People do not get an eating disorder in the same way as they get mumps or a cold. An eating disorder is something that creeps up on an individual, sometimes gradually and sometimes suddenly. The eating disorder often starts well before someone knows that they are having a problem with food.
To understand why people get eating disorders, we first have to describe what an eating disorder actually is. The experts describe an eating disorder as “extreme shape and weight control behaviour” which is underpinned by excessive concerns about your weight or your body shape. These feelings about shape and weight have an excessive influence on your self esteem. As a rule, self esteem is generally very low in someone who has an eating disorder to the point where you feel like a bad and unworthy human being.
People with eating disorders also complain about feeling fat a lot; we know that they commonly misinterpret emotional experience as “feeling fat” although this is something sufferers are not aware is happening.
The “extreme shape and weight control behaviour” we mention above leads to rigid rules about food, binge eating to the point of obesity, getting rid of unwanted calories by purging, self starving to the point of emaciation, and many other ways in which a faulty relationship with food can manifest.
The eating disorder also shows itself in a lot of worrying about food, obsessing about how you look, comparing yourself to other people or to images in magazines and feelings of guilt and shame.
What An Eating Disorder Is Not
With all the current fuss about skinny celebrities, it is tempting to regard the eating disorder as vanity, weak willpower, attention seeking behaviour or even “just a phase”. An eating disorder is, in fact, a complex mental health problem which takes on a life of its own. However, we cannot say that people with eating disorders are mentally disturbed. Many people with eating disorders live normal lives, have normal relationships and do not have any other diagnosable emotional problems or an underlying “can of worms”.
Association is Not Cause
Eating disorders are associated with many different factors. This does not mean that any of these things have caused the problem. All we can say with any certainty is that certain events and situations are risk factors for someone to develop an eating disorder. Even if there is one very significant event in someone’s life, it may or may not be responsible for creating or even maintaining the eating problem. Below are some of the known risk factors for eating disorders.
- Your genes
Twin studies show a very high tendency for identical twins to develop anorexia, although this relationship is smaller in fraternal twins and for bulimia in siblings.
- Parents with food issues
Mothers who diet or have obvious weight issues; fathers who make comments about your weight or shape; tend to have girl children with body image problems.
- Fat-Teasing at home or at school
Brothers and sisters can be especially cruel. Even comments such as “that would suit you better if you lost a couple of pounds” can be hurtful.
- Abuse, neglect or abandonment in childhood
There is a lot published about the link between sexual abuse and eating disorders, showing an increased likelihood of getting an eating disorder if you have had unwanted sexual attention. But some studies have not shown such a link. The association between emotional abuse and eating disorder is stronger.
- Trauma or loss in childhood
A link exists between PTSD (post traumatic stress disorder) and eating problems. Bullying, divorce, dyslexia, can all lead to stress related problems. Anything in childhood which dents a solid sense of self can lead to the low self worth which is the root of an eating problem.
- Early puberty (in girls only)
- Obesity in childhood
- Family relationships
Parenting patterns of enmeshment, avoiding conflicts, high expectations, are connected to anorexia. Alcoholism, high levels of drama, depression in the mother; are associated with bulimia. But this will not be true for everyone.
- Sexual identity problems
In males, but this is true for only a small proportion.
- Having a friend with an eating disorder
Girls and boys may teach each other to be bulimic to control their weight. They do not realise that what starts as a strategy can go wildly out of control.
- Your core personality and character
Whether you think personality is forged in your genes or whether it is driven by experience, there is an association. Personality styles we call borderline (difficulty managing and tolerating emotions) avoidant (mistrusts other people) and narcissistic (needs to be the focus of attention but self esteem is low) are most at risk.
Character traits such as lack of confidence, needing to please other people, and perfectionism (either you are perfect or you have totally failed) are traits we commonly see in people with eating disorders.
- The culture
Everyone blames the culture for the craze for dieting and the epidemic of eating disorders. What appears to mediate the link between the culture of “thinness” and eating disorder is whether a vulnerable individual internalises the impossible ideal images they see on TV or in magazines, and continually compares herself unfavourable to those images. People who can admire a beautiful model but say “I could never look like her but it doesn’t bother me too much” are the people who are least likely to fall victim to problems with food.
There is a distinct link however with dieting behaviour and eating disorders. You can read more about the effects and the psychology of dieting on our information page. Most eating disorders begin with a diet, but of course not all dieters will get an eating disorder.
So, What Causes An Eating Disorder?
The above list shows us that there is no one cause, just any number of things can make someone vulnerable and any number of things that can trigger it off.
People with eating disorders are sensitive intelligent people. This sensitivity may serve as the genesis of the eating problem. Time and again when I discuss the history of an eating disorder, I see one member of a family, for example, taking on board the problems in the family and taking responsibility for putting it all right no matter how small these problems are. Or trying to cope with very difficult situations outside of the family and failing to find a good way to solve these problems with the adults at hand.
A child who lacks good understanding of what is really going on around him comes to mistrust their own emotions. The usual response to this is “If I feel bad it is all my fault.” One way to deal with this is to split off your feelings and make them forbidden. Fearing your emotions usually causes bad feelings to disappear to do damage elsewhere in your life; you may find yourself turning to food to squash them down or starving so you do not need to feel anything at all.
This responsibility to keep things in control, together with other personality factors and any combination of the events above, lead to boundary problems with others (such as helping too much), and difficulty solving problems in life. To put it simply, boundary problems are usually a combination of personality and familial factors arising from situations in which a child’s needs for comfort and understanding are not met, and just experiencing a need can evoke a sense of shame and guilt
An eating disorder can be an expression of this psychic pain, which is thought to be unjustifiable and undeserved.
Because of the internal shame experienced, together with a strong need for control there are themes among people with eating disorders of wanting help but not being able to ask for it or to accept it. Part of this difficulty with accepting help reflects the fact that the eating disorder has become valuable in some way.
Eating disorders contains many powerful destructive rituals and rules. It allows for the expression and regulation of all kinds of needs. The need to be “good” by following rules and reducing weight; or “getting rid” of what is bad. It allows for the suppression of unbearable feelings. It allows for aspects of punishing the self for having feelings in the first place. It important to note that the rituals of an eating disorder such as bingeing, can be deeply soothing, no matter how destructive they are.
As the eating disorder deepens, all the positive qualities of a person come to be buried. The eating disorder will interfere with normal aspects of life, such as work, education and relationships. This ultimately leads to a sort of spiritual void which must be filled with food or starved away.
What Can Be Done If You Can’t Treat “The Cause?”
The treatment of an eating disorder is about reclaiming the positive qualities in a person which have become buried away. This involves treatment of the whole person, nutritionally, emotionally and spiritually. A person who has recovered from an eating disorder is able to self-soothe appropriately, use food to take care of themselves properly, solve personal problems more effectively, and have a grounded self esteem that is not dependent on having a perfect body size.
Only part of this therapy is helping clients to understand their childhood and the role of the eating disorder as an adaptation to stress. Going endlessly over the past doesn’t always help.
Eating disorders are a lonely place to live. A holistic therapy thus must foster a sense of connectedness to other people. In this process, some relationships may need to be changed, rejected or eliminated. The relationships that remain will be deeply rewarding and respectful of the client’s higher needs.
At NCFED we help people to thrive, not just survive.
Deanne Jade 2010