What's Up with Eating Disorders
- Dr. Margy Sperry
- May 2, 2018
- 4 min read
Updated: Apr 17
When people learn that one of my specializations is eating disorders, they often ask me to explain why a person develops anorexia, bulimia, or binge-eating disorder. Many people can't fathom how a basic physiological need can become complicated and the source of so much internal conflict. For some, the cure for an eating disorder seems obvious - people with anorexia just need to eat, and over-eaters need to stop eating! "If only it were so easy!" my patients and I respond.
The truth is that a person develops an eating disorder for more complicated reasons than you might expect, and there is not just one explanation that fits all people. That said, I have noticed some common trends and issues that have helped me to understand why something as basic as eating can become so problematic. I'll share some of my observations with you in this post. In a future post, I'll address some other factors (cultural, familial, etc.) that may also play a role.
First of all, it's essential to understand that an eating disorder is not simply a body image issue, nor is it really about food per se. Sure, people with eating disorders are often dissatisfied with their bodies (many think they are "too fat" or are obsessed with a particular part of their body that seems imperfect), and most think about food a great deal of the time (whether counting calories, burning calories, bingeing, cooking, etc.). And to make matters even more complicated, lots of people would like to lose a bit of weight and can even diet or exercise healthily without developing an eating disorder. I think that the difference between those who struggle with an eating disorder and those who can diet and exercise without a problem reflects one’s ability to tolerate imperfections and other painful feelings like inadequacy and uncertainty. No one enjoys those feelings, but if they’re unbearable, then one is more vulnerable to developing an eating disorder or other form of addiction. In other words, the symptoms that are associated with an eating disorder (like restricting, bingeing, purging, etc.) usually reflect anxiety about a myriad of feelings that can't be openly discussed or acknowledged. For many, needing something (food, comfort, support, etc.) feels shameful. This is why I emphasize that eating disorders are not really about food or trying to control one's weight. Eating disorders are about trying to gain a sense of control over one's life and emotions through controlling, and sometimes even punishing, one's body or by using food as a source of comfort.
Let me elaborate on this idea a bit further. An eating disorder is usually triggered by a crisis or event(s) that is subjectively experienced as overwhelming. It's important to underscore that the trigger can be something that many people would think of as minor or as something that occurs in everyday life - like a breakup or struggling to do well in a new class. I can’t underscore this enough - the experience is subjectively experienced as overwhelming. Of course, an eating disorder can also be triggered by something that most of us would think of as overwhelming - like the death of a parent or a sibling. It matters not whether it's objectively and universally seen as overwhelming; instead, the individual's perceptions matter.
This event or experience, as minor as it might seem to someone from the outside, generates feelings and reactions that overwhelm the person who experiences them. In the case of a person who develops an eating disorder, they don't know how to manage and regulate these feelings. When a person also sees such feelings as evidence of weakness or being out of control, the picture becomes even more complicated - the feelings evoke feelings like shame and humiliation. It’s also not unusual to believe that their feelings will burden others, so they hide their feelings from others and rely instead upon their symptoms (bingeing, restricting, over-exercising, etc.) to manage the feelings and anxiety. Unfortunately, others often confirm this in the person’s relational world (more on this in a future post). Whereas many people would gain support and comfort by sharing those feelings with friends or family, people with eating disorders more often feel ashamed of their feelings and needs.
Without another way of managing and regulating these overwhelming feelings, the body (and food) offers an avenue for dealing with anxiety and pain. The focus shifts from the real source of pain to controlling and managing one's body and/or using food as a source of comfort and containment. The focus is diverted from emotions that make the person feel out of control and vulnerable to a behavior that offers a reliable, physical outlet and distraction. This is why it's not as simple as gaining or losing weight. Trying to gain or lose weight without addressing the underlying feelings will overwhelm the person more. This is why sometimes an eating disorder can get worse at the beginning of treatment!
In my work with people who are suffering from eating disorders, I am as focused on identifying and understanding these underlying feelings and helping the person to learn how to respond to their feelings as I am on developing a healthy relationship with their bodies and food. I am interested in helping people reflect on the meaning of their problematic relationship with their bodies and food. It's not simply my goal that the person gains or loses weight, though this is a necessary part of the recovery process. Nor is it my goal to stop a person from restricting, bingeing, purging, or over-exercising. However, these can be expected outcomes of addressing the underlying emotional issues and personal meanings. Instead, I help my patients learn to listen to their bodies and emotions in a new and meaningful way - to hear and respond to anxiety and pain differently. As we understand the origins of the symptoms and develop new strategies for responding to overwhelming feelings, we will also establish a healthier relationship with one's body and food.
Please feel free to post any comments or questions you may have after reading this summary, and I'll do my best to respond. You may also email me privately through this site.
Also, if you or someone you love is suffering from an eating disorder, you might want to check out these websites:
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