Why Eating Disorders Are So Misunderstood and How to Heal From Them
Why Eating Disorders Are complicated and Difficult to Treat
“What’s wrong with me? Eating should be simple!”
This is a statement I so often hear from my patients who struggle with eating, and it always pains me. Such a statement is an internalization of what society tells people — that eating is a basic drive and there is something wrong and shameful about not having it under control. Yet the very society that tells us we should have it under control is the same society that perpetuates thinness as an ideal, eating as a way to push down feelings, and in turn, ends up perpetuating this struggle.
As opposed to disorders like depression and anxiety, which are generally more accepted as a disease with a biological basis, eating disorders are so often misunderstood. What’s particularly troubling are the false beliefs people may have about them — such as, it is a choice, it should be easily overcome, and ‘normal people’ don’t struggle with food — all of which are very far from the truth. In fact, eating disorders are quite common. According to the National Eating Disorder Association, nearly 10 million American women suffer from an eating disorder, with between 10 to 15 percent of all Americans suffering from some type of serious eating disorder. According to the South Carolina Department of Mental Health, eating disorders are far from easily being overcome: 77 percent of individuals with eating disorders in the U.S. report that the illness can last anywhere from 1 to 15 years, and only around 1 in 10 people suffering from an eating disorder receive treatment. Eating disorders are a serious problem, and too many people have been struggling alone for far too long.
Eating Disorders, Obesity and the Media
The relationship between eating disorders and obesity is also complicated. On one hand, the United States is obsessed with thinness, as evidenced by what we see on television and in films, on social media, and advertising every day, and ranks among the top countries in the world in terms of eating disorders. On the other hand, we also have the highest obesity rate in the world. According to the Center for Disease Control and Prevention (CDC), over 61 percent of Americans fall into the category of being overweight, with 42 percent meeting the criteria for obesity. This creates a vicious cycle in which people feel pulled to a thinness ideal for fear of being labelled as “fat.”
The reality of body shape and size in the United States is in sharp contrast to how people are portrayed on TV. According to Banker (2010), people tend to judge their own body shapes and sizes, as well as their loved ones’, on public opinions and beliefs about eating, food, and weight. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAS), only five percent of American females naturally possess the body type that is most often portrayed in advertising. They also note that 47 percent of girls in fifth to twelfth grade reported wanting to lose weight because of magazine pictures and 69 percent of this same group said these types of pictures influence their idea of a perfect body. What is especially concerning is how young this starts: 42 percent of first to third grade girls report they want to be thinner, and 81 percent of ten-year-olds report they are afraid of being fat.
What Causes Eating Disorders?
While we are all subject to the ideals of thinness portrayed in the media, not all of us end up with an eating disorder. Why? What contributes to the likelihood of developing an eating disorder?
While researchers tend to debate the exact reasons some people develop eating disorders while others do not, there is general consensus that there are significant risk factors. These include both genetic and environmental factors, which oftentimes interact with one another. As suggested by Verywell Mind, if a person has an increased biological sensitivity to weight-related teasing, it may make them more likely to develop an eating disorder, while another person who was equally teased may not. However, this same biological sensitivity could be counteracted by a positive environmental factor, such as supportive parents, who help instill a healthy body image and adaptive responses to teasing.
Eating Disorders and the Tendency Towards Perfectionism
While there are a myriad of genetic and environmental factors at play, the most prominent personality trait I see in my work with patients struggling with eating disorders is perfectionism. This idea has been widely researched and is generally accepted as a significant risk factor. For example, Bardone-Cone et alt, (2007) identified a total of 55 papers published between 1990 and 2005 that assessed perfectionism among individuals with diagnosed eating disorders. Of particular interest is a study conducted by Bulik et alt (2003) entitled, “The Relation Between Eating Disorders and Components of Perfectionism, which notes that “elevated concern over mistakes is associated with anorexia and bulimia nervosa, but not with other psychiatric disorders.” In other words, those who obsess over mistakes are more likely to develop anorexia and bulimia, but are not as likely to develop other mental health disorders.
My conceptual understanding of this relationship between perfectionism and eating disorders is that deeply rooted perfectionism leads people struggling with eating disorders to feel quite imperfect. Because they feel their current weight is imperfect, they feel compelled to strive for perfectionism in both their looks and their eating. What I find is that it is less about “I need to be pretty,” and more about “I need to be good.” I find that patients believe, consciously or unconsciously, that if they can only be “good” and reach their goal weight, get rid of what they perceive as fat, and maintain the perfect/restrictive diet, then they will somehow feel absolved; not only of their imperfect bodies, but also of what they perceive as the inordinate amount of mistakes they have made in their lives, for which they tend to have an exaggerated sense of guilt.
Getting Help for an Eating Disorder
While there are a variety of types of therapy that address eating disorders (e.g., CBT, DBT, mindfulness, etc.), the most important aspect of therapy is the connection between the therapist and the patient. It is always important to find a therapist who is well-credentialed and licensed to practice mental health, but it is equally important that a person feels free to discuss his or her issues without fear of judgment. This is true for most concerns, of course, but I find it even more important for those struggling with an eating disorder, because they are so often plagued with guilt and remorse.
We incorporate hypnosis into our treatment in addition to more traditional techniques, such as CBT, interpersonal therapy, and psychodynamic techniques; however, hypnosis should never be considered a quick fix. When used in a therapeutic setting, hypnosis offers the opportunity for the patient to quiet his or her own mind and get in touch with that true desire for change. This therapeutic technique doesn’t change the person, but instead, helps the person put the power back into his or her own hands.
Dr. Sera Lavelle is a Licensed Clinical Psychologist at NY Health Hypnosis & Integrative Therapy. To learn more about how mindfulness & hypnotherapy can help you or to make an appointment, please contact us here.
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