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Eating disorders can affect anyone – children and adults, male and female. And they cause more deaths than any other mental illness.
The behaviour of the eating disorder is not so much the problem but the solution, to a whole series of other problems. The sufferer uses under- or over-eating, and related patterns, in response to unresolved emotional issues. Eating disorders serve a function in the person’s life, and in most cases are a coping mechanism.
(For a more comprehensive understanding than is possible here of what causes eating disorders, how a sufferer views the world, and the recovery process, see Helena Wilkinson, Beyond Chaotic Eating, details below.)
Behind eating disorders may lie:
· Attachment issues (separation, lack of bonding, and disruptions to attachment);
· Emotional hunger (unmet emotional needs, resulting in inner emptiness);
· Negative attitude towards self (low self-worth, loss of sense of value and identity);
· Sexuality issues (fear of the adult world, and need for sexual protection);
· Past or current trauma (physical, emotional and sexual abuse, bullying and loss);
· Family issues (unhelpful communication, boundaries, handling of painful feelings);
· Personal factors (personality and genetics).
Whilst the underlying issues may be similar, there are clear distinctions between the different eating disorders in terms of how they manifest.
With anorexia a person severely limits their food intake, has a distorted body image, refuses to maintain a normal body weight, and is intensely afraid of gaining weight despite being below what is considered healthy. When the anorexic looks in the mirror a distortedly large figure stares back, and fills the individual with horror and disgust.
The anorexic may try to establish a sense of individual identity and independence, and yet fears that without anorexia they are a ‘nobody’.
Anorexia provides a sense of achievement over one area of life when other areas are considered out of control. There is a strong pull towards perfectionism in this – to attain a life that is ‘nice’ and pure.
Not eating may become a substitute for expressing anger. This anger may be denied or suppressed because it causes shame, but inner conflicts remain. All the feelings, needs and drives become bound up in shame, and the sufferer looks upon themselves with disdain. This lack of self-acceptance drives them into routines of calorie counting, starvation and self-punishment.
The main feature of bulimia is binge eating, followed by unhealthy behaviours to compensate for eating and to prevent weight gain, such as self-induced vomiting.
The nature of the illness is about hiding: hiding the truth; hiding feelings; hiding food. Everything is done in secret: the eating, the vomiting and the tears.
There is a split between the part of the bulimic which is very much in control and copes, and the part which is dependent and does not cope well. The person tries hard to take control of their life, but they are also in a great deal of conflict. They want to present themselves as strong, and yet inside they feel needy and emotionally hungry.
The bulimic often feels so desperate and in need, yet they fear that these desires, if exposed, will consume everything and everyone in sight. Their emotional hunger drives them to continue looking for love, but nothing ever seems to satisfy. They turn to food to fill the empty hole, and then get rid of the food to return to a place of numbness.
Compulsive eating is characterised by uncontrollable eating, ‘grazing’ on food, and consequent weight gain. Food is used to block out feelings, and provides a means to cope with stress, emotional conflicts and daily problems.
To the compulsive eater, food means either overeating or dieting. It is also something about which they fantasise a great deal, and which offers comfort.
When the compulsive eater gives an account of what they have eaten that day, they frequently fail to include certain foods. Some sufferers subconsciously believe that if they eat whilst standing up, driving, or walking, it ‘doesn’t count’.
The compulsive eater may set out on a diet because of the pressure to be slim, but dieting feels like imprisonment, and so they often find themselves making up for those things of which they have been deprived.
The person often eats guiltily and with speed, not really enjoying what they are eating, afraid that others might ‘catch them’.
The process of recovery
Before sufferers can change, they need to look at the advantages and the disadvantages of having an eating disorder.
In the early stage, they may want and yet fear recovery. This is a normal part of the healing process.
We are physical, emotional and spiritual beings, and with eating disorders there is brokenness in all three areas. For recovery to happen there needs to be restoration in all three areas:
· Physical: eating patterns, weight, and body image
· Emotional: feelings, thoughts, reactions, behaviours and choices
· Spiritual: identity, worth, value and maturity
Helpful tips for those helping
It is important that throughout recovery sufferers are helped to have a support network around them, including medical supervision; nutritional advice; therapeutic input; spiritual counsel; and friendship. Whatever your role in supporting a sufferer, the following tips may come in useful:
· Be well informed about eating disorders
· Don’t make assumptions; ask the person to explain why they do what they do
· Eating disorders are a form of communication, so ask yourself what is being communicated
· Maintain clear boundaries, as eating disorders can be all consuming. Be mindful not to become overly involved and to set out what is realistic in terms of the help you can offer; be specific, rather than saying ‘Phone me any time’, or the person may call at 2 am and then be upset that this is suddenly not OK any more
· Don’t `rescue`, but rather encourage the person to make choices themselves
· Help the person identify a reason to get better and work towards goals
· Affirm healthy ways of coping, rather than doing battle with the person’s unhealthy patterns
· Work on establishing identity and value in Christ
· Recognise the spiritual battle
· Don’t give up hope: ‘Trust in the LORD with all your heart and lean not on your own understanding’ (Prov 3:5).
Many people believe that a person has to learn to live with an eating disorder, but we have seen so many times that full recovery is possible.
Eating disorders are unhealthy and self-destructive ways of dealing with painful emotions, such as guilt, anxiety, and anger. With expert help, the sufferer can learn more positive ways of dealing with the pain of these emotions, and to address the deeper roots underlying their feelings.
In order for recovery to be both possible and sustainable, it is essential for the person’s thinking to change, as thinking affects feelings and behaviours. The Bible says: ‘Be careful how you think; your life is shaped by your thoughts’ (Prov 4:23, GNB).
A healthy relationship with food will need to be developed: letting go of the dieting mentality and the fear of hunger, establishing boundaries around eating, and maintaining a normal body weight.
Ultimately the sufferer will have to let go of the control that the eating disorder has had, and the identity that it has shaped. Honesty, repentance and love are a part of letting go and choosing a new identity - firstly as a child of God, and secondly as a unique, maturing individual.
Steps to change
Some steps on the road to recovery include:
· Making the decision to get better: looking at the pros and cons of having an eating disorder, and realising that there are more disadvantages to holding on to it than there are advantages
· Working out a viable strategy: looking at what particular help would be beneficial: seeing a nutritionist, joining a supportive organisation, having counselling/prayer ministry, attending a course, reading a book, etc.
· Reaching out for help: not bottling the problem up, but being proactive in contacting people and organisations for support and being open and honest with those who can be trusted.
· Modifying one’s life circumstances: looking at what is hindering recovery and what needs to change - type of job, working hours, mixing with encouraging rather than discouraging or critical people, changing where you live (the location or people with whom you live), reducing stress levels, etc.
· Building in emotional and spiritual support: developing friendships with people who understand eating disorders and the underlying issues, and having an outlet to talk and pray with someone when needed.
· Facing the pain: not running away from the underlying causes, but being helped to face them, to feel, to cry and to express hurt in a healing way.
· Developing trust: gradually learning to trust one or two ‘safe’ people, since trust will have no doubt been shattered over the years.
· Allowing time to process the changes: remembering that recovery is a process which takes time and not giving up when there are slip ups; getting up again and learning from the mistakes.
Helena has worked with eating disorder sufferers for over 20 years. A recovered sufferer and trained counsellor, she is the author of ten books, including the bestseller Puppet on a String, her own account of recovering from anorexia, written at the age of 19. She speaks internationally on eating disorders and related subjects. Visit her website.
Residential Courses and Training Days
Helena runs residential courses for eating disorder sufferers which address the physical, emotional and spiritual components of all eating disorders. They are held at a Christian Retreat Centre on Gower, South Wales, in a stunning location, and are suitable for sufferers aged 16 plus. For further information click here