Eating Disorders
By Patricia Kelly and Orit Morse
For years, Sandra has heard the line "You
have such a pretty face, if only you had the will power." That alone is enough to
make her so angry and drive her to food. The anger, disappointment and fear drive her into
the food and eventual oblivion. She feels discouraged about the way she looks, fat or
thin. Sandra has tried so many diets so many times, only to lose a few pounds but regain
them plus more. After dieting, she always feels defeated, empty and deprived.
As she passes by the store mirror, Nancy sees
herself as grossly obese, when in reality she weighs a mere 97 pounds. From morning to
night, she picks away at a dry bagel, afraid that it would make her fat. She feels that
even one bagel a day will be too much food for her.
Within a time period of two hours, Susan
consumes one gallon of chocolate ice cream, a frozen Sara Lee cake and a box of stale
cookies that she threw away the night before. She is in a frenzied state, going from
cupboard to fridge, feeling totally out of control. Then subdued and stuffed, the fear
begins. The routine is set. Susan begins by regurgitating what she ate, getting rid of it.
She then takes some laxatives to eliminate whatever else was in her stomach. She resolves
that for the next two days she will fast and triple her visits to the gym.
These three women have one thing in common.
They all have an eating disorder.
Sandra is a binge eater, a compulsive
overeater. She has crossed the line from occasionally bingeing to being ruled by food.
Binge eaters like Sandra tend to either eat large quantities of food very quickly or
consistently eat more than their bodies require. They feel out of control and ashamed of
their behaviour.
Nancy is an anorexic. Looking at her, it is
fairly obvious because of her low body weight, a characteristic of anorexics. Other
characteristics are an intense fear of gaining weight, becoming "fat" and a
distorted body image. Some anorexics experience the cessation of menstruation. In general,
anorexics drastically restrict their intake and may resort to bingeing and purging.
Susan is bulimic. Her weight, as with most
bulimics, is often in a healthy range. However, the patterns of bingeing and self-induced
purging, use of laxatives and excessive exercise, are physiologically and psychologically
damaging.
In all of these disorders, there is secrecy
about eating, obsession with food and body size or shape, feelings of not being in control
and intense shame. Physically and emotionally, the results can be devastating. For
example, anorexia and bulimia nervosa affect up to 3% of young women, with the incidence
of bulimic behaviours as high as 40% in college women. Men too are affected.
Many women and men have not crossed the line
that designates a diagnosable disorder, yet their lives are very much affected by an
obsession with body size and eating. In Canada, up to 90% of women report being unhappy
with their bodies, 70% are dieting at any given time and 40% are continually gaining and
losing weight. Other statistics suggest that in our society, body size and eating are
concerns that consume a great deal of time, effort and energy of women.
On the surface, eating disorders appear to be
about eating and body size, but in reality they are about much more. Disturbed eating and
related behaviours, including purging and manipulation of body size, are used for real
though often unconscious reasons to deal with emotions and difficult situations. Thus
eating itself can serve as a way of suppressing or enhancing feelings, nurturing oneself,
escaping or numbing out and punishing oneself. Restricting food also serves a purpose. It
can be an attempt to assert control over the body. Being able to control intake and alter
body size creates the illusion of control over one's life. Purging is done for reasons
beyond ridding the body of extra pounds. Where eating is taking in nourishment, purging is
rejecting it. The act of purging provides a release of physical and emotional tension. In
such a way, purging and bingeing exhibit the ambivalence of the bulimic.
The manipulation of body size, weight gain or
loss, may function on the unconscious level. Culturally, being fat, obese, is associated
with being out of control, powerless, unattractive, unworthy, unlovable, even deviant and
somehow immoral. Being thin is associated with being outgoing, intelligent, successful,
rich, attractive, valued, worthy, lovable, sexually desirable, in control and powerful. To
accept such assumptions, being "fat" can become a coping strategy that has as
its goal the keeping of others at a distance, provide an excuse for not trying or failing,
express anger or rebellion, avoid problems, provide a source of identity and provide power
and control. Being "fat" can also be a way of avoiding being "thin"
when being thin means having to be all the many things associated with thinness in
present-day society. Believing you must be all those things can be frightening.
Recovery from an eating disorder requires an
understanding of the usually unconscious reasons for the disturbed eating behaviours and
body image and size manipulation. One has to recognize that people use food and body size
to deal with emotions and difficult situations. If recovery from an eating disorder is to
be successful, new living strategies need to be developed. Unless the underlying issues
are confronted, a program will not work or be successful.
A comprehensive treatment for those seeking
recovery from eating disorders should have at least the following components to assist
clients:
Accepting and trusting their bodies, paying
attention to and responding to their signals, especially hunger
Developing a greater understanding of who
they are and what they can be, the reality and potential
Exploring attitudes and beliefs about
themselves, others and life. Then changing those no longer functioning adequately for them
Creating an inner sense of self-caring, trust
and personal power
Recognizing, processing and expressing
feelings
Developing communication skills
Reducing stress in healthy ways
Taking responsibility for themselves and
their lives.
Many individuals may not realize they are in
need of such a program. In fact, they may not want to acknowledge this. Yet if they:
think about food and weight constantly
feel frustrated with dieting
eat in response to anger, loneliness,
anxiety, stress and boredom
feel out of control with food
feel guilt and remorse when overeating
eat when not hungry
feel unworthy because of body shape or weight
want to be rid of food and weight obsession
and have two or more of these, they may well be
able to benefit from an holistically structured program.
Such a program functions optimally through
education, group process, imagery, art, movement and role playing. It strives to assist
clients to stop self-destructive behaviour with food, eliminate the use of body size to
speak for the person, and heal wounds that food and body size have being trying to mask.
Clients have the opportunity to express needs and emotions, increase self-esteem and
confidence and feel more in control. Within such an holistic program, qualified
professionals can assist them to a more fulfilling and joyful life.
References
American Psychiatric Association
(1994). Diagnostic and Statistical Manual of Mental Disorders (DSM IV),
Washington, DC.
Kaplan, H., Sadock, B.,Grebb,J.
(1994). Kaplan and Sadock's Synopsis of Psychiatry: Behavioural Sciences
Clinical Psychiatry (7th ed.), Baltimore, MA, Williams & Wilkins.
Rice, C. (1992). Women
and Body Image Program Funding Proposal. Toronto, ON. Unpublished.
Sheinin, R. (1990). Body
Shame: body image in a Cultural Context. National Eating Disorders Information Centre
Bulletin, 5.5. 1-3.
Reprinted from Psychologica
Vol. 15, No.3, July 1996 (The Ontario Association of Consultants, Counsellors,
Psychometrists and Psychotherapists Newsletter)
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