Factors and Root Issues ~

Understanding Anorexia

Anorexia was originally defined as “loss of appetite of nervous origin”. There is more to anorexia than “nerves”, however, because the physiological changes resulting from the disorder cause further problems to develop. Also, the anorexic has usually conquered her appetite rather than lost it. The nickname “the slimmer’s disease” is also misleading. It does not take into account the underlying psychological problems that go with the desire to be thin, including in some cases wanting to avoid adulthood by staying a child externally.

Signs and Symptoms of Anorexia

Some of these may be seen and some will be hidden. It is important that diagnosis is made by a doctor as the weight loss may be due to some underlying illness. Anorexia nervosa often includes depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories. Person may have low tolerance for change and new situations; may fear growing up and assuming adult responsibilities and an adult lifestyle. May be overly engaged with or dependent on parents or family. Dieting may represent avoidance of, or ineffective attempts to cope with, the demands of a new life stage such as adolescence.

• Active refusal to eat enough to maintain normal weight, or vomiting or purging with laxatives
• severe weight loss of 15% or more of body weight normal for height and age
• loss of menstrual periods for at least three months, or very light, irregular periods for six months.
• Excessive concern over appearance, with fear of weight gain
• excessive exercise in an attempt to control weight
• avoidance of “fattening” foods
• denial of hunger
• skipping lunch at school or college
• hiding or discarding food
• obsession interest in calories, weight and body shape
• having to eat alone, unobserved
• emotional and irritable behavior, indecisiveness, apathy, depression
• possible change in personality
• adopting ‘black and white’ thinking and attitudes
• arranging rigid and inflexible routines for work and exercise
• perfectionism about work, reworking material over and over again
• becoming aggressive and manipulative
• increasing isolation
• loss of close friends
• changing from team sport to solitary sport
• insomnia
• feeling cold
• growth of downy hair on the body.

Portrait of an Anorexic

A 15 year-old schoolgirl looked at her family’s holiday photos and decided that she and her mum ought to go on a diet together. Mum failed and she succeeded, which made a rift between them because her mother became unsympathetic when the girl began to refuse anything that wasn’t a diet food. Her school friends were full of admiration though. She was already the ‘best’ at academic work and now she had decided she must be the slimmest. Everyone was competing to eat very little at lunch time and they had ways of disposing of their packed lunches, throwing them in the river or giving them to the boys. No one noticed how thin she was getting because the big school jerseys hid her arms. She was away from everyone else too because she had started running several times a day, even getting off the bus early and running part of the way home. Her school marks began to drop but she was unconcerned because she now had a new and totally absorbing main interest, namely calories and food avoidance. She got up earlier than her family, disposed of a bowl of cornflakes and milk down the lavatory, so really the evening meal was her only problem. Often she managed to have an argument at the dinner table and leave the meal uneaten.

Underlying Issues in Anorexia

• longing for love
• low self-worth
• perfectionism
• negative feelings
• desire to be in control
• denial
• distorted view of body image
• intense fear of gaining weight
• intense fear of rejection
• wanting independence versus wanting to be dependent
• identity crisis
• fear of sexuality

Understanding Bulimia

Bulimia means “ox-like hunger” or voracious appetite. It was first diagnosed in 1979 and so is a relatively new disorder, although the habit of bingeing and vomiting or purging with laxatives has been recorded for thousands of years. Bingeing usually involves eating exceptionally large amounts of high calorie foods in a comparatively short period of time. This generally happens in response to negative feelings of anger, anxiety or shame caused by what the person tells herself about a given situation or set of circumstances. However in some cases there are physical factors involved, such as a food sensitivity (in which eating a little of a specific food, such as chocolate, seems to be a powerful trigger) or premenstrual syndrome giving rise to sugar-craving.

Bingeing can bring the person to a point of sedation and ward off sexual feelings, or it can be used to ease a sense of loss in a relationship. By eating enormous amounts the person is saying “I am desperately needy”, and then by purging herself through starvation, vomiting, laxatives or diuretics, she is saying “I reject it all. I don’t deserve anything”. Two episodes of bingeing and purging per week for three months is one of the criteria for diagnosis.

Bulimics can be of normal weight, or under- or overweight.

Signs and Symptoms in Bulimia

You may observe some of these, but often the bulimic will make every effort to keep them hidden. Many sufferers with bulimia have depressive symptoms and it may be that their binges started off as a way of coping with feeling unhappy. However, feeling stuffed and bloated will make these feelings worse, while vomiting and purging leave a feeling of guilt and wretchedness.

• Recurrent episodes of uncontrollable eating
• devious and deceptive behavior
• repeated attempts to lose weight
• vigorous exercise and dieting
• sore throat and erosion of tooth enamel due to vomiting
• menstrual disturbances
• dehydration and poor skin condition
• intense desire to look good and be in control
• dramatic extrovert behavior
• making close friends, being demanding, dropping them
• seeking help, then rejecting it
• ‘multi-impulsive’ antisocial behavior (any of the following in addition to the bulimia: alcohol or drug abuse, stealing money for binges, lying, promiscuity)

Portrait of a Bulimic

An attractive young woman who has tried several slimming diets recently, usually consisting of an allowance of 500 calories a day because she is keen to get results quickly. She admits that she can never keep to that for more than a week. The more she tries to diet the more she wants to binge and she just cannot stop thinking about food. She gets home from work before anyone else in the house and she eats all the sweet food she can find. Then she goes out and buys replacements from the corner shop, plus an extra bag of food, preferring things that she can eat really quickly. She eats a normal evening meal, then goes back and eats all the leftovers. By that time she is not bothered what the food is. It matters a lot to her to look good and appear to be very confident, but inside she’s very unsure of herself. She worries a lot about what other people think of her. She has had lots of close friendships, but always ends them suddenly. When her diets didn’t work she tried taking laxatives and a friend took her to a rather seedy ‘clinic’ where a man who said he was a doctor gave her some slimming pills. That was when she started to sleep badly and began having extra binges in the early hours of the morning. She felt so awful after them that she was glad to find that it was really easy to make herself vomit. At last she had the answer and she could eat as much as she liked without suffering the consequences.

Underlying Issues in Bulimia

• longing to be loved
• low self-worth
• negative feelings
• ambivalence about desiring control and independence, and conversely feeling helpless and wanting to be dependent
• conflict
• ambivalence to food, to relationships and to recovery
• misuse of sexuality
• denial
• fear of discovery and rejection

Understanding Compulsive Overeating: Food hunger or love hunger?

We define compulsive eaters as people who eat to satisfy emotional hungers, of which they may not be aware. The compulsive eater may be many pounds or stones overweight but this is not the real issue. More important are the reasons for compulsive eating. The compulsive eater is addicted to food in much the same way that an alcoholic is addicted to alcohol or a workaholic to work. This strong emotional reliance on something external makes the person feel good on the inside and is called codependency. Unless the underlying issues for this behavior are identified, the person will never be free from this compulsive relationship with food.

Common Reasons for Compulsive Eating

• eating to relieve stress or depression
• using food as a tranquilizer
• using food to satisfy the need for immediate gratification
• focusing on the desire for food to avoid facing real problems
• subconsciously wanting to add pounds to protect oneself from intimacy

Portrait of a Compulsive Overeater

A warm and cheerful 36 year-old woman, who is single and has a full-time job in the church. She has always been somewhat overweight, but it doesn’t seem to make any difference to her competence and she says: "what matters most is who you are, not how you look". She’s invited out for meals quite a lot and people make a special effort then, with puddings and pies and cream, and butter on the vegetables. Church functions center around endless quiches, sandwiches, cakes and biscuits. The problem is that when she goes home she feels very lonely and needs to eat quite a lot to feel okay before she tries to get to sleep. The more she eats the more guilty she feels. She likes muesli and thinks that’s all right because it’s a healthy food, but the dried fruit makes her crave for raisins and nuts, so she often raids her store cupboard for those items and eats them in handfuls. Sometimes when she’s preparing talks she starts on the biscuit box - and doesn’t stop. After a difficult business meeting she usually treats herself to a chocolate ice cream bar. She keeps them in her freezer for the youth group. She remembers that her Mum always handed them out to cheer the children up when they were ‘down’. They don’t make choc-bars so big nowadays so she sometimes eats two or three. Then she feels angry about her lack of self-control.

Underlying Issues in Compulsive Overeating

• love-hunger
• low self-worth
• negative feelings
• sense of loss, loneliness, emptiness
• disappointment in relationships
• denial
• food masking emotional problems
• food being used as a tranquilizer
• fat seen as a means of self-protection
• fear of slimness

We consider compulsive overeating, bulimia, binge eating disorder, and some forms of anorexia ( e.g. bulimarexia) to be part of an addictive process. Hence, we refer to these in terms of "food addiction." The "drive" or compulsion to overeat despite obvious consequences is similar to the plight of alcoholics and those suffering from other addictions. In fact, many food addicts are either currently struggling with, or have encountered problems with other dependencies.

Compulsive eaters who resort to "purging" via laxatives, diuretics, diet pills, vomiting, food restriction, and/or excessive exercise are addicted to a vicious cycle of binge eating and a relentless effort to avoid weight gain (bulimia). Still others are equally driven to lose weight by purging in one form or another whether binge eating or not (bulimarexia). We believe all food addicts have in common a debilitating obsession with food and body image coupled with an inability to manage (control) their eating behavior.

The poorest measure of an eating disorder is what someone weighs or how often they binge eat or purge...rather, it is the degree to which the quality of their life has deteriorated. Although food addiction presents itself in many different forms, the common denominator is a loss of control: first over food, then over the ability to effectively manage one's life.