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An honest look at eating disorders
By Michele Harman
UAS Counselor
If you think you don’t
know anyone with anorexia or bulimia, think again. These problems
are common among females (and less often, males) on college campuses.
Anorexia and bulimia are struggled with in secret and the person
feels alone and helpless. Living in close proximity to the sufferer
may give friends and family an inclination that something is wrong,
however, their behavior with food and weight changes are sometimes
ignored or rationalized. Often, it takes a crisis for the person
to own up to what they are doing to themselves, and to give a name
to their problem: bulimia and anorexia.
According to the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders (or DSM-IV-TR) anorexia
and bulimia have many common features. The hallmark of these disorders
is extreme concern with thinness and weight. This is accompanied
by an obsession with body size and shape, and a distorted negative
image of themselves. Their relationship with food is very disturbed.
Anorexics and bulimics engage in peculiar behavior with food and
eating. There is a high rate of depression among these groups. The
relationships in the family of these women are usually impaired,
and weight and appearance are heavily emphasized.
What is the difference between anorexia and bulimia?
Anorexics fall into two categories. Both have obtained
a significant percentage of weight loss from their pre-eating disorder
weight. The restricting type of anorexic has achieved weight loss
through dieting, fasting, excessive exercise. During this period
of the disorder they have not engaged in binge eating or purging.
The binge eating or purging type has also achieved the same weight
loss, but does engage in binge eating and purging. (DSM-IV-TR)
Bulimics may be of “normal” or higher than
average weight, but they are distinguished into categories based
upon whether they purge or not. (DSM-IV-TR)
What is a binge? What is a purge?
Try to describe the sensation of a roller coaster ride
to some one who has never been to an amusement park, and that is
what it’s like to try to describe the experience of bingeing
or purging. Not that it’s nearly as much fun.
Bingeing is the act of consuming a large amount of food
in a very short period of time. (DSM-IV-TR) It is like entering
into a fog, where time and space are experienced differently than
normal. It is as if the brain shuts off, and the individual is compelled
and unable to resist the act of binging. After a binge, a woman
may not be able to recall what happened with clarity, or how much
food she’s eaten.
Purging is an act of desperation to undo the binge.
It is an equally driven act, and can be virtually impossible to
control at first. People purge in very dangerous ways: vomiting,
water pills, laxatives, excessive exercising.
With time, anorexics and bulimics are consumed by the
demands of their disorders to the point where everything else in
life becomes irrelevant. Sleep is sometimes the only break from
the mental torture they experience. Life becomes very small, and
the genius and beauty that was possible for their lives dwindles
and dies. According to the DSM-IV-TR, 10 percent of anorexics will
die.
What Causes Eating Disorders?
According to the DSM-IV-TR, both disorders are prevalent
in industrialized societies where there is an abundance of food,
and where attractiveness is linked to thinness. Very few studies
have examined the prevalence of these disorders among other cultures.
Anecdotally, it does appear that very few women of color
present for treatment for these disorders, although that does not
mean they don’t experience these problems. Although most women
in western culture experience the pressure to be thin in varying
degrees, not every woman develops an eating disorder. Despite exposure
to similar social imperatives to be thin, it cannot be that “white-western
culture” creates Anorexia or bulimia by itself. There are many
other biological, psychological, and familial issues that add to
the mix to develop and eating disorder. It is our cultural hatred
of FAT that fertilizes the soil around the seeds of the disorder.
This hatred of fat becomes the hatred of SELF for both disorders,
in which suicidal thinking and desperate measures are common.
In agreement with many great thinkers on the causes
of eating disorders, the common denominator tends to be an initial
significant weight loss through deprivation DIETING. Until the diet
happens, I have never encountered a woman with an eating disorder.
So despite many other contributing factors, women typically do not
develop an eating problem until they DIET. That is the nasty four-letter
word among those in recovery and who treat the disorder.
An individual’s biology and psychology also affect
the development of an eating disorder. It has been found that there
is a high rate of depression and alcoholism among family members
of the anorexic or bulimic. There is also a high rate of depression
among the women with these disorders. Depression and alcohol ism
have been found to run in families, and despite the debate about
nurture or nature, some sort of a genetic component is widely recognized
for these disorders. (DSM-IV-TR)
My personal and professional opinion is that family
dynamics affect the development of an eating disorder as much as
any other factor. I have no research to prove this assumption. In
the years that I have been treating women with ED’s, I have
found two things to be true; it starts with a diet, and there are
family problems. Many times these problems are marital and those
involved are typically unaware of their impact. Very few families
are purposefully harmful to their children, and this is usually
the case with ED families as well.
What can we do?
If deprivation dieting is a common experience that precipitates
the development of the problem, then untying the knot begins with
preventing young women from dieting to fit social norms or cope
with emotional or family problems.
How do women define their worth in society other than
with their looks? By golly, I have been asking myself this for years.
Female worth needs to be redefined to include achievement and ability-based
sources of value, such as academic success, creative power through
the arts, sports, business and financial success. But when 16-24
year old women look for meaningful sources of value for themselves,
they see Victoria Secret models, Playboy playmates, hard-body pop
stars, and 40ish actresses who look 20. All of these women are thin,
beautiful and appear young. It would be hard not to think that losing
weight would be the first step toward this type of social value
and worth. We need role models of beautiful, talented, adored women
who are healthy not necessarily thin. We need to teach our young
people that strict deprivation diets are unhealthy and ultimately
cause more problems with eating and weight loss.
Family Therapy
Families that have health (physical and mental) provide
advantages for their children. No families are perfect, but families
can work to deal with their particular problems. Solving familial
problems, not avoiding or denying them, is one of the greatest gifts
to give children.
Treatment for the disorder
Women with these disorders are caught in a treatment
paradox; they will not be able to change without support and help,
yet they ultimately have to do it on their own. The form of help
that is needed varies depending on the severity of the problem.
Many emaciated anorexics will require inpatient hospitalization
for re-feeding followed by out patient mental health treatment.
Most women with ED’s can benefit from group therapy. Support
groups are invaluable aspects of treatment. These can serve as the
place wherein ED people decide to get serious about recovery, and
become a place for after care once they have made significant improvements.
It is best for all sufferers to work with knowledgeable doctors,
therapists, nutritionists, psychiatrists and family therapists.
How to help a friend
• Tell them you care about their lives and want to help if
you can.
Tell them you think they have a problem with eating.
• Do not give positive or negative feedback about weight loss
or gain. Ignore their body size changes.
• Describe the problematic behavior that you see (I see you
binge, disappear after eating, starve yourself, exercise more than
is healthy, take laxatives, obsess about your body size, isolate
yourself, deny you have a problem, fail in school, seem depressed,
etc)
• Expect denial and minimization of any problem, expect anger
or shame.
• Tell them that what they are doing to themselves is unhealthy,
and can kill them.
• Ask them to make a call to the college counselor for help.
• Stay with them while they call, even come to the first meeting
together.
• Expect that they will not follow through on getting help;
giving up the ED is more difficult than you can imagine.
• Do not ignore their problem, but do not focus only on this
in your friendship. Have fun together too.
• Continue to tell them that you know there is help available,
and that you will go with them if they need the support.
• Never, ever, congratulate them on weight loss, or commiserate
with them on weight gain. Just say that it’s their eating behavior
that is the problem, not their body, and you won’t
• Remember that their eating disorder belongs to them, not
you. Do not work harder to help them than they are willing to work
to help themselves.
• Take care of yourself; it can be exhausting to try to help
someone with anorexia or bulimia.
Women who are affected by these problems are cut down
in the prime of their lives. At the moment in the life cycle when
important choices are being made, these young women are being forced
back into the “kitchen” by their eating disorders. They
are then excused from making self-aware choices about their futures
and goals. It is a retreat, a stagnation, and avoidance of becoming
valuable, adult, and female, which unconsciously, our western culture
does not have a healthy template for in the modern world. It may
be exactly because there are so few role models for females (except
young, beautiful and thin) that women falter at this developmental
crossroad.
In order to recover, these young women have to pull
their worn bodies and tired minds up and out of the hole their in,
eat for strength and well being, and venture off into the unknown
territory of self-re-definition. Eating disordered women in recovery
are among the bravest and most courageous of people; they face the
future, often standing alone for unvalued principles, and create
themselves as women as they go.
If you or someone you know struggles with anorexia or
bulimia, there is help available. Please call Michele Harman at
465-1298 in the counseling office on campus for help finding the
right treatment.
A free on-campus support group is forming and slated
to begin 1/24/02, from 11:45-1:00. Location will be announced. Please
sign up at the Student Resource Center information desk, or call
Michele Harman directly.
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