IntroductionEating disorders are associated with significant morbidity and mortality. The Internet is a popular medium for individuals with eating disorders to discuss and reinforce their affliction. However, the available literature on Internet usage and eating disorders is scarce, especially in the area of social media and smartphone application (“app”) usage.Objectives & aimsTo look at the Internet and smartphone app usage patterns of participants who presented with an eating disorder in Singapore, and whether it corresponded to severity of illness.MethodsIndividuals who presented to the Eating Disorders clinic at the Singapore General Hospital from 13th June 2013 to 20th December 2013 completed a self-reported questionnaire on Internet and app usage. They also completed the EDE-Q, EAT-26 and CIA 3.0.ResultsFifty-five participants completed the study. A total of 41.8% had anorexia nervosa, 34.5% had bulimia nervosa, and 9.1% were ED-NOS. 41.8% felt that apps helped to perpetuate their illness, while 32.7% felt that apps were helpful for recovery. Overall, any smartphone application usage was associated with younger age and greater eating disorder psychopathology and psychosocial impairment. While 30.9% had encountered eating disorder-related content on Facebook, only 12.75 visited Facebook groups related to eating disorders. For YouTube, “Cooking and Food” and “Beauty and Fashion” videos were among the top 3 types of videos that participants watched.ConclusionsInternet and smartphone app usage is significant, and they are used to prolong or worsen eating disorder behavior in those with greater severity of illness. It is necessary to include interventions in this aspect as part of treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThough eating disorder cases have been on the rise in Asia, little is known about them. Bulimia nervosa (BN) has been associated with poor treatment outcome and high mortality risk, and is the second most commonly diagnosed eating disorders in Singapore, after anorexia nervosa (AN), yet no report thus far has explored this condition.ObjectivesThe current study seeks to describe the clinical population diagnosed with BN in our hospital treatment program, as well as to compare their clinical characteristics with a previously published local study on patients with AN.MethodRetrospective medical records review was carried out for patients diagnosed with BN in our hospital's eating disorders treatment program. Patient records from 2003 to 2013 were retrieved and analyzed. We also further compared presenting characteristics across genders and with AN patients.ResultsBetween 2003 and 2013, 348 patients were diagnosed with BN by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). BN patients presented with high rate of self-harm behaviors (37.1%), previous suicide attempts (19.0%) and psychiatric comorbidities (67.5%), many of which require inpatient treatment. Significant differences were found between genders and in comparison with the AN patients.ConclusionOur results suggest that many patients with BN present with severe psychiatric comorbidities, in some aspects more severe than the AN population. The current study appeals for the development of more effective detection and treatment of vulnerable populations in Singapore. We further discuss about the potential roles of mental health literacy and stigmatization in influencing treatment-seeking behaviors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe prevalence of eating disorders has been increasing in the Asian countries. Malays in Singapore are at the crossroads because they are largely traditional in practice and almost all are Muslim, but are exposed to western culture. Studies found that Malays at increased risk of eating disorders but yet those that present for treatment are very small, and this study aims to study Malays with eating disorders to unveil this contradiction.MethodsAll Malay patients presenting to Singapore General Hospital (SGH), which hosts the only specialized eating disorder programme in Singapore, between 2003 and 2014 were identified and medical records studied retrospectively.ResultsMalays constitute only 42 out of 1340 patients treated in the same period. The mean age at presentation is 18.81 years (SD = 5.54) and the majority are students (78.6%). A total of 92.9% are single. There are more cases of bulimia nervosa than anorexia nervosa (45.2% vs. 26.2%). In total, 54.8% have psychiatric comorbidities, the most common is depression (31.0%), 38.1% have a history of deliberate self-harm and 21.4% attempted suicide. A total of 52.4% reported teasing as a trigger, while 16.7% were triggered by being overweight.DiscussionThere is only a small number of Malays that presented. Fasting is commonly which may be confused with restriction. Other factors could be lack of awareness. The higher prevalence of bulimia nervosa suggests that purging is recognized as abnormal. High prevalence of comorbidities suggests that family members recognize comorbidities better. Outreach programs for Malay will help increase awareness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPica is the consumption of non-nutritive substances, which is inappropriate to the individual's cultural practices or developmental level. It is frequently associated with mental retardation, and occasionally observed in pregnant women and children.ObjectivesWe describe a case of long-standing pica in a woman with no co-morbid psychiatric condition.CaseMadam NA is a 27-year old married Malay housewife, with 4 sons and 4 miscarriages. Her mother had addiction problems. She sought help from the Eating Disorders Clinic, Singapore General Hospital, for uncontrollably eating uncooked rice. This started at age 8, when she was left alone at home with no food. Since then, she had been eating up to 10 cups of raw rice daily. She was unable to leave the house without carrying a bag of raw rice; if she forgot, she would feel intense discomfort and would need to return to get the rice. She persisted in eating raw rice despite it causing friction in her marriage. When she tried to stop, she would get irritable and crave it. This behavior only ceased during her pregnancies but would restart soon after delivery. There was no other psychiatric history. Blood investigations showed anemia, with iron and zinc deficiency, as well as newly diagnosed Grave's disease. After iron and zinc supplementation, her raw rice intake decreased substantially.ConclusionsWe report an unusual case of long-standing pica with compulsive features in a young woman with no psychiatric co-morbidity, which improved during pregnancy and with iron and zinc supplementation.Disclosure of interestThe authors have not supplied their declaration of competing interest.