeing the micro-knowledge, quit the toxic "mantra", who wants to be a tiger mother? The elementary school student has repeatedly electrocuted the electric shock in the mouth: in fact, I don't want to hurt myself at all, anorexia dancer, please care about all my emotions