People, especially women, love two things that don’t often come together: sumptuous food and svelte bodies. The prevalence of eye-popping imagery in the media barrages us with images of both, tempting us to covet both, inadvertently causing us to lose both. It works something like the proverbial Catch 22—we see beautiful bodies, then observe our own paunches, sags and cellulite. In despair of attaining the standard of beauty, we self-medicate with food. A cycle has begun. We get fatter, get sadder, and then get another bowl of Bryer’s Fudge Ripple from the freezer. Most of us settle into less than perfect figures that result from less than perfect eating habits. Some of us, in an desperate attempt to straddle food and fitness, fall into the quagmire of disordered eating.

The two most prevalent kinds of eating disorders are anorexia nervosa and bulimia nervosa. Let’s get acquainted with them:

Anorexia Nervosa

The name of this illness is inaccurate. Anorexia literally means “no appetite,” but in reality sufferers are extremely hungry and tend to obsess over food. Anorexia is characterized by severe, prolonged limiting of food intake and a refusal to maintain normal body weight. With it comes an intense, irrational fear of becoming fat and “cognitive distortion” regarding one’s body image. Often anorexics, which are typically underweight, think themselves fat. A high rate of adolescent girls develop anorexia, perhaps in an attempt to simplify an increasingly complicated life down to one primary quest—to be thin.

The effects of anorexia are quite grave. Left untreated, anorexics often become amenorrheic (without periods). The resultant low levels of estrogen can contribute to bone loss. Failure to shed the cells of the uterine lining each month can predispose a woman to female cancers. Malnourishment can lead to heart problems, as was the case with singer Karen Carpenter, who dropped dead of an anorexia-related heart attack at the age of 32. The skin and hair becomes dry as the body attempts to economize. Lack of fat “padding” can lead to bone and joint injury. Nervous system challenges arise, including insomnia. The brain can actually shrink, exacerbating cognitive dysfunctions. Although anorexics often feel a sense of pride about being thin, they can collapse in despair when the condition worsens to the point of health breakdown. Up to fifteen percent of anorexics die—the highest fatality rate of any psychiatric illness. Most of the victims are female, and a majority of them are young.

Bulimia Nervosa

Bulimia is Greek for “hunger of an ox.” This time the name is a correct one, for bulimics eat with a seemingly endless appetite for more. Its characteristics are: Recurrent episodes of binging on high-calorie foods, secretive eating, compulsive dieting, use of diuretics and laxatives and self-induced vomiting to “purge” the excess, unwanted calories. While anorexics are thin, bulimics are typically average or a little overweight. Bulimics are aware that their eating patterns are abnormal, but there is a loss of control as the compulsion takes on a life of its own. Typical post-binge emotions include a sense of self-loathing and shame.

The typical binge averages over 3,415 calories, but binges as high as 11,500 calories have been reported, and there can be several binges a day. Typical binge foods are calorie-dense junks foods such as cookies, ice cream and bread, the purchase of which causes the food bill to skyrocket. Bulimia is called the “college girls disease” because it claims as much as one fifth of the college female population.

Bulimia isn’t as often fatal as anorexia is, but it can cause a heart attack by throwing off the balance of electrolytes, which give the chemical signal necessary for the heartbeat. The digestive system of a bulimic is constantly insulted by both binge eating and frequent vomiting. The stomach is overexpanded, and the pancreas can become inflamed as it is jolted into action. Esophageal inflammation, loss of natural gag reflex and a predisposition to esophageal cancer can also result from frequent vomiting. The throat can become strained and the vocal cords compromised from contact with stomach acid. Bulimics sometimes have swelling in the parotid glands, giving them a “chipmunk cheek” appearance. Frequent use of laxatives results in the breakdown of the protective mucous lining of the intestine, leaving the bowel vulnerable to diseases of various kinds. A telltale sign of bulimia is the sores that develop on the back of the bulimic’s hands as a result of shoving the hand down the throat repeatedly. Impulse-control weakness both precurses and worsens with bulimia, paving the way for substance abuse, promiscuity and even shoplifting.

Causes

In attempting to understand complex issues, we often search in vain for a simple answer. There is no one cause for eating disorders, but rather an interplay of causes that can be summed up into three categories; psychological, biological and cultural.

Psychological causes

Although it is difficult to find a typical family profile for eating disorder patients, there are certain prevailing psychological tendencies in both anorexia and bulimia. These tendencies can be inherited either environmentally or genetically. Among them are perfectionism, low self-worth, sexual identity confusions and depression. Like so many who resort to escapist behaviors, ED sufferers have trouble perceiving their real value and usefulness. Lacking this spark of personal vision and purpose, they pursue either elusive physical perfection, or sensual indulgence, or both. Once the disorder is in place, they often fluctuate between self-loathing and self-indulgence or grandiosity. As the isolation that accompanies addictive behavior increases, the sufferer has an even keener sense of worthlessness and despair.

While not all those with eating disorders have a past history of sexual abuse, many who suffer these traumas will resort to disordered eating later in life in an attempt to regain lost control. Childhood abuse generally predisposes an individual to escapist behaviors. More than this, sexual abuse often triggers feelings of abhorrence in a young person toward their budding sexuality. Self-starvation can conveniently “desexualize” a person by lowering vital force and thus minimizing sex drive, and also by reducing the sexual attractiveness of the body.

More and more research is indicating that social connection has a profound effect upon physical and psychological health. Those who do not reach out to others for help and comfort may face higher stress levels and increased health risks, including EDs.

Biological causes

There is an intimate relationship between the mind and the body, so that the thoughts can affect health quite dramatically. The reverse is also true--the body can affect the mind. Since the mind is housed in a physical organ, and that organ is connected to other bodily organs and systems, the condition of the body can powerfully impact thoughts and emotions. Because of this, biological factors can contribute to eating disorders. For instance, there is a body of research that has linked eating disorders with a family history of depression and other mental health problems such as bipolar disorder. This suggests a genetic predisposition, especially to bulimia. This genetic factor does not always cause an eating disorder, but can contribute when combined with other “hits,” or contributing causes.

Cultural causes

Various feminists have spoken out on the exploits of fashion in books that focus upon dieting, eating disorders, and something called “looksism.” Looksism is characterized by two things: an undue emphasis upon the importance of physical appearance and a distorted ideal of beauty. This phenomenon has factored into the eating disorder issue by placing overmuch pressure on women to be “figure-perfect.” At the same time it has purveyed a distorted definition of what the perfect figure is. When the gangly Twiggy made her debut in a 1965 issue of Vogue, she was five feet six inches tall and 97 pounds. Suddenly teen girls had to be rail think in order to be fashionable. This standard changes with the whims of the fashion industry. As women try to outdo one another by redefining beauty in their own terms, everything from muscle-man athleticism to billowingly oversized breasts are idealized. But the rail-thin idea of beauty has been a constant in catwalk culture, simply because clothes hang on the models’ waif-like bodies as they would on a hanger, and this keeps the focus upon the clothes. This is why victims of eating disorders are more often young women--more than older women, teens and college-aged girls strive to follow fashion trends.

In the early 1900s, women’s magazines began to extol a thinner and thinner ideal of beauty. As the model woman’s weight has decreased, two things have increased: the weight of real women, and eating disorders. It seems that the more unrealistic and unattainable the perfect body becomes, the fewer women actually try to reach it. Of those that do, more and more are resorting to anorexia and bulimia.

Bringing it all together

Why some women take up with these practices and others do not is due to a complex interplay between psychological, biological and cultural forces. One woman is surrounded by a looksist society, but her family of origin was nurturing, she is well-connected socially, and she has a strong faith and no genetic tendency toward depression. Another woman is ensconced in the same looks-obsessed society, but she was sexually abused as a child, is disconnected socially and depression runs in her family. The first woman never develops an eating disorder, but the second one battles for years with anorexia-bulimia.

Thank God that there is more to the ED picture than the odds life has dealt. There is a mysterious, often unmentioned factor called choice, which is what makes the ultimate difference. Choice is the way an ED suffer avails herself of the grace of God as well as the lifestyle and treatment options available. The sufferer may have the psychological, biological and cultural odds stacked against them, but there is still hope of recovery. This will be our focus in Dying to be Beautiful, Part II.

Joan J. Brumberg, Fasting Girls, The History of Anorexia Nervosa (Markham, Ontario, Canada: Penguin Books Canada, Ltd., 1988), p. 202.

Ibid, p. 9.

Harrison G. Pope and James I. Hudson, New Hope for Binge Eaters (New York: Harper & Row Publishers, 1984), p. 68.

M. Sean O’Halloran, Focus on Eating Disorders (Santa Barbara, Calif.: ABC-CLIO, Inc. 1993), p. 43.

Pope, New Hope for Binge Eaters, p. 97.

There are many of these books, but one of my favorites was Reviving Opheila by Mary Pipher, Ph. D.

People, especially women, have always had a love-hate relationship with food. Eating disorders are one expression of that age-old tangle. The medieval saints such as Veronica and Catherine of Siena fasted on herbs and orange seeds and received what was believed to be affirmative revelations from God. Enlightenment-era Protestantism attempted to refute the claims of Rationalism through fasting miracle-women such as Ann Moore, who appeared to abstain from food for five years. The late nineteenth century brought forth the attention-seeking daughters of the bourgeoisie, who engaged in food-shunning as a means of emotional manipulation.

Today Anorexia and Bulimia have taken center stage in the dieting fixation saga, and more and more people—mostly women, mostly young—are falling under their spell.

A Face on the Disease

Perhaps the truth of these words assault your consciousness. Perhaps you can’t look at these afflictions in a cold, clinical way because when you think of them, there is a face attached. Perhaps it is the face of a daughter, son, parent, friend, or spouse. Or perhaps it is your face. If you have a loved one who suffers from Anorexia or Bulimia, or if you yourself suffer, you may be wondering if things will ever change. You have noticed the power of compulsive behavior, and the persistence with which it rears its ugly head, and you wonder if these conditions are treatable. You ask if there is hope. The answer is an unequivocal, indisputable, unambiguous “yes.”

The means of treating these disorders have multiplied along with the cases themselves. Outpatient options for the less severely afflicted, as well as treatment centers for those who need inpatient treatment, are popping up everywhere. Wading through the milieu of methods, however, can be a daunting endeavor. For the sake of clarity, let’s get an overview of therapy types:

Behavioral therapy

This type of treatment deals primarily with the overt habits involved in an eating disorder. The idea is to retrain the person to eat normally. “Systematic desensitization” pairs deep muscle relaxation with the imagination of scenes involving food. This ostensibly enables an anorexic to relax their fears of eating. “Reinforcement” is nothing more than behavior modification which rewards good behavior with special privileges and, in some cases, punishes bad behavior. For instance, some treatment facilities confine patients to their beds for binging. Behavior therapy is useful for bringing the behaviors under control, but since it doesn’t get to the root of the problem, it has a high relapse rate when used alone.

Cognitive-Behavioral therapy

This type of therapy has received very positive reviews from health luminaries such as Neil Nedley, who verifies the effectiveness of Cognitive-Behavioral therapy in the treatment of depression. This type of therapy not only brings negative behaviors under control, but addresses the wrong thinking behind the behaviors. During CB therapy, there is a concerted, systematic effort to bring the thoughts into sync with reality. Diseases of the mind always involve some kind of cognitive distortion, and eating disorders are no exception. Correcting wrong thoughts such as, “I’m fat,” “Binging will make me feel better,” “if I lose weight, I will be successful,” and “I’m worthless,” is essential to the healing process.

The trick with treating eating disorders, and especially anorexia, is that the behaviors can affect the mind in such a way that the mind itself becomes resistant to treatment. The brain is a physical organ and must be properly nourished in order to be sufficiently malleable to undergo change. The malnourishment of anorexia can put the brain into an “unreachable” state that must be corrected before therapy can begin. This is why cognitive therapy is combined with behavioral therapy.

“Bibliotherapy” is essentially cognitive therapy, because it prescribes the reading of books and articles on the individual’s illness. Often this journey out of ignorance into awareness provides a needed sense of objectivity. Eventually the student achieves a sense of mastery as they learn to speak transparently and accurately about their problem. This also enables them to take responsibility for their own recovery process.

Psychodynamic therapy

This therapy is related to Freudian psychoanalysis and similarly delves into the patient’s experience with early caregivers, usually parents, and the role those relationships played in the formation of the emotional/cognitive patterns. Childhood traumas can and do hamper an individual’s development, and result in a deficiency of the internal resources required to handle life. Some schools of psychotherapy purport to “reparent” the individual so that proper development can be resumed. Some forms of therapy treat patients like infants, incorporating touch and other forms of coddling.

It is true that love is the grand, overarching power behind all healing. This love, however, is most effectively experienced in a non-clinical, spontaneous setting. Much research indicates the very positive effect of socialization upon mental health. Coming out of isolation into community is essential to an addicted person. But we must be cautious here. Since this first step toward connection is nearly impossible for someone who is locked away in an addictive cycle, a professional counselor is often an essential aid.

Freudian psychoanalysis, which can lead the patient to dwell extensively on past abuses, has not been proven effective. The patient must, however, “connect the dots” between past trauma and the poor choices they have made in response. Then it is the job of the therapist to lead the patient in making better choices.

Family therapy

The goal of the family therapist is to work their way out of a job. Ultimately, if successful, patients will rebuild and repair familial relationships in such a way that the family becomes the primary support network for the patient. In the 1970s, therapists often recommended a “parentectomy” for eating-disordered patients while they were undergoing treatment. Many patients, upon returning home, fell back into old patterns because they were reconfronted with old triggers. Today many therapists include family therapy in their work with eating-disordered patients because healthy family functioning is essential to relapse prevention.

Support groups

Support groups, because they bring a sufferer out of isolation into community, are often a powerful push toward healing. Eating disorder recovery groups range in intent from educational to therapeutic. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) sponsors support groups all over the country, as does Overeaters Anonymous (OA). These groups are free of charge, making support groups the most economical form of therapy.

Drug therapy

A large percentage of eating disordered patients, especially those with bulimia, have a family history of depression. This seems to imply that there is some genetic/biological predisposition involved in the disorder. Because of this, antidepressant therapy tends to work for bulimics.

Anorexia is not as responsive to antidepressant therapy. This may be because, unlike bulimics who feel a keen sense of self-reproach about their problem, anorexics tend to like having their disease. Anorexia is considered an “ego-syntonic” disease, meaning that it is “in sync” with the ego. For this reason, anorexics can tend to erect a barrier of complacency and self-satisfaction which makes it difficult to alert them to danger. Yet even anorexics can eventually feel a sense of defeat as their condition advances. It is essential to stay on the lookout for opportune moments to offer help.

There are several natural means of mood elevation that are worth trying before seeking drug therapy. The negative ions in fresh air have a mood-elevating effect. Morning sunlight increases melatonin production, which enhances sound sleep. Exercise is a powerful stress reducer. A healthful, plant-based diet can improve mental functioning.

What’s a Mother to Do?

. . .or a father, brother, friend or lover. When you love someone who has an eating disorder, how do you offer help without scaring them away? Please consider these three steps; disclosure, decision and connection.

Disclosure

Approaching someone with any addiction requires a gentleness and tact that most of us are strangers to. If you have never prayed before, now is the time to start. God is the Opener of doors and the Giver of words. Read up on your loved one’s condition, and then look for the opportune moment to speak. Take care not to be overbearing, judgmental or controlling. Be as non-confrontational as possible. Your goal, and the ideal scenario, is to lead them to self-disclosure.

Once this takes place, be on your guard against confusing the individual and the disease. Remember they are not a problem, they are a person with a problem. Retaining a strong sense of personhood is essential to their healing.

Decision

Some eating-disordered individuals will want help, some will not. This is where you can patiently, carefully share the effects of the disease on both the individual and their loved ones. The process of leading a person to decision to get help may a protracted one, with much listening, reasoning, and give-and-take. If it starts to escalate into an argument, take a break and wait for another open door.

Beware of your own tendency to shut off the expression of pain. Most of us are poor listeners and will say such things as, “I know,” of “I’ve been there,” prematurely. Listening is one of rarest of social skills. Be someone who has it.

When heart-to-heart communication has taken place, the opportunity to make an appeal will come. Ask gently if the person is willing to get help. Let them know that you will work with them toward that end.

Connection

Once this decision has been made, it is your job to connect the sufferer with those who can help them. First and foremost, family and friends are essential. Continue to engage in social activities (preferably those that don’t revolve around food). Attend church and nurture spirituality. Professional help may be needed as well. See the sidebar for websites that can assist in finding just the right counselors, therapies and treatment centers.

Grace

We must never forget that the power behind all healing agencies is God. Because He is a God of compassion and love, He bathes the world in something called grace. This grace is available to all, at any time, and in any circumstance. Bear in mind that God will not force His grace upon anyone. It is through the channel of free choice that God pours healing power into our lives. When all human resources have dried up, and when every person we know has lost confidence in our potential, God still considers us candidates of grace. The moment we choose Him, the way is opened for hope and healing.

Nedley, Neil, Depression, the Way Out, (Ardmore, OK: Nedley Publishing, 2001) p. 92.

As is developed in the book The Secret Language of Eating Disorders by Peggy Claude-Pierre.

Nedley, Neil, Proof Positive, (Ardmore, OK: Nedley Publishing, 1998) p. 500.

Ibid.,p. 194.

Ibid., p. 493.

Ibid., p. 541.

Treatment Centers:

Remuda Ranch

1 East Apache St.

Wickenburg, AZ 85390

www.remuda-ranch.com

Center for Eating Disorders

St. Joseph Medical Center

7601 Osler Dr.

Towson, MD 21204

www.eating-disorder.com

Small Group Support Organizations:

Overeaters Anonymous

World Service Office

6075 Zenith Court Northeast

Rio Ranch, NM 87144-6424

www.overeatersanonymous.org

National Association of Anorexia Nervosa and Associated Disorders (ANAD)

PO Bx 7

Highland Park, IL 60035

www.anad.org

Eating Disorders Awareness and Prevention (EDAP)

603 Stewart St. Suite 803

Seattle, WA 98101

www.edap.org

Websites on Eating Disorders:

www.somethingfishy.org

www.anred.org