Eating Disorders rank among the most serious public health concerns in the United States and have the highest mortality rate of any mental illness.
We, as a country and as a culture, are obsessed with how we look, and the parameters we have created for what is considered beautiful are quite limited. Is it any wonder that so many people resort to extreme measures in their efforts to meet these beauty ideals? Additionally, familial and social messages contribute to how we see ourselves.
Are we told messages such as, "you are beautiful, no matter what." Or, on the other hand, are we told messages such as "that's how fat people think," or "fat is ugly"?
We need to believe the message of "You are beautiful." Period. "You are beautiful." Not pretty, not attractive, not gorgeous, not sexy. Just ... Beautiful. Distorted ideals of beauty are epidemic in our world. And for some, these distortions reach monumental levels that risk their happiness, their sanity, and their very lives.
Eating disorders have everything to do with food, and nothing at all to do with food. They have everything to do with the number on the scale, and nothing to do with that number. They have everything to do with what is perceived in the mirror, and nothing to do with it. Eating disorders are fraught with contradictions that, on the outside, make no sense, but are matters of life and death, both literally and metaphorically, to the individuals experiencing them.
An eating disorder involves an obsession with food, with weight, and with size and shape of the body and specific body parts. It involves going to extremes to lose weight or avoid gaining weight. For some, this means restricting intake to a starvation level. For others it means purging through means such as laxatives, vomiting, or over-exercising. For some it means both. For others it involves a cycle of uncontrollable binging followed by inconsolable guilt and shame.
Whatever the combination of methods and behaviors, an eating disorder involves control. Sometimes, it involves the need to be in control. Sometimes it's the need to feel out of control. And this control is gained by using the body as a weapon.
Secrecy - Secrecy is one of the defining characteristics of an eating disorder. Secrecy is what keeps the eating disorder special. It keeps it personal. It makes the eating disorder a best friend, confidant, primary support, and a dependable coping tool. Secrecy is also what fosters isolation and disrupts primary relationships.
Safe Foods - Something that loved ones of someone with an eating disorder often don't understand is how some foods can be "safe" and other foods can be "unsafe." Often, the rationale behind either of these definitions falls apart under logical scrutiny, and the loved one with the eating disorder is left trying to defend something they know doesn't make any sense.
Here is a message to his or her loved ones:
I know that these distinctions don't make sense. But they hold sway anyway. These definitions, these restrictions - they provide a purpose for me. They give me a sense of strength. They give me the sense that I am in charge. They provide me with assurance that I know exactly what is and isn't going in and out of my body. To me, this is power. And, more importantly, this is safety.
The risks of eating disorders include damage to the gastrointestinal system such as esophageal and gastric ruptures, hair loss, kidney failure, liver problems, and death. Eating disorders have the highest mortality rate of any mental illness.
- Anemia, which can lead to fatigue, shortness of breath, increased infections, and heart palpitations.- Sunken eyes, hair loss, bloating, and dry skin.
- Infertility, increased rates of miscarriage and other fetal complications.
- High blood pressure, elevated cholesterol levels, and elevated triglyceride levels, which may cause hardening of the arteries and heart disease.
- Increased rates of irritable bowel syndrome (IBS), fibromyalgia and insomnia.
- Arthritis (degenerative), caused by hormonal imbalances and vitamin deficiencies as well as increased stress on the joints.
- Increased risk of bowel, breast, and reproductive cancers.
A commonly used technique in treating any mental health disorder is to externalize the problem and give it a name in order for the client to interact with and potentially confront this part of themselves. In treating an eating disorder, a common term for this externalized component has become "Ed", an abbreviation of Eating Disorder.
So, who is Ed? - Ed is the enemy and the best friend. Ed is always there, and can always be depended on. Whenever she turns to Ed, she feels more in control. When he consults Ed, he can breathe easier, knowing he has done the right thing to stay thin.
What role does Ed play in therapy? Externalizing a client's eating disorder helps to separate the person from their eating disorder. It helps to reinforce the idea that the person is NOT their eating disorder, and the eating disorder is NOT them. It helps in the process of excavating the beautiful person that Ed has been attempting to bury all these years.
Recovering from an eating disorder involves a grieving process because it is the loss of a best friend, a coping tool, a security blanket. By giving the eating disorder a name, by externalizing it, a client can more readily conceptualize their grieving process. Grieving the loss of their eating disorder is an essential step in the recovery process.
Harm Reduction - Harm reduction is specifically related to the behavioral side of eating disorder treatment. But before I explain harm reduction, consider this. An alcoholic can entirely abstain from their addiction. But someone with an eating disorder cannot entirely abstain from food. They have to live with it. They have to consume it to live. One comparison I've heard is, "Imagine telling an alcoholic, 'You must take one shot of liquor a day. But no more. And no less. And you have to stay sober and not slip up.' " That is what someone with an eating disorder is facing.
Harm reduction is an approach that must accommodate these contradictions. It involves a very gradual reduction in destructive behavior while increasing health-promoting behaviors. Thus, someone who has had a near-zero intake of calories will not be put overnight on an 1800 calorie a day meal plan the next day. Someone who purges 5x a day will not be required spontaneously to bring that number to zero. Instead, the treatment plan will set up realistic goals that are both challenging and attainable.