This is the question with which people with eating disorders are confronted again and again by parents, spouses, friends, and themselves. Costly experiences with programs promising an end to the food behaviors once and for all frequently lead to brief abstinence followed by devastating resumption of old and familiar patterns. Regardless of whether the person starves, binges, binges and purges, abuses laxatives, compulsively overeats, the story of a roller coaster experience with behavior changes is all too common. Until the behaviors in an eating disorder are viewed as the symptoms rather than the problem, the focus of recovery remains in the wrong place, and the person is likely to experience limited success in attempts to recover.
Most people have great difficulty understanding the function of the behaviors in an eating disorder. Why would someone starve herself to the point of death, as often happens in anorexia nervosa? Why would someone binge and then induce vomiting or painful diarrhea, as happens in bulimia nervosa? Why would someone eat so much that all she can do is lie down and fall asleep, as often happens for compulsive eaters? Why would someone maintain a body weight that is so high that she is physically uncomfortable and potentially endangering her health, as often happens in obesity?
There is rarely a simple explanation for an eating disorder. It is an extremely complex problem and may be caused by a number of factors which may include family and cultural pressures. Eating disorders may also occur as a result of psychological and interpersonal factors. Feelings of inadequacy, depression, anxiety and loneliness, difficult family and personal relationships may all play a part.
Frequently the person who has an eating disorder outwardly appears to be managing life very well. She is also a person who feels she would look better if she lost some weight, which means she could be virtually anyone in our society. At some point in that person's life there is an event or a series of occurrences and situations which symbolizes one or more of the following seven scenarios.
The common thread in all seven scenarios is that a person is experiencing emotional pain at a level of intensity that she does not know how to manage in a healthy way, mainly because she did not learn to express feelings directly while growing up. Many families are not able to model or teach how to express feelings in a way that promotes closeness, support, or resolution of conflict. So when a person who grew up lacking these skills experiences intense emotional pain, she lacks the tools to talk about it or to ask for support.
It is at this point that something very significant happens. The person begins to focus upon her body or food, looking outside rather than inside for the source and solution to the emotional pain. Once this starts, the person travels one of two paths. Following the first path, she begins to eat and finds food a source of comfort and nurturing. Food is consistent, reliable, and always there. It is something to look forward to coming home to at the end of the day as well as something to which to turn to when alone and scared. The person finds that when she eats, the pain does not hurt quite so much. This person is vulnerable to becoming overweight or obese due to compulsive eating.
Following the second path, the person begins to restrict food intake or to binge and purge and starts to lose weight. As she loses weight, people make comments like "Oh, you look so good! You've lost weight!" In a world that is very painful, suddenly there is something that feels good, brings positive attention, and is within her control. The person finds that the more she focuses on counting calories, exercising, dieting, losing weight, or purging, the less she feels the emotional pain. This person is vulnerable to developing anorexia nervosa or bulimia nervosa.
Portions of this article are reprinted from "Eating: Disorders. Nutrition Therapy in the Recovery Process" (1990) by Dan Reiff and Kim Reiff, PhD of Mercer Island, WA, published by Aspen Publishers, Inc., Aspen, CO. The portions of the article that are directly quoted have been reprinted with full consent and permission from the authors.