Eating disorders are extremely complicated.  They involve psychological, emotional, physical and spiritual “malnutrition”, if you will.  Persons with eating disorders have very deep feelings about the psychological, emotional, physical, and spiritual malnutrition they have suffered throughout their lives.  I have told clients for years that eating disorders are about disorders of feelings.  Be this I mean that people who suffer from eating disorders are numb to many if not all of their feelings and when they do not begin to feel their feelings, they do not know how to deal with them internally nor how to express them externally.  Eating disordered persons speak a non-verbal language which expresses their feelings about this malnutrition via intrapersonal and interpersonal relationship dysfunction.  Understanding the meanings of this non-verbal language is the key to treatment and recovery of eating disorders.

    In my experience, both personal in that I am a “recovered” anorexic and compulsive overeater, and as a clinician with almost 20 years of treating eating disordered clients and teaching other clinicians about eating disorders and their treatment, I have found eating disorders the most difficult of the “addictions” both to treat and from which to recover.  Eating disorders are similar to other addictions in many ways and they are vastly more complicated in other ways.

    It is my opinion that the “disease/addiction” model of eating disorders is the most effective both in treatment and in recovery.  An eating disorder can be characterized in many ways.  An eating disorder is a dis-ease which is progressive; it is chronic; and it is fatal.  It is progressive in that it continues along a predicable course.  It is chronic in that it persists and gets worse over time.  It is fatal in that a person can die from it just as surely as one can die from alcoholism or other drug addiction.

    There are two types of addictions.  One type of addiction is an addiction to a substance such as the legal drug alcohol or prescription drugs or an illegal drug such as cocaine.  The other type of addiction is to a process, the action and ritual involved in doing something.  Compulsive gambling, debting, shopping, and codependency are examples of process addictions.  Actually, the substance addictions also involve process addiction in that they contain ritualistic behaviors which are part of the addictive process, for example, the alcoholic going to the same bar and being greeted by his or her familiar friends, or going at the same time of day to the bar, or drinking a certain drink with a certain meal before participating in a certain activity.  The ritualistic behavior serves as a purpose in that in its familiarity it has a comforting quality.  The actual ritualistic behavior as well as the emotional comfort it provides calms the addict and diverts his or her attention from negative emotions.  That is, the addict can focus on the ritualistic behaviors surrounding eating, not eating, purging, to avoid dealing with the world and their emotions. 

    Eating disorders are both substance and process addictions.  For eating disordered persons food is the drug, just as for alcoholics alcohol is the drug, for cocaine addicts cocaine is the drug, and for marijuana addicts marijuana is the drug.  Eating disorders are process addictions in that part of the addictive quality is about the process of buying the food, preparing it, cutting it, obsessing about whether or not they will eat it or not eat it, throw it up or not throw it up, whether or not they will compulsively exercise, take laxatives, diuretics, or diet pills, whether or not they have gained weight or not, whether or not a certain size of clothing still fits or won’t fit.  The process has a “drug like” quality in that a type of “high” is achieved and there is a temporary diversion or escape from the current life situation.  Likewise the process of gambling is the compulsive gambler’s drug, the process of shopping is the compulsive shopper’s drug, the process of sex…the secrecy, the chase, the conquest, is the sex addict’s drug.

    Eating disorders are the most complicated of addictions for a number of reasons. First, abstinence is an option with other addictions.  An alcoholic abstains from alcohol, a cocaine addict abstains from cocaine, a compulsive debtor abstains from using credit cards, a compulsive gambler abstains from going to the race track.  Eating disordered persons are unable to totally abstain from food!  We must deal with food at least three times a day.  Total abstinence is not possible, because we must eat to survive.  Eating disordered persons must continue to deal with their “drug” numerous times everyday, every month, every year.  The “drug” is constantly “in their face”.  This alone complicates the treatment and recovery process.

    Second, eating disorders involve distorted body image.  That is, persons suffering from eating disorders do not accurately see their bodies as others see them.  Anorexics and bulimics are disconnected from their bodies and assess their bodies as larger and weighing more than they actually do.  Thus anorexics are continually focused on not putting food in their bodies, while bulimics are continually focused on ways to urge consumed food from their bodies.  Compulsive overeaters are also disconnected from their bodies and are most often unaware of their actual body size and weight.  Thus, compulsive overeaters can continue to eat and eat over years until one day they report “awakening” and being incredulous that they weight so much.

    Third, there are tremendous societal and peer pressures toward developing eating disorders because of our society’s focus on physical appearance.  We are a society obsessed with looks.  The message we hear from the time of being very young children is that in order to be accepted we must look a certain way.  This preoccupation with looks tells us that we must be obsessed with our body size and appearance.  As a society, we have allowed media to define for us what we should look like, in essence, who we are.  Since the media has created impossible standards, the majority of the population is unable to “appear” as we are told and shown we should “appear”.  This disparity between this unrealistic standard and reality creates very deep dissatisfaction which fuels low self-worth.  Low self-worth is a core issue to be dealt with in the treatment and recovery of eating disorders. 

    Fourth, discomfort with sexuality is a pervasive issue for persons with eating disorder.  Most often there is a conflict between wanting to grow up and be an adult and the fear of growing up and becoming a sexual being, a person responsible for one’s body and sexuality.  By this I do not mean gender preference, but a “comfortableness” being a sexual being and all that that involves from dating, to becoming the object of another person’s sexual desire, to having sexual intercourse, to becoming a parent, and so forth.  Exacerbating these issues of sexuality very often are the traumas which come from being sexually abused a s a child, teenager, or adult.

    There are essentially three types of eating disorders: anorexia, bulimia, and compulsive overeating (also know as binge eating).  Anorexia can be defined as an obsessive pursuit of thinness.  Anorexics intentionally starve themselves in order to be thin.  The term “anorexia” literally means “without hunger”.  This term is actually a misnomer, because anorexics do feel hunger, but disavow it, and over time become numb to the physical sensation of hunger.  Most often, anorexics become malnourished due to their sever food restriction, for example, allowing themselves to eat only one apple or one carton of yogurt in a day, or eating vegetables and no protein.  Most anorexics are obsessively fastidious about their food, for example cutting every little bit of fat off a piece of meat, or cutting their food into minute pieces before consuming.  Most compulsively exercise and abuse laxatives and/or diuretics.  Medical complications include but are not limited to cardiac arrest, osteoporosis, amenorrhea (loss of the menstrual cycle).

    The second type of eating disorder is bulimia.  The term “bulimia” actually means “ox-like hunger”.  Bulimics compulsively eat often very large quantities of food and then to avoid gaining weight purge the food through a combination of self-induced vomiting, compulsive exercising, use of laxatives, diuretics, strict diets, and fasts.  This is called the binge-purge cycle and this cycle can be several times a day, daily, every other day, or weekly, just as alcoholics can drink several times a day, daily, every other day, weekly, or several times a year.  Medical complications include but are not limited to dental problems such as tooth enamel loss and receding gums, cardiac arrest and kidney failure. 

    The third type of eating disorder is compulsive overeating, or binge eating.  Compulsive overeaters are unable to control their food intake and have continually used dieting, unsuccessfully, to either control or lose weight.  Studies show that over 90% of people who lose weight by dieting gain all the lost weight back plus up to 30 pounds more!  This is a phenomenon called “diet induced obesity”, whereby with each diet, the body’s metabolism slows down, so that the body retains more weight, because it thinks it is starving to death.  This is one of the human race’s instinctual survival mechanisms to eschew famine.  This “yo-yo dieting” syndrome characterizes compulsive overeating and negatively affects self-esteem.  Medical complications often include but are not limited to joint stress, hypertension, diabetes, and heart disease.

    In this series of articles on eating disorders I will discuss in more detail the etiology, or causes, characteristics, and effective treatment of eating disorders in general and each of the three eating disorders specifically.

(This article appeared in the July 2000, edition of www.anonymousone.com, an Internet recovery magazine.)

Carol R. Hughes, Ph.D., is a licensed marriage, family and child therapist, a board-certified clinical hypnotherapist, and a former professor of Human Services at Saddleback College.  Her academic background includes being a summa cum laude graduate, a Phi Beta Kappa member and a two-time Fulbright scholar.  Twenty-five years of wide-ranging experience have given her a unique perspective on human problems.  Carol is a respected expert and sought-after speaker in the fields of family therapy, child and adolescent behavior, adult children of alcoholic and other dysfunctional family systems, and addictive disorders.  Her clinical background includes extensive training in chemical dependency and eating disorders and their effects on families.  In her private practice, Carol currently facilitates therapy groups and workshops for parenting, eating disorders, sexual abuse, addictive disorders, and adult children of alcoholic and other dysfunctional family systems.