Who, What and Why?

People often use the term "eating disorder" to describe bizarre or different types of eating patterns. Overeaters often use the term to describe their relationship with food. An actual "clinical" eating disorder however, is very different. It is characterized by severe disturbances in eating behavior. The Diagnostic and Statistical Manual of Mental Disorders IV, (DSM IV) only lists Anorexia Nervosa and Bulimia Nervosa as specific diagnosis. Although many people suffer with other food related problems, their symptoms are more often related to other types of diagnosis (such as OCD). This does not make them any less important or problematic, but it may mean that the way to work with them and help them is entirely different than with actual anorexia or bulimia.

Are anorectics afraid of growing up?

Another early misconception of anorexia was, young girls desired to remain "childlike" and so became anorectic as a way of preventing puberty. When you look at an emaciated anorectic it is easy to see how this assumption could be made. However, the disorder is not a preconceived notion on the part of the anorectic to prevent puberty. Delayed puberty and a childlike appearance is merely a side effect of being overly thin. The young anorectic may use this side effect as an attempt to meet her need for attention. Because most anorectics are adult women, this theory cannot be generalized as a reason for an eating disorder.

On the other hand, appearing to be frail often causes friends and family members to cater to the anorectic as if she were a young child, just as we often find ourselves speaking childishly to a seriously disabled adult. Underneath the surface of anyone with an eating disorder is a very needy child, regardless of their age, who quickly learns that being treated like a frail child is an efficient premise from which to manipulate others. Most manipulation is a subconscious attempt to fill basic, human, needs (see parenting chapter-9 for details).

I don't have typical symptoms of Anorexia or Bulimia but I have problems around food. Do I still have an Eating Disorder?

Although you may not have a clinical case of Anorexia or Bulimia, you may be using food or weight as your arena for relieving stress or stuffing uncomfortable feelings. Often people will have almost ritualistic behaviors around food like not eating before a certain time of day, or feeling so uncomfortable at the dinner table that they quickly eat and leave. There are any number of rituals one can utilize to find control, or to relieve anxiety. If you think you may be focusing on food or weight to deal with life's difficulties, you may find relief by seeking help from a trained professional.

Approximately 90% of people with some form of food problem have a history of childhood abuse. As little children we had very few ways to provide nurturing for ourselves. Food was often the easiest and quickest-fix we could find. Food feels good. Is it any wonder then that, later in life, we turn to food (or away from it in the case of anorexia), to nurture ourselves. Even the anorectic's apparent loathing for food is most often an oppositional response to the intense desire for it. Feelings of unworthiness often lead the young anorectic to deprive herself of anything pleasurable. Because her desire for food is so intense, (because of the comforting and nurturing effects of it) she resists it vehemently, convinced that she doesn't deserve it. Consequently when she gives into her desire to eat, (or binge) she feels overwhelming guilt.

Is Over Eating an eating disorder?

Over eating can be very problematic and often feels like it is very "disordered." The INTERNATIONAL CLASSIFICATION OF DISEASE (ICD) lists obesity as a general medical condition, but it does not appear in the DSM IV as an eating disorder because it has not been established that it is consistently associated with psychological or behavioral syndrome. However, when there IS evidence that psychological factors are at the core of the obesity (i.e., PTSD) it can be classified as a disorder. In other words, in certain cases, clinical exceptions can be made. There is evidence which suggests that people abused as children (especially sexual abuse victims) are more likely to develop obesity, and other eating disorders such as anorexia or bulimia.

Are all anorectics teenagers?

Absolutely not. Although the onset of an eating disorder is often seen in adolescents, anyone of any age can develop an eating disorder. In fact, most of the people in the US with an eating disorder are over 45 years old. The exception may be taken in cases where the cessation of eating is based on factors unrelated to those outlined for an eating disorder.

Do guys have eating disorders?

Yes. Approximately 1% of the male population on college campuses has a clinical eating disorder. They develop all of the different varieties of disorders that women do. Like women athletes, male athletes are much more likely to develop an eating disorder than their non-athletic counterparts. For men in wrestling, the numbers go up markedly.

Is There a Common Cause for Eating Disorders?

What causes an eating disorder?

Evidence indicates that eating disorders are a combination of genetic predisposition and environmental influence. Children of alcoholic and/or drug dependent parents are more likely to develop the disorder. Children raised in homes where one or both parents have unrealistic expectations, are emotionally controlling, or disapprove of the child's growing independence, are more likely to develop an eating disorder.

Is it genetic?

Studies indicate that there may be a gene that plays a role in developing an eating disorder. It may be linked genetically to alcoholism, and other "habitual" illnesses such as drug abuse or gambling. Those with a family history of eating disorders or alcoholism are at greater risk than the general public.

Is the media responsible?

Although the media play a role in how our society feels about body size and shape, it cannot "alone" be held responsible for someone developing an eating disorder. The problem is when people who have other predisposing factors already in place, begin to allow the media images to become their ideal or their goal. Basing one's self worth on a fantasy or a social standard, can be a platform for developing an eating disorder.

What's Going On In Their Head Anyway?

Do people with eating disorders hate food?

Yes and no. Most often, the person's love affair with food frightens them. They fear loosing control and/or gaining weight and therefore choose to limit their intake to maintain control; not because they dislike food. They love the food but hate the results of eating. Instead of nurturing themselves with their cherished foods, they often become obsessed with other's food. They may spend hours a day cooking lavish meals for their families or baking cookies just to put them in the freezer for guests, (or binges). They may collect recipes with a passion or learn the calorie content of every edible food-product.

Why don't anorectics just eat?

Often anorectics claim to want to "get well" but continually fail to do so. Eating, seems to others, to be a simple solution. Like living in an abusive relationship, it is not that easy to "leave" the benefits of the eating disorder. Once the person has lost 30% or more of their normal body weight, their mind becomes affected and their ability to make rational decisions diminishes to the point that they cannot "choose" rationally, to eat. Their fears and their rituals have control of them, making it very difficult for them to do what seems logical to anyone else.

Can't they see that they are too thin?

All anorectics have a distorted body image and are unable to see their own size clearly. Because others tell them frequently that they are thin, they often realize (intellectually) that they are too thin, but they are unable to "see" it for themselves. Often they find themselves watching other people and making instant judgments about their body size.

They often compare themselves to others with thoughts such as: "I'm sure glad I'm not as fat as him" or "Gee, I wonder if I'm as thin as she is?" the reason that Group therapy is not recommenced for anorectics is that they compare themselves constantly to the other anorectics. This leads to a fierce competition to see who can become the thinnest.

What Happens to Their Body?

Can someone die from Bulimia?

YES! Many die each year from a variety of complications of bulimia. Although low weight is not always a problem with Bulimics, electrolyte imbalance is very common. Purging causes the body to lose precious chemicals such as potassium and magnesium (not easily replaced). The loss of these chemicals can result in many awful physical ailments including heart failure and death. Bulimics can also die from a rupturing of the stomach or the intestines. An overly distended stomach may explode when it is too full, causing gastric juices and stomach contents to fill the body cavities, causing infection or death.

What's an electrolyte imbalance?

An electrolyte imbalance is when the body's required amount of certain chemicals are depleted, or otherwise thrown off balance. This can occur from dehydration, purging (vomiting or laxative abuse, etc.), poor diet or over exercising. These chemicals may be lost through sweating, diuretics, vomiting, low liquid intake or laxatives. With any of these, self-abuses, the body looses its potassium and magnesium, both of which are very difficult to replace with supplements Without the needed amounts of electrolytes, the body cannot create enough electricity to keep the vital organs running. The person becomes weak, unable to think clearly. The heart looses its ability to pump sufficient blood through the body and the person eventually dies.

Can the body ever heal completely?

It depends. The severity, duration and type of disorder plays a huge role in determining how much, and what type, of damage is endured. Eroded teeth will never re-grow. Most types of liver damage will not regenerate. Heart damage may not allow the heart to fully recuperate. It may be years of having a "normal" eating pattern before the metabolism returns to a healthy balance. The skeletal system suffers greatly from malnutrition and bones can become weak and brittle. It takes approximately 5 years of healthy diet and exercise for the skeletal system to regenerate.

Helping a Friend with an Eating Disorder

Should I try to make her eat?

No. This type of relationship is not helpful for the anorectic. In fact it can cause additional anxiety, which may intensify the disorder. Although it is tempting to "tempt the anorectic to eat, it actually allows them opportunity to prove to you and the world how "strong" they are. It usually results in a power struggle in which you both will lose.

If she gains weight will she be cured?

No. In the eighties it was a medical myth, once you "fattened up" the anorectic, she was cured. It is natural for friends and family members to heave a sigh of relief when they see an anorectic gaining weight, but the "relief" may be premature unless the anorectic has completely dealt with the issues that led up to her developing the disorder. This type of introspection doesn't usually come with a 30-day stay in the hospital.

Should I ignore that my friend or family member is suffering?

No. Feeling unimportant or ignored is already a common feeling among people with eating disorders. For those who have issues around meeting their "attention needs," it is vital that those around them, help them fill that need in healthy ways. This means loving them unconditionally, supporting their nonfood related goals, and focusing on their unique and special qualities, apart from food or disorder related problems.

I think a my friend might have an eating disorder. Is there anything I can do to help her?

One of the most important things a friend can do for someone with an eating disorder is to continue to love them without judging them. There are several ways you can let her know that you are concerned about her.

1. Let her know that you are concerned about her symptoms. You can do this by using I statements. "I" statements are when you express your feelings, expectations, and concerns without placing blame, guilt or judgment on the other person. "I" feel_____, when____, because_____." An example might be "I feel frightened when I see you this way because I am concerned about your health." This allows you to express yourself without putting the person on the defensive.

2. Let her know that you will support her in her efforts to get help. This may include helping her make a phone call to a therapist to set up an appointment, or to drive her to the clinic for her first appointment. It might include letting her know to what extent you will be there for her.

3. Set limits and boundaries for yourself. This is very important because you need to, first, take care of yourself, before you will be able to expend the energy it takes to help another.
4. When you do things with her, try not to center your activities around food. Help her to find arenas in her life where she can begin to feel relaxed without thinking about food.

5. Don't lecture her. Offer to get her help, or read a book WITH her about eating disorders, but refrain from trying to SCARE her into submission. It won't work; it will only make her feel guilty, which will exacerbate her symptoms. Just as someone trying to tell you you've got to stop eating so much, would affect you.

6. For someone who is adamant that they don't have a problem, it is important NOT to get into a power struggle with them by insisting that YOU are right. She probably already knows she has a problem but she may be too afraid to deal with it. Whatever is underlying her need to starve herself may be more powerful and threatening than death to her. She needs friends who will not leave her, but who will also not play her games or enable her condition to get worse. She also needs to find areas in her life that she can completely control, other than food, and she needs professional help. Either she will choose to get help or she may put herself in a position where others are forced to help her (when she pushes the limits of death ).

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