Understanding Eating Disorders

Eating disorders are difficult for many people to understand. “Why won’t she just eat?” “If she hates bingeing, why does she keep doing it?” It may seem that the person is just being stubborn in the name of vanity. What is actually happening is that food and weight have become tools to manage profound emotional pain.

An eating disorder (ED) is when a person’s relationship with food is used to soothe emotional pain such that it causes significant negative physical, psychological, or emotional consequences.  If you know someone with an eating disorder, you know someone who has been dealing with big pain. The pain often involves low self-esteem, depression, and/or anxiety.

In ways that I will try to describe below, they have found a way to avoid or organize their pain using their ED. In their mind, they have to maintain and protect the ED to continue getting relief from their pain. Protecting the ED often means spending less time with loved ones or anyone who might confront the ED. It often means not attending social events that have food. It might mean not going anywhere until they meet their daily exercise quota. It means living a life dictated by the rules of their ED.

It is important to note that if the person is medically malnourished, their judgment and ability to effectively use logic and other cognitive functions may be significantly impacted. They are also more likely to experience depression and anxiety. This is a physical status and can be reversed only by nourishment.

We are still working to understand exactly how and why EDs occur.  There are neurotransmitters and brain structures related to the detection of hunger and satiety and to the feeling of reward some of us get when we eat that may be damaged or are not at typical levels in people who develop EDs. We also know that genetics play a role: genes contribute to 50-80% of the risk for developing an ED. While there is no “eating disorder gene,” our genes do contribute to our personality traits, and there are some traits that seem to increase a person’s risk for developing an ED. These traits include being: anxious, risk-avoidant, sensitive, perfectionistic, compliant/people-pleasing, obsessive, and achievement-oriented.

People with these traits who are in emotional pain and don’t have effective coping strategies are likely to turn to the thing that our society promises will improve our lives: losing weight/getting fit. They develop a focus on food and weight to achieve the promised popularity and happiness. In addition, because these folks are inherently obsessive and achievement-oriented, they tend to take whatever they do to the next level (from diet to anorexia, from overeating to bingeing, from focus to obsession).

One path to an ED begins with a person who is anxious, perfectionistic, a people-pleaser, and dissatisfied with her appearance. She begins college or a new job and worries about being judged by everyone.  She stays awake night after night worrying whether she can do well in her classes or work tasks. She badly wants to be accepted, so she starts to diet and loses weight. After some time, she begins to feel better about herself because she is seeing a smaller body in the mirror and other people make positive comments about it. This soothes her anxiety that people will reject her. She decreases her food intake further to speed up the results. As an added bonus, eating less than everyone else becomes something she is good at, something she feels proud of. She secretly begins to feel superior to others for the first time in her life. For those who experience the pain of low self-esteem, this is very powerful. All of these things – or even any one of them – make her push herself past “reasonable” limits to keep going.  She feels like she finally has the key to being accepted. She can feel emotionally safe as long as she can maintain this body size and discipline around food.

There are infinite other paths to developing an ED. It can start with a particular relationship with food. For example, many people turn to food as a comfort. Overeating, like undereating, can be psychologically rewarding. It can be very comforting to know that the pain of feeling alone, stressed, or angry can be dulled by zoning out and eating a gallon of ice cream. Bingeing on fast food from three different places every night after work might be the strategy that “works” for someone who is trying not to think about the abuse they endured. If you have no better way of coping with emotional pain, you might turn to food more and more often. It feels like a readily available, constant friend.

For a person who tends to be obsessive, making extensive rules and lists about food that must be checked and triple checked every day can be extremely soothing. It is also a way of creating a system to tell yourself whether you were “good” or “bad” that day. Many people don’t have an internal way of gauging themselves, which leaves them feeling painfully insecure. The way you do food (or, more likely, the way you don’t do food) can be used to assure yourself that you are a good person.

To understand EDs, it is crucial to understand that the behaviors associated with EDs (e.g., eating very little, bingeing, purging, overexercising, focusing to an extreme degree on food and weight) become coping mechanisms. They help the person manage whatever stress or painful feelings they are living with at the moment in ways that may be hard to understand or even see. The behaviors feel absolutely necessary for getting through each day. To complicate things further, the person is often unaware of the connection between their food-related behaviors and their emotional pain.  They themselves may not understand why the ED feels so necessary.

The person with the disorder is focused on managing pain. The people in their life are focused on the negative consequences of the ED. These often include loss of relationships, loss of physical health, and loss of joy. It can be very hard to find any middle ground. For the person with the disorder, it is incredibly hard to give up the unhealthy behaviors because they offer relief from pain when nothing else does. It is difficult for most of us to understand that this relief feels worth the consequences.

All of this is necessary to appreciate if you are trying to understand why someone you love is being so protective of their ED behaviors. Think about a toddler with their security blanket – how terrifying to be told that you are no longer allowed to have your blankie! The world simply doesn’t feel safe or manageable without it. The person with the ED needs to be assured that they are going to be shown other ways to manage life, and that they are going to be loved through the process.

No one sets out to develop an eating disorder, but the behaviors can quickly become addictive and the person loses control over them.  Professional treatment makes a difference, and it is important to begin as soon as possible. Research shows that the longer an eating disorder exists, the harder it is to treat.

Begin by contacting a therapist or primary care physician who specializes in eating disorders (see my Eating Disorder Resources page for some places to start).

“People have a hard time letting go of their suffering. Out of a fear of the unknown, they prefer suffering that is familiar.”

— Thich Nhat Hanh