Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
There is a common denominator to the problem of eating disorders. This common denominator is that those with eating disorders have difficulty expressing the management of their feelings. How emotions are handled depends on the kind of eating disorder suffered by the patient. Anorectics starve themselves to prove how good they are. Bulimics, denying emotions, purge after having binged. Those with binge eating disorders stifle their emotions by stuffing themselves with carbohydrates. Whether it’s the purging of bulimia or the frantic eating of binge disorders, people are drugging themselves into passivity and sleep.
The theme of each of the eating disorders is the attempt to cope with emotions that feel chaotic, frightening, overwhelming and dangerous. When people indicate that the eating disordered individual is trying to exercise control, they are correct. However, the issue of control is misunderstood. The anorectic, bulimic and binge eater are attempting to gain a sense of control over their internal worlds of chaotic and frightening emotions. The problem is that the strategy selected to control emotions is dangerous to the individual’s health and life. Anorexia, if left uncontrolled, leads to death as a result of malnutrition. Constant purging in bulimia is harmful to teeth, esophagus and stomach and binge eating leads to obesity and early death due to strokes, heart conditions or complications caused by diabetes.
What is not clear is why the people who develop these disorders experience difficulty coping with emotions? At the same time, it is important to point out that not everyone who has difficulty with emotions develops an eating disorder. Despite the fact that there are many theories about the causes of eating disorders and research continues, very little is really known about why particular individuals develop these problems as opposed to a variety of other disorders. Theories range from the emphasis in Western Culture on thinness with advertising campaigns portraying the ideal man and woman as thin, to depression, the need for perfection, family dynamics and genetic predispositions. Also, there is a tendency to believe that the symptoms of these illnesses point to the causes. For example, if the need to be perfect is a symptom of anorexia, the cause may be demanding parents who are never satisfied with the child and who demand more than the child can deliver in school, sports and physical appearance. All of these theories contain elements of truth. The problem for so many people is the inability to know what to do to prevent children from developing an eating disorder. In addition, parents end up feeling terribly guilty if their children develop eating disorders. With so much emphasis on dysfunctional families, it is natural for thoughtful and caring parents to assume they must have done something terribly wrong to cause the problem.
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For some individuals, eating disorders begin quite by accident and for others, there is a conscious effort to lose weight or relieve tension. For example, a number of male and female patients suffering from bulimia nervosa, report that discovered the importance of purging either by accident after recovering from too much alcohol consumption, by being ill with the flu, by experimenting with purging or by learning about it from a friend and experimenting with the same behavior. While the reaction to having purged is usually disgust and a feeling of shame, there is also a sense of relief from having purged. It is that sense of relief that is sought after among those who purge. The relief is based on two major factors: 1. After purging there is a false belief that the intake of calories has been avoided and 2. After purging, the brain seems to increase the amount of endorphins secreted, resulting in a euphoric and calm feeling, much like that experienced by drug abusers. Because of the intense feeling of shame experienced by the bulimic, the purging is done in privacy and is kept secret from friends and family.
Individuals, who become anorectic, usually begin by attempting to lose some weight. Immediate success in weight loss produces a feeling of exhilaration and power that spurs the individual to increased efforts to reduce and restrict food intake and lose weight. It is a myth that the anorectic does not feel hunger. In fact, hunger and food become major fixations in a way that is typical of obsessional thinking. It is the ability to master and control hunger pangs that fills the anorectic with joy and with the thought that they are accomplishing something that friends and other peers cannot accomplish. The joy of weight loss and mastering hunger becomes so powerful, that the individual looks in the mirror, sees his or herself as fat and goes at weight loss with renewed determination.
The binge eater is an individual who experiences a sense of tension relief that results from consuming large amounts of carbohydrates in a manner that is incredibly fast. Taste and quality of food mean little or nothing. The main goal, either consciously or unconsciously, is to achieve a tranquil state of being, similar to that achieved with Valium. In this case, the intake of food serves as a kind of drug abuse. Following a binge and sense of calm, usually after a nap, the individual experiences of storm of self-hate and self-contempt for having consumed so much food. In addition to this self-loathing there is the realistic worry about gaining weight. The binge eater is often afflicted with weight gain that can result in obesity.
Whatever the particular eating disorder with which the individual is struggling, there are powerful emotions lurking underneath. These emotions include depression, hopelessness, emptiness, self-hatred and anxiety about entering the adult world.
What characterizes each of these illnesses is the lack of learned skills on which the individual can rely to cope with stress in school, at work and in social situations. If left untreated, the downward spiral of hopelessness and depression can result in a kind of suicide resulting from the very real physical problems created by the eating disorder.
Cutting and Self-Mutilation
It is not unusual for some people suffering from eating disorders to engage in direct bodily self-harm in an attempt to reduce the emotional pain and suffering. The self- harm can occur in the form of cutting and self-mutilation with a razor, knife or any sharp instrument. The individual suffering from bulimia or binge eating may engage in alcohol and drug abuse. This is less likely with someone suffering from anorexia because they are extremely restricting with their diet and with what they allow into their bodies. Ironically, the restrictive anorectic may escape the dangers of drug and alcohol abuse. However the anorectic is not at all immune to the dangers of all types of self-harm.
Males and Eating Disorders
Eating disorders, especially anorexia and bulimia, are most commonly associated with females. The illness asserts itself during early adolescence. However, it is not unusual for women to experience the first symptoms of starvation or purging during their twenties. There are some people who experience a combination of anorexia and bulimia. These are people who severely restrict their diets but purge after eating any meal they consider fattening. Increasingly today, more young men are experiencing the symptoms of eating disorders. Parents can no longer feel secure in the belief that, if they have sons, they are immune from the distress of eating disorders. Similar issues are at work for males with eating disorders as with females. Managing the inner world of emotions, including sexual tension, anger, fear, depression and hopelessness motivate more young men to resort to bingeing, purging or starving as a way of burying uncomfortable feelings.
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