What "defines" an eating disorder?
No one wakes up one day and says, “today sounds like a great time to start my eating disorder.” Eating disorders are not a choice. The are not pleasant. They are by definition a mental health condition.
But what creates this shift for people and why are they so hard to let go of?
What are eating disorders?
I could rattle off the clinical definition and descriptions of eating disorders according to the DSM. There’s anorexia nervosa, bulimia nervosa, binge eating disorder, other specified eating disorder, and avoidant restrictive food intake disorder.
But more often than not, clients don’t fit “neatly” into any given box. They struggle to see their own experience within those descriptions, which feel too clinical and behavior based, not encompassing the lived experience.
While the DSM has its place, I find that exploring the shared drivers of over identification, fear, rigidity, and isolation more valuable.
Over Identification
With the exception of ARFID, eating disorders are experiences that often start with someone over starting to over identify with a certain body, food, and/or performance. This means that folks develop beliefs that “who” they are the value they offer to the world is based upon their body shape/size, food decisions, and / or movement patterns. ARFID often doesn’t have this identity aspect, but it shares many of the other characteristics.
It isn’t disordered in and of itself to have goals (or even values) around food choices, sport, or appearance. But the distinction is that true values are NOT rooted in fear of what might happen if this pursuit is interrupted or violated.
Fear
Folks become afraid (terrified) of what might happen if they do (or don’t) continue to eat or move in a certain way. That fear leads to rigid behaviors and rituals that feel protective from the fear of what might happen. This often looks like obsessing around numbers, nutrients, textures, and/or ingredients. There may be compensatory or backlash behaviors that occur as a result of the restrictive behaviors.
Rigidity
As a way to respond to the fear, folks may create rituals for reassurance that their fear won’t happen. These are the disordered behaviors we are often working to interrupt and soften. How it shows up varies person to person.
Some examples include, eating the same foods, eating (or not eating) at particular times, avoiding foods based on ingredients, comparing themselves to others, weighing themselves, body checking, counting calories, compulsively exercising, and more.
There’s often a strong tendency to rationalize choices – that deviating from the rules is only permissible under certain conditions. This leads to a LOT of rumination (or excessive thinking) when rigidity is challenged trying to find a way to make it feel emotionally ok, and feel reassured that their fear won’t come true.
Isolation
The relationship of fear, worth, and worry often leads to social isolation. It can feel like “too much” to be around others when your mind is perpetually trying to plan how to respond to certain body cues and eating opportunities and spending excessive time after trying to rationalize behaviors.
Due to the overidentification, folks start to attribute uncomfortable emotion to their food / body / movement. Basically, they experience an uncomfortable emotion like uncertainty, sadness, or isolation. Instead of understanding this emotion in isolation, they believe, “I feel alone because my body is bad/wrong.”
On one hand, this creates a sense of control – “if I can just ‘fix’ this part of me, I won’t have uncomfortable emotions.” But it’s a short cut in the wrong direction and reinforces the eating disorder. It keep folks from learning the actual skills needed to sit with and navigate uncomfortable experiences.
It’s important to be clear that eating disorders are not a choice.
They are a mental health condition that affects folks across the age, gender, size, and racial continuum.
They arise from a combination of genetic, environmental, social, and biological conditioning.
What makes this so hard?
Clients commonly want to be free of the distressing parts of their eating disorder. They often share desires such as …
- “I want to think less about food”
- “I want to be more present with my friends and family”
- “I want to be less obsessed with movement”
- “I want to be less hungry”
- “I want to eat without guilt”
- “I want to be able to eat out”
- “I want to feel better in and about my body”
While folks long for these experiences, the “threat” of their body changing is over powering and ultimately keeping them from these experiences.
In short, they want to experience less fear, rigidity, and isolation but struggle to confront experiencing their worth / value beyond their food / body / movement.
How do we heal?
Challenging the protective parts of the eating disorder is uncomfortable (to put it lightly). Often when folks try to change their behaviors and shift out of past rigid patterns, they experience significant distress and discomfort. It is far “more comfortable” to maintain disordered behaviors than to let go.
It is important that folks pursue recovery rooted in their values – which is about identifying what qualities / characteristics are most important to you and the experiences that you want more of out of your life.
By knowing what’s truly most important to you, it creates additional identities, that balances the power of the eating disorder.
With this guiding light, it begins to feel more possible to challenge fear and rigidity without losing who we are and what we stand for.
That doesn’t mean the journey is “easy” – it’s uncomfortable to step into new space and forge a new path. But the result is a life lived moving towards purpose.