Shanti just wanted to look good. The 15-year-old Jaipur student thought the best way to appear “sexy” was by losing weight — and virtually stopped eating. In the last three months, she lost nine kilos.

Shanti’s family, concerned by the weight loss and her falling blood pressure, did the rounds of physicians and endocrinologists with her.

The diagnosis finally came from a psychiatrist: Shanti suffered from Body Image Disorder — a malady that makes people detest parts of their bodies, focusing obsessively on them.

Adolescents and teenagers are increasingly becoming visible at the psychiatrist’s. And problems such as anorexia and bulimia, once a mega-city scourge, have now struck smaller cities like Jaipur and Pune.

At the Sawai Man Singh Medical College and Hospital in Jaipur, Dr Sanjay Jain used to see one case in three months. These days, he gets two such cases a month. In Pune, clinical psychologist Anupama Shah says that she has been treating girls as young as 12 with eating disorders.

Yet eating disorder continues to be a silent killer. The number of actual cases, doctors warn, is a lot higher than the reported ones.

Mumbai-based psychiatrist Anjali Chabria says every month one youngster goes to her for treatment for an eating disorder. But she finds that 10 or 15 young people who have come to her for other problems also suffer from eating disorders. “In fact, many serious gym-going youngsters would be suffering from eating disorders, too, but would be blissfully unaware of it.

“It took Hema, a socialite in Mumbai, a while to realise that her daughter was not just being picky about food. By the time she discovered that her daughter was suffering from anorexia nervosa, Malavika, now 15, was almost at death’s door. “She just collapsed one day and had to be rushed into emergency. Her blood pressure and pulse touched a dangerous low, her heart was failing,” says Hema.

Malvika’s problems started when she was eight. “She would avoid eating with me, insisting on carrying food with her in the car, from where she chucked it.” At home, she hid the food in the cupboard or behind a sofa or even fed it to the dog. She survived on milk shakes and loads of water and her weight loss was not visible. By the time she was 12, she had started fainting.

But Malavika didn’t see it as a problem because her thinness made her the toast of her friends’ circle. At birthday parties, the pre-teeners often compared paunches — and Malavika, with her nymph-like body, was the clear winner.

The young, clearly, are being seduced by svelte or even under weight images in the world of glamour. “It’s not enough to just have good grades. You need to look good as well, for better career prospects,” says Dr Prabha Chandra, a psychiatrist at the National Institute of Mental Health and Neurosciences (Nimhans) in Bangalore. Shanti, for instance, says she was first inspired to look sexy, “like models and actresses,” at a fashion show.

What starts merely as an unhealthy way of losing weight often ends up as a serious and sometimes fatal disorder. The signs of anorexia, a psychiatric condition, are low body weight with an obsessive fear of gaining weight. A person suffering from bulimia overindulges — and then undergoes guilt, depression, and self-condemnation with intentional purging, through vomiting, laxatives or over-exercising,to compensate for the excessive eating.

What makes it easier for many to escape detection, Chandra says, is that families do not often eat together. Working parents are mostly not around to witness the young’s eating habits. And playing with food is brushed off as just one of those troublesome signs of adolescence.

Sometimes, even the weight loss is not all that apparent. Naina, a 28-year-old college drop-out in Mumbai, was diagnosed bulimic 10 years ago. She appears slim, even well-endowed. But Naina’s problem is visible at meal times. At a restaurant in downtown Mumbai, she eats, in quick succession, three large buttered naans with paneer butter masala — washed down with a fresh lime soda. Moments later, she squirms in discomfort, only to rush to the bathroom and throw up.

The problem is not always related to the impact of stick-like media images. Psychiatrist Chabria blames any oral fixation on emotional trauma in the first couple of years of childhood.

On the face of it, Malavika’s problem began with wanting to shed baby fat. But there were serious emotional problems that troubled her — caused by her parents’ divorce when she was five. A few years later came the trauma of moving across four schools over two years. “The other kids would bully her and she’d be emotionally shaken,” says Hema.

At times, though, food also becomes a means of exercising control. “When they cannot face conflict situations at home, they can at least control how much food they can eat,” says Dr Chandra. Take Riddhi, an 11-year-old Jaipur student who shed 10 kilos through laxatives. She says she felt neglected amidst the constant tension caused by her parents’ domestic wrangling.

At Christian Medical College, Vellore, in Tamil Nadu, psychiatrists are looking at how stress can aggravate eating disorders. A study, from 2003, of children and adolescent patients revealed a significantly higher incidence of stress-related vomiting than in anorexia. “This could be mistaken for bulimia,” says Dr Paul Russel, head of CMC’s Adolescent Psychiatry department.

Meanwhile, Malavika is inching towards recovery. Though there are phases when she can be “vicious and mean”, her mother says that she does not need to be under constant supervision. “She even ate an entire pizza by herself,” says she with a gleam. Junk food can sometimes be a reason for rejoicing.