Eating Disorders

Eating disorders are becoming an increasingly serious problem in our society, especially among young women. Some reports estimate that 25-40% of women college students suffer from an eating disorder.

Rooted in the drive for perfectionism, eating disorders can occur in children as young as 7 years of age. These disorders frequently occur among the daughters--rarely the sons--of middle and upper middle class families in the United States and other affluent countries.

Most people from time to time give some thought to their weight, or even are occasionally worried about it. The key difference in this and in the person with an eating disorder is obsession. An individual with an eating disorder will talk about, think about, and act on the food obsession almost constantly. It controls her life.

Eating disorders can be categorized in three separate forms: anorexia nervosa, bulimia (or bulimia-anorexia, which combines the two disorders), and compulsive overeating. In the first two, food is denied in one way or another; in the third, food is consumed obsessively. Some causes and characteristics are common.

CAUSES

The search for control is the basic psychological issue in eating disorders. The child or young woman may be seeking control over her own drives and impulses, or there may be a power struggle with parents whose discipline or authority has been seen as excessive. She may think, "I can't control anything else in my life, but I can at least control what I eat."

Food issues are only symptoms that camouflage the real illness, which is a severe lack of an inner sense of competence and capacity for satisfaction. Underlying causes may include low self-esteem, faulty learning, disturbed family relationships, and conflicting social/cultural influences. Often eating disorders occur in families where there is some form of substance abuse or obesity in other family members. Conversely, these disorders may surface in stable families who are oriented toward success, achievement, and an attractive appearance.

The rapid spread of eating disorders must be attributed to psycho-sociological factors, in particular the emphasis that our society places on slimness. Many young women respond to their expanded horizons and new freedom not as opportunities for personal fulfillment and development, but as a burden of unrealistic expectations. Throughout their lives they have engaged in a desperate struggle to make themselves appear "perfect" in the eyes of others. They must achieve, must excel, and at the same time must also be beautiful.

They are well cared for as children, but life is governed according to the parents' decisions, not the child's ideas or preferences. Thus the child fails to develop the capacity for independent thinking and action. The parents take pride in the child's obedience and goodness, and thus send the message that love and acceptance are tied to being the "perfect child." When this role becomes too demanding, an eating disorder may develop as a declaration of independence.

In adolescence there is a natural drive for independence and self-assertion. The adolescent or young woman who is anxious about self-worth and striving for perfection may use food as the means of establishing a sense of selfhood and autonomy.

One possibility which sadly must be addressed is that the person with an eating disorder may be reacting to experiences of sexual abuse or molestation. The abused girl is filled with fear, anxiety, and self-loathing; she feels powerless to control her life or prevent the abuse. Even later, as an adolescent or young adult, she blames herself often because the abuser told her it was her fault, that she had acted in an enticing way or that "you wanted it too." She assumes a connection between the abuse and her own developing sexuality, and she is frightened by this.

So she protects herself by trying to remain a child--to stay small and thin and to keep normal sexual characteristics from developing. Or, she tries to protect herself by gaining so much weight that she would be undesirable as a sexual partner. This possibility should be investigated if the more common factors are not present.

ANOREXIA NERVOSA

Although more attention is given to anorexia nervosa than to bulimia and compulsive overeating, only about 5-6 percent of people with eating disorders have anorexia. The chief characteristic of this illness is a devastating weight loss resulting from self-inflicted starvation.

Though there are individual differences in the way the illness manifests itself, anorexics display similarities in several areas of disordered psychological functioning. The symptom that arouses most anxiety, frustration and rage in parents or other close family members or friends is the anorexic's refusal to eat.

Anorexics may give a first impression of being active and vigorous, but they suffer from a paralyzing sense of ineffectiveness which pervades all their thinking and activities. Unable to solve their real problems, they gain a sense of accomplishment, even of superiority and power, from manipulating their bodies and making themselves thinner and thinner. They experience deep feelings of depression and self-hatred when they regain any weight.

Anorexia nervosa has a tendency to be self-perpetuating, leading to chronic invalidism. It is one of the few psychiatric diseases that can result in death. This tragic outcome is unnecessary and avoidable when proper treatment is begun before the condition becomes irreversible.

BULIMIA

The majority of people who have an eating disorder are bulimic or bulimic-anorexic. Bulimia is characterized by eating binges followed by "purging" through vomiting or using laxatives, enemas, or diuretics.

The consequences of this monstrous procedure can be extremely serious--even fatal. The body loses many essential nutrients (potassium, for one), and the person becomes susceptible to all sorts of physical problems. The damage done to the stomach is indescribable. It can wreck the reproductive organs and cause life-threatening gastro-intestinal disorders.

In bulimic-anorexics, abstinence from food alternates with eating binges during which the individual consumes enormous amounts, though she claims not to feel hunger.

COMPULSIVE OVEREATING

Possibly the most misunderstood of the eating disorders is compulsive overeating. Unlike anorexia and bulimia, in which there is the drive for perfection and thinness, the compulsive overeater seeks comfort in food. The disorder is characterized by recurrent episodes of binge eating, a sense of lack of control during the binge, obsession with eating, persistent remorse, and feelings of hopelessness over loss of ordinary willpower.

WARNING SIGNS

Although the three common eating disorders manifest themselves in different ways, there are some common warning signals which indicate the possibility of an eating disorder.

A common misconception is that a person's appearance will indicate whether she has an eating disorder. When we think of these illnesses we picture the 70-pound anorexic, the bulimic who constantly purges, the 400-pound overeater. In fact, most people with eating disorders look like anyone else.

The primary characteristic of a person suffering an eating disorder is a severe disturbance in body image and body concept. There is great anxiety about the self and negative attitudes toward the body. These young women do not see themselves realistically and continue to be frantic about being fat even when they are severely emaciated. They see their body as something separate, not part of "self," but something over which they must exercise rigid discipline.

Specifically, these symptoms may indicate the presence of or potential for an eating disorder:

• Obsession with food, weight or body image. There may be a slavish adherence to a reducing program, with the person insisting it is easy and she is not hungry.
• Increased social isolation
• Mood swings from extreme highs to suicidal depression
• Increased physical exercise (up to several hours a day). At first, this may be an effort to prove oneself competent and superior. Later it becomes aimless activity "to burn off calories." There is often an absence of sexual feelings; especially in anorexia nervosa, menstruation may cease or become irregular.
• Frequent excuses for not eating with family or friends
• Difficulty sleeping
• Pride in ability not to eat
• Preoccupation with planning meals for others
• Lack of self-esteem

TREATING EATING DISORDERS

No one recovers from an eating disorder on her own. The only known cure is counseling. Often it takes months or years of intensive therapy--with a skilled and knowledgeable expert.

Unfortunately, many parents are themselves so preoccupied with slimness and dieting or with their own stressful agendas that they may overlook serious degrees of malnutrition, and not seek treatment for their child until the illness has progressed to a dangerous point.

Friends may be reluctant to "interfere," but not encouraging the person to get help only enables the progress of the disease. Anyone who suspects that a friend has an eating disorder should be supportive and non-critical, but should not keep the problem a secret. Parents or school counselors should be informed of the symptoms so action can be taken to get the person into treatment.

Treatment involves two distinct tasks: developing proper nutrition and dealing with the underlying psychological problems--which means involving the whole family. Weight normalization alone, without addressing the personality problems, is not true progress. Psychotherapy will attempt to deal with the lack of self-awareness and the feelings of inferiority and ineffectiveness. Patients must be encouraged to become capable of living as self-directed, competent individuals who can enjoy what life has to offer, so they no longer need to manipulate and dominate their bodies by starving themselves, purging, or eating obsessively.

The most important word of hope to people with eating disorders comes from God. The search for acceptance and worth can find its highest fulfillment in a relationship with God. By the act of creation, he declared each of us persons of worth and dignity. The life he offers is one of joy and fullness, not one of a continual search for perfection which results only in destruction.

RESOURCES FOR HELP

National Association of Anorexia Nervosa and Associated Disorders, PO Box 7, Highland Park, IL 60035
Hotline: 847-831-3438
Web: http://www.anad.org/
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