The meaning and origins of eating disorders
By Abigail H. Natenshon, MA, LCSW, GCFP
Please note the following information is copyright © 2004
by Abigail H. Natenshon and appears here with the author's permission.
Republication and reproduction of this work, in whole or on
part, without the author's express written consent is strictly
prohibited. Please also note that although the article that
follows specifically address eating disorders from the vantage
point of the helping professional; it speaks with equal potency
to patients, parents and families who seek to heal themselves,
or to provide support and incentives for loved ones to heal.
What are eating disorders? More importantly, what are they
Myths and misconceptions about eating disorders
Early warning signs of eating disorders
How do eating disorders develop?
What are eating disorders?
More importantly, what are they about?
One of the most critical aspects of disease recognition is developing an understanding of
how these diseases present, and of what they mean for the afflicted individual. Eating
disorder recognition is never simple, as eating disorders are typically not easily apparent;
these diseases present in ways that are unique, from one individual to the next. Anorexia
is not about eating too little; bulimia and compulsive overeating are hardly about eating
Bulimia nervosa is an eating disorder
marked by out of control eating followed by some form of purging.
It typically accompanies a pathological fear of weight gain leading
to food restriction, followed by the need to gorge in response
to extreme hunger. The excessive caloric intake leads to the perceived
need to purge. With bulimia, eating becomes disregulated and feels
out of control.
Anorexia nervosa is a disease marked
by the pathological fear of weight gain leading to rapid or extreme
weight loss. Victims with anorexia restrict or limit their intake
of food, as well as their behaviors in life spheres beyond food
and eating. As an example, an anorexic young adult refused to
go to her roommate's wedding because the ceremony was to take
place at precisely the moment when she would need to be eating
dinner. She did not have the flexibility to diverge from her daily
schedule; and so her life became severely compromised. Another
anorexic woman ate the same limited number of foods every day
of her life in the same order and in the same amounts; she felt
compelled to wear the same few items of clothing as well.
(BED) or compulsive overeating is the lesser-known eating disorder,
following anorexia nervosa and bulimia nervosa. It is characterized
by eating when one is not hungry or by continual eating without
regard to physiological cues. Binge eaters typically eat to the
point of feeling extreme discomfort or even pain. I have worked
with people whose bingeing behaviors are so severe as to be experienced
as a form of self-mutilation; one 33-year-old patient of mine
describes eating so much food at a sitting that her skin hurts
from being stretched. The patient will typically report frequent
episodes of binge eating, with an inability to stop or to control
the behavior. One in five young women today report this experience
with food. Forty percent of binge eating disorders occur in men
Activity disorders, or exercise disorders, which take the form
of exercise compulsions, are a form of eating disorders. For many,
formalized exercise becomes a chief source of stress relief and
ultimately can camouflage underlying feelings, which are a source
of self-knowledge, problem definition, and therefore, problem
solution. With the release of endorphins that comes with formalized
exercise, disordered individuals can become reliant on brain chemistry
changes as a substitute for resolving problems, a dynamic that
can be a precursor to addictions and eating disorders.
You may be surprised to know that there is a purging type of anorexia, and that
not all anorexics are emaciated or even thin; in actual fact, many are of normal
weight. Anorexics do eat; there is commonly held misconception that if people eat
at all, they cannot be sick.
Many bulimics restrict food, as do anorexics. Some do not purge. Most people
with bulimia are of normal weight. Bulimic purging may take different forms.
Some bulimics purge through spitting masticated food. Others purge through
over-exercise, abuse of laxatives, diet pills, diuretics, Ipecac. Most bulimics do
not recognize these behaviors as being purge-related.
For some, an eating disorder may represent a brief and fleeting, relatively benign
coping glitch at a critical or troubled time; in other instances, it may represent a
life-long struggle with food, and may be indicative of an Axis II personality
disturbance, of childhood abuses, and severe emotional disturbance and pain.
Behaviors involved with bulimia may become a form of self-mutilation, like
cutting; in these instances, the individual eats to the point where the skin becomes
so stretched from overeating as to put the individual in excruciating pain.
Eating disorders are not teenage
diseases, nor are they women's diseases. Victims may be male
or female and they can be as young as
age 5. It may also come as a surprise to many that increasing
numbers of individuals in their late twenties, thirties, forties,
and fifties are coming forward for treatment now, having carried
unresolved issues of eating disorders into their adult years,
perhaps hoping they would grow out of them. These people invariably
live productive and typically successful lives; they are professionals,
parents, and business people, highly accomplished and talented.
Many have wrestled with disease for 20, 25, 30 years, living the
"big lie", fugitives or sorts, in pain and in hiding
from friends, families, husbands, children.
Eating disorders become the "third wheel" in marriages,
the triangulating third party in the marital system. Whether conscious
or subconscious, the partner invariably prefers his or her partner
thin, feels comfortable "looking the other way", or
is equally as perfectionist and compulsive in lifestyle. People
find each other for a reason. As a result, with recovery from
these disorders, marital systems change and partnerships may be
in danger of splitting up unless both parties undergo treatment
and change simultaneously.
In short, anorexia,
bulimia, and compulsive overeating
are the misuse of food to resolve emotional problems.
For those with eating disorders the extremism and the deregulation in eating
behaviors and appetite spill over into other life spheres, beyond
food. These diseases denote an entire personality organized around
a dysfunctional set of attitudes and values, around self-hate,
ineffectual problem-solving, poor coping mechanisms, denial and
fear, compulsivity, and the need to be in control.
Myths and misconceptions about eating disorders
The following are some examples of myths and misconceptions surrounding disease and treatment:
- Eating disorders are incurable.
- Eating disorders are about food and weight loss.
- Anorexics are always thin and do not eat.
- Fat-free eating is healthy eating.
- Dieting is the best way to lose weight.
- Eating disorders are caused by dysfunctional parenting, by the child?s low self-esteem,
by a bid for attention, or by the media or peer pressure.
- Children don't want their eating disorder "secret"
to be discovered.
- Parents must not infringe on their child's privacy and independence
by becoming involved in treatment and recovery.
- An intervening parent is, by definition, an interfering parent.
- Parents should never discuss food with their disordered child.
- Therapists breach the child's confidentiality by talking with
The most debilitating myth of all is that once children become
adolescents, they no longer need their parents who are left no
alternative but to step out of their children's lives. Eating
disorders signify that there are important emotional and developmental
tasks yet to be achieved, coping and problem-solving skills yet
to be attained. This is hardly the time for parents to bow out
of the picture!
There are 11 million sufferers in the US today, 87% are under the age
There are increasing numbers of men and boys with eating disorders
today, though 10 times as many young women are afflicted. In the past
decade, the number of males with eating disorders has doubled.
The most lethal of all the mental health diseases, 6 to 13
percent die or are maimed from eating disorders. What is more,
people don't have to look emaciated to die. It is not atypical
for bulimics with a normal appearance to develop electrolyte
imbalances that can result in heart failure. These are the
kids who go to bed one night feeling fine and just don't wake
up in the morning.
One of the families who appeared on the Oprah Show with me had
a teenage daughter who had been treated effectively for bulimia for
years. Her family was apprised, activist, and supportive. She was an
intelligent and responsible young woman who had gone through treatment
programs, had participated willingly in outpatient treatment, and had
experienced substantive recovery progress. This youngster went to sleep
one night and never woke up again.
In another instance, a young woman
who was a scholarship student at a prominent California university fell
into a bulimic coma for three weeks from which she emerged with permanent
and global brain damage. Never able to return to school again, this
young woman was to spend the rest of her life in a facility for people
with brain dysfunction.
Eating disorders are curable, in as many
as 90% of cases where detected early and treated effectively. The eating
disordered recovered will have learned more than how to eat healthfully;
through treatment and recovery, they will have learned what it takes
to face adversity and the self as effective problem solvers. Eating
disorder recovery can be seen as an insurance policy for success in
adult life. Invariably, recovered individuals say they have their life
back, their personality back. Parents invariably proclaim that they have their child back. The
practitioner who treats eating disorders needs to keep this bigger picture in mind.
Early warning signs of eating disorders
Your patient may:
- be preoccupied with the fear of becoming fat, or may feel
fat even though she is not
- lose weight rapidly
- display idiosyncratic eating habits, such as limiting food
choices, cutting food into small pieces, moving food around
plate, chewing and spitting out food
- restrict food through dieting, skipping meals, becoming vegetarian
- display signs of anxiety such as compulsions, perfectionism,
- display signs of depression such as social withdrawal, irritability,
and difficulty concentrating
- display low self-esteem, seeking approval, and concerned about
her physical appearance
- feel dizzy, faint, fatigued, or constantly cold
- need to feel in control of all aspects of life, even beyond
food and weight management
- exercise compulsively
- spend excessive amounts of time in the bathroom.
- lose her menstrual period
How do eating disorders develop?
Clinical eating disorders are, relatively speaking, rare, involving
5% of adolescents; the attitudes and values
that lead to them, however, are rampant, putting lots of kids
at risk. But that's the good news, because
it is far easier to change disruptive attitudes
than to dislodge ingrained habits and behaviors. Consider
this fact to be the parent's and the professional's call to action.
Eating disorder onset is a process
that happens over time, gradually; a person doesn't wake up one
day with an eating disorder, as they would with a strep throat.
Happily, this offers fair warning to those who know enough to
read the signals. Eating disorders develop along a continuum or
time, emotional development and life experience.
Eating disorder etiology is a kind of "cocktail" that consists
of dysfunctional attitudes about weight and eating that
coincide with stressful life transitions (entrance into
high school or college, parental divorce, reaching puberty at
an early age); in response, children may turn to disordered
eating and dieting behaviors to give them a sense of well-being
or self control. When these circumstances occur in the company
of genetic propensities towards disease, (through temperament
and/or hereditary addictions) dysfunctional eating patterns may
eventually lead to clinical eating disorders.