As with most people, I am sure you have an opinion about this topic. I think most people have ideas around this subject, and possibly under or overdiagnose this disorder. I hope this article will answer some of your questions and outline some of the criteria giving you a clearer picture of a disorder which affects more individuals than we can begin to imagine.
It is a myth that eating disorders affect just adolescent girls
Also known as a process addiction, like most addictions, eating disorders are not sexist or ageist.
Process addiction, what is that? Unlike chemical addiction, where you uncontrollably and repetitively ingest chemicals or alcohol, a process addiction is characterised by uncontrollable, repetitive behaviour, and the thoughts connected to that behaviour. Examples may be sex, eating, gambling, shopping, excessive exercising, and co-dependent relationships.
It is important to remember that sobriety from a chemical addiction is complete abstinence from drugs. Whereas sobriety in the case of a process addiction is a much more tricky affair. An individual suffering from a binge eating disorder, cannot just stop eating. Likewise, a sex or love addicted person, cannot be expected to just stop having any form of relationship with others.
Another important piece of information is that eating disorders do not always stand alone, and people may suffer from both a chemical and a process addiction, or have more than one of each. This is where cross addiction comes into play, giving up the one addiction, but then turning to another, or using one addiction to support another. An example may be when an eating disorder client uses drugs to curb their appetite.
But what behaviour explains the eating disorders very essence?
To answer this I make use of the term dysfunctional eating. Dysfunctional eating, in this case, refers to an obsessive preoccupation that the person develops with eating and what they look like. So much so that there is very little time or energy left for anything else, and their lives become unmanageable. Their relationships, work, self-care, and daily responsibilities take a back seat, due to these obsessive behaviours and thoughts. The person has taken to reaching outside of themselves, to solve an unhealthy relationship within themselves. Food is what they use to process their emotions. Food is what they sometimes deny themselves as a means of personal punishment. Food is something they might indulge in, to use to soothe themselves or reward themselves. Food is something they might reject to change their body shape, in the belief that this will fix their internal turmoil. They might use it to drive people away or control the way people behave towards them. Everyone’s eating disorder is different, but also strangely the same.
Three of the classification categories according to the DSM5 (diagnostic and statistic manual of mental disorders, fifth edition) are Anorexia, Bulimia and Binge-eating.
Anorexia is thought to be the most fatal of all psychiatric illnesses. The main criteria for “ANNA” (as some clients refer to it) is a low body weight. People suffering from this disorder will also have body image distortions, i.e. seeing themselves as overweight, even when they are not. Anorexics have an obsessive fear of gaining weight, which manifests by the individual depriving themselves of food. This behaviour will more than likely be coupled with excessive exercise or laxatives, induced vomiting, over-exercising, diuretics or enemas.
Try and imagine your worst fear and being faced with that every day, three times a day. This is how the Anorexic experiences meal times, and any interaction with food, or even potential interaction with food.
It is a myth that if you have an eating disorder you will be under weight. Bulimia Nervosa is characterised by an individual eating abnormally large amounts of food in a considerably short period of time. These foods are normally high in fat and sugar content. Also, known as binge-eating. The Bulimia cycle is exhausting and soul destroying. The individual starves themselves of food, due to deep-set feelings of physical and mental loathing, shame and guilt. This starvation triggers a compelling need to eat – a normal starvation reaction. The individual ignores the signals from the body, until the need to eat nourishment is experienced as unstoppable. Then the individual breaks down and binges. The binge is then followed by increased feelings of self loathing, shame, guilt and a sense of loss of control. The individual then compensates for the binge, through self-induced vomiting. Not all people suffering from Bulimia purge through vomiting, and some use overexercising, fasting, and or the use of enemas, or diuretics, including laxatives. Whatever the chosen behaviour is, the importance is that the self defeating cycle continues, and the person is stuck, not moving forward or backward, but staying on what might feel like treading water, with their head just millimetres above the surface.
Unlike Anorexia, a person suffering with Bulimia usually maintains a normal weight or is slightly over or under, which generally makes it harder to detect than serious cases of Anorexia or Binge-eating. Many people, including some health professionals, miss the diagnosis of Bulimia, and this disorder can go undiagnosed for years.
It is a myth that all over weight people are over weight because they just love food. Binge Eating Disorder is when individuals binge without the overcompensatory behaviour, including frequently eating large amounts of food when not hungry. The individual might eat excessively throughout the day, or eat moderately and then have one or more binges per day. During binges, the food is consumed more quickly than normal. These often happen in secret, and binge eaters might hide or lie about their food intake. This cycle is also characterised by guilt, and shame, around their eating pattern. In response to these emotions, the individual will go through periods of choosing to starve themselves of all nourishment, or attempt diets to try and reduce the traumatic and overwhelming emotions they experience around eating. The individual losses all enjoyment around food, and there is a push pull dynamic around eating, guilt, shame, and physical and mental loathing.
Its all about the food but it is not about the food
The most important fact to remember about eating disorders is that no matter what dysfunctional pattern the person has chosen, it is a symptom of an unhealthy relationship with themselves. The individual, in desperation, has reached outside of themselves, to try and solve a problem inside of themselves.
So treating this disorder needs to be a dual process. The individual needs to build an awareness around their dysfunctional eating patterns, and look at less dysfunctional options. Including looking into their personal dynamic, and working on making positive changes to their relationship with themselves.