Do you know someone with an eating disorder? Do you know what it is? Trying to support a loved one or friend who sticks her finger down her throat to purge the food she just ate, strips you of your ability to reason and make sense out of life. Observing a loved one or friend refusing food out of a strong fear of gaining weight to the point of starvation, changes everything you thought you ever knew. For a therapist who works with eating disorders (or any mental health problem for that matter), the situation can bring you to a point of desperate seeking for understanding.
Eating disorders usually develop during adolescence or early adulthood such as age 18, but they can also develop during other ages or stages of life as well. You might believe that an eating disorder (such as bulimia or anorexia) does not affect males, but believe it or not, males also struggle with eating disorders and perceptions of health and attractiveness. The thing to keep in mind is that eating disorders are more prevalent in females than males, only occurring in about 5%-15% of male cases. Even with binge eating disorder, males account for only 35% of cases.
Sadly, most individuals with eating disorders are highly perfectionistic, self-critical, and lack proper perspective about themselves and others. This is what spawns the disorder in the first place. Professionals are still unsure what causes eating disorders, but the field of psychology agrees that eating disorders stem from three important influences:
- the environment or one’s culture
- social influences such as social images of “the perfect physique” or things people say
- biological influences or genetics
One of the most difficult things about being a therapist is coming to terms with your own confusion over the “symptoms” of your cases. A therapist has a lot to deal with and cope with mentally. On Monday a therapist could get an adult struggling with depression and suicidal thoughts, on Tuesday and Wednesday a therapist could receive a new client experiencing domestic violence and struggling with substance abuse, and on Thursday to Saturday a therapist could get 4 new clients all struggling with homicidal thoughts and criminal behaviors. All of these clients have one thing in common which is that they need psychiatric support. But some clients stick out more than others and that often includes the most severe cases. For me, right now that includes eating disorders. I am ashamed to admit that I don’t know much about them as this is not my area of expertise. I recognize more than ever before that even though I don’t fully understand eating disorders, the underlying causes must be examined. For you, you’ll want to examine what your loved one or friend is TRULY trying to achieve. Is is peace of mind? Is it control? Is it happiness? Is it some unrealistic level of beauty? What is it!? This is your job.
There are three most common eating disorders that you should be aware of which include:
- Bulimia – overeating and purging. Bulimia is driven by a fear of weight gain. An unhealthy self-perception also exists and a need to be thinner or “perfect” in body weight. The individual may engage in overeating during short periods of time and feel so guilty after the fact that the only band-aid is to purge or induce vomiting.
- Anorexia – fear of food or gaining weight. Despite maybe already being thin, the individual may seek to become thinner. Some individuals are so imprisoned by their disorder that even at 100 pounds the individual might seek to become thinner. Being thin is never really enough. Excessive exercise may also be a symptom of this disorder.
- Binge eating disorder: this disorders also includes eating excessive amounts of food in a short period of time. The difference between binge eating disorder and bulimia is that in binge eating disorder, the individual does not purge but tends to gain enormous amounts of weight. It’s difficult to handle emotions of life and sometimes the individual resorts to food (like many of us) for comfort. The problem is that binge eaters do not know how to stop and the brain does not signal when the body has had enough food. The individual continues to eat, almost as if they do not feel physically full until it’s way too late.
For individuals struggling with eating disorders, the core of the problem is related to a lack of ability to regulate emotions, genes, and the psychological influence social and cultural messages have on the individual. But questions still remain as to what really causes eating disorders because many of us have probably exhibited many of the above “symptoms” at one time in our lives. For example, as a teen, you may have exhibited some anorexic traits (over-exercising, avoiding meals, or fearing weight gain), as a young adult adjusting to adulthood you may have exhibited some bulimic traits (using laxatives or diet pills), and perhaps as a middle aged person going through a series of life crises you may exhibit some binge eating symptoms (overeating out of depression or anxiety or uncertainty). No one knows exactly what pushes an individual into the dangerous cycles they become entrapped by.
One of my dearest clients would always say to me during an hour long session of going back and forth about the binge-and-purge cycle “I still want to purge.” Nothing I said felt like it was getting through and nothing he did could erase what his logical mind told him was wrong about purging after every meal including snacks or even drinks. He could not erase the fact that he understood why purging was bad because the urge to purge outweighed everything, including his ultimate health. Bulimia had conquered him in so many ways. Bulimia is one category of an eating disorder whereby the individual eats large amounts of food and as result, feels guilty or ashamed and only feels relived when the food is excreted from the body through induced vomiting or laxatives. Another one of my clients became addicted to castor oil, Benefiber, and Metamucil because these laxatives made her feel like she had actually accomplished something as opposed to having lost something after overeating. The cycle became so cemented in these two individual’s lives that nothing could break the cycle. Fear tactics did not work, nutritional counseling did not work, medication did not work, even hospitalization failed. So then…what’s next?
For many individuals with eating disorders the cycle is a prison that requires years of treatment. That treatment might be psychological, familial, group-based, support-based, nutritional, and even spiritual. The individual is trapped by their perception of not only food, but themselves and others.
It’s very normal for many of us to question how we are looking for the day or to desire that we look different (have a smaller nose, straighter or maybe even more course hair, are thinner or maybe a bit curvaceous more appealing to the opposite sex, etc). It’s easy for most of us to reject food because we know that we had way too much to eat over the weekend. It’s normal for most people to want feel better about themselves and lose weight. But what makes eating disorders different is the level of extreme desire to be different with little to no consciousness about the consequences. It’s an addiction, an addiction to food and an addiction to an impossible image.
What have you heard about eating disorders? Do you know someone struggling with a severe mental illness and also an eating disorder? Research suggests that individuals who are struggling with depression or anxiety might also struggle with bulimia or anorexia.
It may be difficult for you to understand the person’s thinking or emotions. It may also be difficult for you to understand why these individuals would treat their bodies the way that they do. Even as a therapist I struggle with trying to understand the mindset, the emotional chaos, and the desperate need to be something other than themselves. But I encourage you to seek, especially with a loved one or close friend, ways to understand and help them out of the prison they may never be free from without you.
I wish you well
Webmd. (2014). Eating disorders in children and teens. Eating Disorders Health Center. Retrieved September 21, 2014 from, http://www.webmd.com/mental-health/eating-disorders/features/eating-disorders-children-teens.
Thompson, C. (1997). Eating Disorders in Teenagers. Mirror Mirror Eating Disorders. Retrieved August 20, 2014, from http://www.mirror-mirror.org/teens.htm.