Humans have always maintained a love-hate relationship with food. Medieval saints such as Veronica and Catherine of Siena fasted on herbs and orange seeds and received what was believed to be affirmative revelations from God. Enlightenment era Protestantism attempted to refute the claims of rationalism through fasting miracle women such as Ann Moore, who appeared to abstain from food for five years. The late nineteenth century brought forth the attention-seeking daughters of the bourgeoisie, who engaged in food-shunning as a means of emotional manipulation.
Today anorexia (prolonged limiting of food intake) and bulimia (binge eating followed by purging) have taken center stage in the dieting fixation saga. More and more people—mostly women, mostly young—are falling under their spell. Perhaps the truth of these words assaults your consciousness. Perhaps you can’t look at these afflictions in a cold, clinical way because when you gaze on them there’s a face attached—perhaps that of your daughter, son, parent, friend, or spouse. Or maybe it’s your face.
If you or a loved one suffers from anorexia or bulimia, you may be wondering if things will ever change. You recognize the power of compulsive behavior and the persistence with which it rears its ugly head. “Are these conditions treatable?” you ask with a hint of desperation in your voice. “Is there hope?” The answer is an unequivocal, indisputable, unambiguous yes!
The means of treating these disorders have multiplied along with the cases themselves. Outpatient options for the less severely afflicted, as well as treatment centers for those who need inpatient treatment, are popping up everywhere. Wading through the milieu of methods, however, can be a daunting endeavor. For the sake of clarity, let’s get an overview of therapy types.
This type of treatment deals primarily with the overt habits involved in an eating disorder. The idea is to retrain the person to eat normally. Systematic desensitization pairs deep muscle relaxation with the mental imaging of scenes involving food. This ostensibly enables an anorexic to relax his or her fear of eating.
The treatment labeled “reinforcement” is nothing more than behavior modification that rewards good behavior with special privileges and, in some cases, punishes bad behavior. For instance, some treatment facilities confine patients to their beds if caught bingeing. Behavior therapy is useful for bringing the behaviors under control, but since it doesn’t get to the root of the problem, it has a high relapse rate when used alone.
This type of treatment has received very positive reviews from health luminaries such as Neil Nedley, who verifies the effectiveness of cognitive-behavioral (CB) therapy in the treatment of depression. It not only brings negative behaviors under control but addresses the wrong thinking behind the behaviors.
During CB therapy there’s a concerted, systematic effort to bring the thoughts into sync with reality. Diseases of the mind always involve some kind of cognitive distortion, and eating disorders are no exception. Correcting wrong thoughts such as “I’m fat,” “Bingeing will make me feel better,” “If I lose weight, I will be successful,” and “I’m worthless” is essential to the healing process.
The trick with treating eating disorders—especially anorexia—is that the behaviors can affect the mind in such a way that it becomes resistant to treatment. The brain is a physical organ and must be properly nourished in order to be sufficiently malleable to undergo change. The malnourishment caused by anorexia can put the brain into an “unreachable” state that must be corrected before therapy can begin. This is why cognitive therapy is combined with behavioral therapy.
“Bibliotherapy” is essentially cognitive therapy because it prescribes the reading of books and articles that focus on the individual’s illness. Often this journey out of ignorance into awareness provides a needed sense of objectivity. Eventually the student achieves a sense of mastery as they learn to speak transparently and accurately about their problem. This also enables them to take responsibility for their own recovery process.
This therapy is related to Freudian psychoanalysis and similarly delves into the patient’s experience with early caregivers—usually parents—and the role those relationships played in the formation of the emotional/cognitive patterns. Childhood traumas can and do hamper an individual’s development, and result in a deficiency of the internal resources required to handle life. Some schools of psychotherapy purport to “re-parent” the individual so that proper development can resume. Some forms of therapy treat patients like infants, incorporating touch and other forms of carefully controlled coddling.
While it’s true that love is the grand, overarching power behind all healing, this love is most effectively experienced in a nonclinical, spontaneous setting. Much research indicates the very positive effect of socialization upon mental health. Coming out of isolation into community is essential to an addicted person. But we must be cautious. Since this first step toward connection is nearly impossible for someone who is locked away in an addictive cycle, a professional counselor is often an essential aid.
Freudian psychoanalysis, which can lead the patient to dwell extensively on past abuses, has not been proven effective. The patient must, however, “connect the dots” between past trauma and the poor choices they have made in response. Then it’s the job of the therapist to lead the patient in making better choices.
The goal of the family therapist is to work his or her way out of a job. Ultimately, if successful, patients will rebuild and repair familial relationships in such a way that the family becomes the primary support network for the patient.
In the 1970s therapists often recommended a “parentectomy” for eating-disordered patients while they were undergoing treatment. Many patients, upon returning home, fell back into old patterns because they were recon-fronted with old mental triggers. Today, many therapists include family therapy in their work with eating-disordered patients because healthy family functioning is essential to relapse prevention.
Because they bring a sufferer out of isolation into community, support groups provide a powerful push toward healing. Eating disorder recovery groups range in intent from educational to therapeutic. The national association of Anorexia Nervosa and Associated Disorders (ANAD) sponsors support groups all over the country, as does Overeaters Anonymous (OA). These groups are free of charge, making support groups the most economical form of therapy.
A large percentage of eating-disordered patients—especially those with bulimia—have a family history of depression. This seems to imply that there’s some genetic/biological predisposition involved in the disorder. Because of this, antidepressant therapy tends to work for bulimics.
Anorexia is not as responsive to antidepressant therapy. This may be because, unlike bulimics, who feel a keen sense of self-reproach about their problem, anorexics tend to like having their disease. Anorexia is considered an “ego-syntonic” disease, meaning that it is “in sync” with the ego. For this reason, anorexics tend to erect a barrier of complacency and self-satisfaction, which makes it difficult to alert them to danger. Yet even anorexics can eventually feel a sense of defeat as their condition advances. It’s essential to stay on the lookout for opportune moments to offer help.
There are several natural means of mood elevation that are worth trying before seeking drug therapy. The negative ions in fresh air have a mood-elevating effect. Morning sunlight increases melatonin production, which enhances sound sleep. Exercise is a powerful stress reducer; and a healthful, plant-based diet can improve mental functioning.
What’s a Mother to Do?
Or a father, brother, friend, or spouse? When you love someone who has an eating disorder, how do you offer help without scaring them away? Please consider these three steps:
Approaching someone with any addiction requires a gentleness and tact to which most of us are strangers. If you have never prayed before, now is the time to start. God is the “Opener of Doors” and the “Giver of Words.” Read up on your loved one’s condition, and then look for the opportune moment to speak. Take care not to be overbearing, judgmental, or controlling. Be as nonconfrontational as possible. Your goal is to lead them to self-disclosure.
Once this takes place, be on your guard against confusing the individual and the disease. Remember, they are not a problem. They are a person with a problem. Retaining a strong sense of personhood is essential to their healing.
Some eating-disordered individuals will want help. Some will not. This is where you can patiently, carefully share the effects of the disease on both the individual and their loved ones. The process of leading a person to a decision to get help may be a protracted one with much listening, reasoning, and give-and-take. If it starts to escalate into an argument, take a break and wait for another open door.
Beware of your own tendency to shut out your expressions of pain. Most of us are poor listeners and will say such things as “I know,” or “I’ve been there” prematurely. Listening is one of the rarest of social skills. Be someone who’s good at it.
When heart-to-heart communication has taken place, the opportunity to make an appeal will come. Ask gently if the person is willing to get help. Let them know that you will work with them toward that end.
Once the decision to seek help has been made, it’s your job to connect the sufferer with those who can help them most. First and foremost, family and friends are essential. Continue to engage in social activities (preferably those that don’t revolve around food). Attend church and nurture the sufferer’s spirituality. Professional help may be needed as well. (See the sidebar for Web sites that can assist in finding just the right counselors, therapies, and treatment centers.)
We must never forget that the power behind all healing is our heavenly Father. Because He’s a God of compassion and love, He bathes the world in something called grace. This grace is available to all, at any time, and in any circumstance.
Keep in mind that God will not force His grace upon anyone. It’s through the channel of free choice that God pours healing power into our lives. When all human resources have dried up and when every person we know has lost confidence in our potential, God still considers us candidates of grace. The moment we choose Him, the way is opened for hope and healing.
Did you happen to miss Drop Dead Beautiful Part 1. If so, be sure to check it out!
Singer, speaker, and anorexia nervosa survivor Jennifer Schwirzer is the author of several books including Dying to Be Beautiful. She’s a mother of two and lives with her husband, Michael, in Pennsylvania.
Originally published in Vibrant Life, used with permission.
1 East Apache St.
Wickenburg, AZ 85390
Center for Eating Disorders
St. Joseph Medical Center
7601 Osler Dr.
Towson, MD 21204
Small Group Support Organizations:
World Service Office
6075 Zenith Court Northeast
Rio Ranch, NM 87144-6424
Anorexia Nervosa and Associated Disorders (ANAD)
P.O. Box 7
Highland Park, IL 60035
Eating Disorders Awareness and Prevention (EDAP)
603 Stewart St., Suite 803
Seattle, WA 98101
Web-sites on Eating Disorders: