Multiple Sclerosis
Deborah DeCairos Grandmaitre, M.Ed., CCC
Canadian Certified Counsellor
Eating Disorders:
An Examination of a Psychological Illness as a Coping Mechanism, and it's Underlying Issues
What is an eating disorder?
In order to keep consistency within this paper, the following definitions for eating disorders stem specifically from Mack's extensive work in the area.
There are different types of eating disorders. One type is bulimia nervosa (BN), which is typified by binge eating. This denotes an intake of unusually massive quantities of food in a discrete time period. The binge eating is pursued by purging, which is an intended behavior used to thwart off weight gain. Some more common forms of purging behaviors can include: excessive exercise, self-induced vomiting, and laxative or diuretic abuse. Therefore, there are two types of BN: purging and non-purging, which typically start to develop in early to mid-adolescents, but are not as common in boys. Some warning signs are: when a person of normal weight will make frequent excuses to go to the bathroom after eating a meal, and you can sometimes notice severe mood swings. Since they may also eat large amounts of food, on the spur of the moment, this may be noticeable in the home, where there will be an inexplicable disappearance of food. There are medical complications that result from this binging/purging cycle, which can include: a flushing of sodium and potassium from the body, which results in an electrolyte imbalance; arrhythmia, which can lead to heart failure and death; stomach acids eroding tooth enamel, which comes from frequent vomiting; irritation and tears in the lining of the throat, esophagus and stomach, also from frequent vomiting, and the failure to have normal bowel movements caused from abusing laxatives (Mack, 2004).
Anorexia nervosa (AN) is another form of an eating disorder, which is affected by a multifaceted fusion of social, physical and psychological problems. However, there are four principal characteristics, which are: a powerful drive to be thin, an extreme fear of gaining weight, a distorted perception directly related to body image, and for women, not having a menstrual cycle for three months or more, which is defined as amenorrhea. Therefore, a feeling of control is achieved by rigorously limiting the amount of food that is eaten. The two types of AN are: restrictive, and the binge eating/purging type. We know that approximately 95% of individuals with AN are female, and that psychological dilemmas are transferred onto food. A common way they allow themselves to take pleasure in food is often by cooking it, serving it or simply being around it. In addition to having a fixation with their body weight, their body image is distorted, often leading to negation of their condition, which can be severe. This causes grave difficulty for those around them, especially their loved ones. Some warning signs in AN are: the substantial or an excessive loss of weight, for no known medical reason or illness, an unusual decline in the intake of food, a ritualistic form of eating, such as cutting up food into extremely small pieces, negating the fact that they need to eat or are hungry, often criticizing and intolerance towards those around them, excessive exercising, making statements such as "I'm too fat", even when it is not true, and concealing their feelings. The medical complications of AN are severe. Intentionally starving the body robs it of protein. It also prevents the body from metabolizing fat, and causes the body to decelerate in order to protect itself. This causes alterations in the heart muscle, its beating becoming irregular. There may be dehydration, with the development of kidney stones, possibly resulting in kidney failure. There may also be loss of bone calcium, which often leads to osteoporosis (Mack, 2004).
Another form is binge eating disorder, which is also the ingestion of extreme amounts of food within a specific period of time. However, there is no purging. There are overwhelming feelings of loss of control, and there is a noticeable anguish regarding their eating behavior. Studies estimate that roughly 25% - 50% of obese people binge. They will also eat hastily, and they continue to eat after the point of being full. They will often eat alone, and feel disgusted with themselves after overeating. Medically, binging without purging can cause high blood pressure, and elevated levels of cholesterol and triglycerides. These can all lead to hardening of the arteries, which produce heart disease and heart attacks. In addition, the pancreas becomes stressed because of the excess consumption of sweets and junk food, causing abnormally low amounts of glucose in the blood. In later years, this may result in the development of type 2 or secondary diabetes (Mack, 2004).
However, it is important to note that approximately half of eating disorders are considered atypical, which means they do not fall under two of the aforementioned types, anorexia and bulimia. This does not mean they are not as serious. Binge eating is considered atypical, and this atypical category is called "eating disorders not otherwise specified" (EDNOS) (Mehler & Anderson, 1999).
Finally, someone who has an eating disorder is worried, or constantly thinking about and controlling their body weight, shape, physical appearance, or food intake. This gets in the way of happiness and every day life. Contrary to a study proposing that disordered eating is simply a "consequence" to shifting attention away from threatened goals, it is recognized that experiencing an eating disorder essentially means the individual is trying to cope with underlying issues or pressures in their life (Troop, 1998; Mack, 2004). I have personally experienced "ED as a coping mechanism", in my own life, and through clients who attended a support group that I co-facilitated.
Eating Disorders as a Coping Mechanism
The traditional treatment approach is to assess the individual's medical history and perform a physical examination. The intention is to arrive at a firm diagnosis of an eating disorder. Taking a medical history includes questioning the patient about dietary habits and weight history. Particular attention is paid to eliciting history of use of diuretics, diet pills, and laxatives. It has been demonstrated that laboratory tests are also mandatory in order to detect complications, such as chest pain, dyspnea, hypotension, intestinal infections, and bradycardia (Mehler & Anderson, 1999). While this is an essential part of the treatment process, especially with severe anorexia nervosa cases, lost in this process is the fact that an eating disorder is a coping mechanism for other underlying issues, such as poor self-concept, family history issues such as sexual abuse, and media influences. It is recognized that eating disorders illustrate some comparable signs with substance abuse and dependence, but this does not rationalize referral to eating disorders as an addiction (Poston & Haddock, 2000). If we compare eating disorders to substance abuse, we know that we need to eat to survive, but we do not need to consume alcohol to survive. We also know that the addiction model cannot connect eating disorders with those who have survived sexual abuse, or those who want to drastically change their body size, which I will do in this paper.
Drawing on personal experience and the literature, I have come to believe that eating disorders are not an addiction, but very much a coping mechanism. As seen with my friend Joy, the start of her eating disorder was after losing her long-time boyfriend and companion. This is both a traumatic event in one's life, and also a loss of personal identity, because part of our identity is interlaced into our intricate interpersonal relationships. I also see eating disorders used as a coping mechanism, through my participation in support groups for eating disorders. Many women and men use it as a means to get through terrible trauma, and to cope with stressors in their lives. This is how they survive the trauma, being or having been inflicted on them. Once we understand this, we can move forward, to gain perspective on the illness itself, and bring the underlying issues to the forefront. It has been reported that having an eating disorder is a significant way of disavowing psychological pain. "Just as people may flee from experiencing physical pain by using sedative drugs, those who misuse food may do so to hold certain feelings and experiences at bay. This distancing maneuver allows them to steadfastly forswear certain aspects of the past and present" (Zerbe, 1995, p 328). Similarly, it has been indicated that uninvited eating habits surface as a means for coping with identity and attachment, and a wide array of trauma, such as sexual, verbal and emotional abuse. While these women collectively have a craving to be thin, their diverse stories expose how this craving disguised their struggles to subsist the pain from the traumas suffered. "Therefore, attention to this ideal of slenderness must focus on its symbolic function rather than its causal significance" (Lelwica, 1999, p.63).
Underlying Issues
The following discussion takes a look at eating disorders as a result of one's self-concept, which include low self-esteem, poor body image, media influence, and family history, such as relationship problems, sexual abuse, trauma and/or violence, and societal and family pressures in general.
Self-Concept
An adolescent going through puberty will experience numerous different physical and mental changes. These changes culminate to an impracticable quest for thinness. Unfortunately, studies report that this leads to an "over-generalized self-improvement", and is considered to be the principal element in forecasting restriction of food, and resultant eating disorders (Fister & Smith, 2004). This has also been linked to the desire to attain social acceptance, through altering one's appearance, resulting in excessive measures to keep body weight under control. These are some of the drastic behaviors undertaken in order to establish one's self-worth. For boys, there is also that need to achieve and keep a masculine appearance/shape, which has been directly linked being grounded in their male identity. Unfortunately, this only provides a pseudo positive self- concept. Some specific practices for males both adolescent and men are the use of anabolic steroids, excessive bodybuilding, which includes weight lifting and muscle toning. It is not uncommon to see males exercising in the gyms for more than two hours at a time, which can be considered excessive. This obsessive desire and these practices have been labeled the Adonis Complex. The risks are high, producing metabolic and endocrine abnormalities due to the steroids. In addition, it has been proven that steroids can produce depression, and reduced sexual functioning (Mack, 2004a).
A recent research study performed by marketing students at the University of Ottawa reported an alarming result, showing that males are dissatisfied with their body. More specifically, males in the social sciences faculties had the highest risk of having an eating disorder (L'Abb‚, Nooyen, Rouleau, Sarault, & Thibeault, 2004). In fact, they had the highest usage of laxatives compared to males in other faculties (L'Abe‚ , 2004). The table below shows interesting results relating to males and females, per faculty, that use laxatives (L'Abb‚, 2004).
| Proportion en pourcentage (%) des étudiants susceptibles de souffrir de troubles alimentaires catégorie boulimie ou utilisation de laxatif par faculté : | |
|---|---|
| Arts | 10% |
| Sciences Sociales | 60% |
| Sciences Santé | 20% |
| Gestion | 0% |
| Autres | 10% |
| Total | 100% |
The males in the social sciences faculty were also more likely to vomit after eating (L'Abb‚, 2004). In summary, they were found to be, without a doubt, the highest risk group (L'Abb‚, 2004). On the contrary, other studies have investigated gender differences in how content people are with their bodies, and the most universal discovery is that women report more discontentment than men (Rugel, 1995). Women report feeling dissatisfied with individual body parts, their body as a whole, and their body weight. In fact, a disturbed body image is so rampant among women that it can be expressed and defined as "normal". This is primarily due to three distinct transformations: onset of menstruation, dating, and academic pressure. We can also categorize these into the following: developmental and socio-cultural. Self-esteem can be explained in relation to three key areas: competence, social acceptability, and physical attractiveness. It has been determined that all are tied into the fear of rejection, fear of failure, and insecurity about their own physical attractiveness (Rugel, 1995). In fact, the process becomes a vicious cycle, as dieting causes stress, which can place people at risk for depression and, at the same time, this can decrease their self-esteem. Also, we know that diets do not work, and only lead to frustration, which again leads to decreased self-esteem. For children, differences in their self-concept are apparent early on, as their body shape is linked to self-esteem in girls, but it is speculated that this is not the case with boys.
It has been observed that for female adults, perfectionism is a characteristic associated with disordered eating, and also linked to the relationship between performance and self-concept, through the superwoman idea (Robert-McComb, 2001). This superwoman idea or perfectionism can also be linked to observed behavior, such as within our family system. Other studies propose that perfectionism is linked to ineffectiveness (Franco-Paredes, Mancilla-Diaz, Vazquez-Arevalo, Lopez-Aguilar, & Lvarez-Rayon, 2005). Therefore, this indicates that low self-esteem, which is a key component of a person's self-concept, is a major risk factor for developing an eating disorder and is greatly interrelated with body dissatisfaction (Johnson, Crosby, Engel, Mitchell, Powers, Wittrock, & Wonderlich, 2004). This is contrary to some researchers who observe neurological disorders as being accountable for poor body image (Thompson, 1996). Clearly media plays a role in poor body image. In addition, low self-esteem has been defined as causing irrationality, defensiveness, non-assertiveness, and self-blaming. Low self-esteem is also related, of course, to family history, such as sexual abuse. For women, it has been speculated that this even extends into their social groups, predisposing them to extreme sensitivity when interacting socially, which results in excessive self-criticism (Brown, Waller, Meyer, Bamford, Morrison, & Burditt, 2003).
Upon examination, this tells us that overall, women report lower self-esteem and higher body dissatisfaction than men, suggesting a partiality of gender. However, one important exemption to these findings is with black women (Johnson et al, 2004). Interestingly, it has been reported that black women's self-esteem, body satisfaction, and eating behaviors bear a strong resemblance to black males. In fact, their high self-esteem scores were practically no different to not only black males, but also white males. This finding is also consistent with the literature that demonstrates that "black females report higher self-esteem than white females, that their self- esteem is more resilient throughout puberty, and that their body satisfaction is less affected by the current cultural idealization of thinness" (Johnson et al, 2004, p.155). Finally, our self- concept, such as our self-esteem, affects our lives in many ways. It especially has a major affect on our emotional, mental, and physical health. It also impacts our spiritual side, and influences our social development. Thus, in the case of an eating disorder, stifles our personal, and occupational growth (Mack, 2004).
Media Influence
The image of an ideal body may come from various sources. However, one common and consistent source is the media. To try to attain the idealistic view of thinness, it has been estimated that 80% of females have dieted or are dieting (Robert-McComb, 2001). This thin white female is predominantly portrayed in film, videos, magazines, and on T.V. Unfortunately, there is substantial proof that this exposure to appealing, thin females escalates depression, shame, stress, and body dissatisfaction, particularly in women already at risk for eating disorders (Fister & Smith, 2004). Even though it has been argued that the media could portrait women of natural size, in order to encourage a positive, and healthy learning experience (Fister & Smith, 2004). However, most advertising is not meant to be a learning experience, but rather to make money. More specifically, females reported that watching T.V., movies or reading magazines makes them want to diet or lose weight. Another result due to this exposure is beliefs such as: "clothes look better on people who are thin" (Cusumano & Thompson, 2000, p.41). Other media influences were portrayed in another study that documented fads over time in relation to the muscularity of male action figures, such as G.I. Joe. They data illustrates that "when extrapolated to human size, today's G.I. Joe figure would be just as unattainable to boys as the Barbie doll is for girls" (Olivardia, Pope Jr., Borowiecki III, & Cohane, 2004, p.112). Even cartoons on television are influenced by the perfect body image (Robert-McComb, 2001). Therefore, not just women, but it is recognized that also men are struggling to meet an unattainable body, due to pressure from the media, which is ever-increasing. (Olivardia et al, 2004)
In fact, as addressed in one study, physical beauty is often shown in magazines, not so much as an "aspirational idea, but rather almost as a holy commandment, with it's "be more beautiful" discourse" (Malson, 1998, p.111). Another study estimates that "a generation ago the average model weighed 8% less than the average woman, whereas today, models weigh 23% less" (Robert-McComb, 2001). Even magazines that are advertising unrelated material will show very thin women on their covers (Robert-McComb, 2001). The current obsession for boys is with the "skinny, lean and hungry look". "Everywhere you look, from the catwalks to the silver screen, desperately thin is in". Harris (2005) writes that "this emphasis on male waifishness is part of the aftermath of the metrosexual trend, and for most men an impossible goal". Advertisers think that we are more likely to buy products from good-looking, thin people than from average or unattractive people. And they may be right. Unfortunately, we buy products not knowing for sure if it will improve our appearance. In the meantime, some of us are actually becoming sick trying to have a "perfect" body or face (Graydon, 2003). It is estimated that women's magazines have ten and one-half times more ads sponsoring weight loss tips and programs than men's magazines do. Researchers have also documented that over three-quarters of the covers of women's magazines contain at least one connotation regarding how to change a woman's physical appearance either by dieting or exercising, which are forms of bulimia, or cosmetic surgery. It is also estimated that the average person sees between 400 and 600 advertisements per day, and 1 of every 11 advertisements carries an unswerving connotation to beauty, and this isn't including messages that are delivered indirectly.
Another study showed that when girls reached the age of nine, 80% had already tried dieting or were practicing on-going dieting behavior (Mack, 2004b). This is directly linked to their self-concept and it's key factors: acceptance and self-esteem. More specifically, although young black girls normally would look up to black women as a role model, which have been reported to have a high self-esteem, this may be shifting. Unfortunately, study findings are proving that since young black girls are being exposed to the same media pressures as white girls, they too are becoming obsessed with their body image, and succumbing to eating disorders. Many of these younger black teen girls also feel insurmountable pressure to have a perfect body, as shown on TV and in magazines (Ward, 2000). There are many ways to remove the obstacles to creating a positive identity. One way is to give our young positive feedback, in order to increase their self-esteem, which will contribute to an overall positive self-concept. In addition, teaching our young how to view media images critically rather than simply accepting them, and recognizing the point of view from which they are presented, and imagining alternatives. Especially concrete tangible misinformation from the media, such as the "air- brushing" in the magazines, in order to portrait the "perfect body".
Family History
We discover hunger within our family, and in the harsh inflexibility of gender differentiation. In other words, men eat, and receive, women feed, and nurture. Even today, when the roles are interchangeable, where we find mothers in the work place and fathers at home on paternity leave, changing diapers, the gospel for the female gender is alive and well. Mothers who are beleaguered by diet and weight loss, are not only troubled and preoccupied with how they look, but disgusted by their own body, cannot easily educate their daughters to love food, to feel happy-go-lucky about their weight and body image or embrace the female shape. It is all about role modeling, which is why the media has such a strong influence on us, and it is also an intricate transmission of a daughter's hunger covered in gloom by a mother's defenselessness or anguish caused by her underlying issues. The intricate relationship between one's identity and attachment are linked to a mother's strengths, weaknesses, hopes, disappointments, love, and rage, all absorbed by a daughter. "Known to the daughter so deeply internal and wordless, that it becomes part of her own marrow, as present and unquestioned as the air she breathes". The daughter cannot grasp an alternative way of being (Knapp, 2003, p.66).
Paternal behavior, especially overprotection, makes an individual feel like they are inadequate or ineffective, and we know that ineffectiveness is linked to perfectionism, which is linked to body dissatisfaction, and can lead to disordered eating. Many bulimic families, therefore, have great difficulty enduring and adapting powerful feelings. "These painful emotions are "unacceptable". This is internalized as a sense of shame about themselves, within the context of the family, and in contexts beyond the family" (Reindl, 2001, p.18). Attitudes and values are absorbed at a young age, and these are the force behind wanting to lose weight, which can be started by one specific incident, such as a comment by a mother, which will trigger something, especially in an individual that is predisposed to an eating disorder (Mehler & Andersen, 1999). Often our mothers grew up with poor self-esteem themselves, along with being influenced by the media, only to keep reinforcing a poor self-concept.
More specifically, children who are exposed to stress that is inescapable, such as childhood traumatic abuse, will be at a higher risk for uncontrollable actions and reenactment of the trauma by punishing one's self through self-abusive behavior. In other words, there is a greater likelihood that clients will show signs of bodily self-injury, such as having an eating disorder, if they have had extreme experiences with trauma related to violation of boundaries, such as with sexual abuse, which is directly related to the disruption of bonding and attachment between parent and child. Some of the adaptive, but very distorted behavior relating to symptoms of an eating disorder are: numbing, reenactment of abuse, such as through repetition and compulsion, self-punishment or punishment of the body, cleanse or purify the self, attempt to "disappear", as with anorexia, create large body for protection, or create small body for protection. These are strategies in attempting to stay alive, in the face of overpowering, devastating, on-going, inescapable stress and acute trauma in childhood. For example, when there is sexual abuse, three factors are disguised as the enemy: the body, one's sexuality, and one's gender. In order to survive, the abused has thoughts such as: "I was abused because of my femaleness". Therefore, there is an attempt made, albeit distorted, to attain an unattractive body, in order to keep the abuse absent (Schwartz & Cohn, 1996). Incest victims will report that they feel or felt "dirty", therefore their bodies are perceived as being dirty or "filthy". This is a form of cleansing the body, refusing to eat. There are many cultural and religious beliefs that relate fasting with virtue and purity. It is believed that fasting can get rid of sin and guilt. However, refusing to eat was still not considered detrimental to the point of officially diagnosing an eating disorder (Marvasti, 2004).
Upon examination, studies reported "women who have been sexually assaulted by family members are more likely to have symptoms of an eating disorder than women who were either sexually assaulted by someone outside the family or were not assaulted at all" (Robert-McComb, 2001, p.168). In addition, there are many other indications, through expressions by the victim, that abuse took place, such as self-mutilation, alcohol and drug abuse, placing oneself in dangerous situations, suicidal, and sexual problems (Mack, 2004c). In fact, self-mutilation, such as cutting, also known as SIV (self-inflicted violence), is an extremely common coping mechanism found in people also experiencing an eating disorder. It is seen as a way to cope by dealing with real physical pain, rather than the pain inside them or their emotional pain (Something-fishy, 2005).
We are not only dealing with abuse or family relationships, but also pressures from society play a role in eating disorders. Studies report that sexual behaviors over the past thirty years indicate that female teenagers are having sex at an even earlier age. Studies hypothesize that it is because teenagers are trying to make sense of life in a sexual atmosphere in which traditional middle class sexual self-regulation has come undone, and on the verge of non- existence. It is speculated that eating disorders may embody the requirement, and the will, to rein in this sexual upheaval. This recognizes that there is a connection between experiential sexuality and eating disorders for among teenagers. To deal with this overwhelming peer pressure and upheaval, suppressing or hampering their sexual reaction provides teenagers with an eating disorder a feeling of, again, control over their lives (Robert-McComb, 2001). Being in control is central to the eating disorder as a coping mechanism. Being able to cope means having control.
Finally, knowing the triggers, some of which are: feelings of failure, depression, abuse, and peer pressure, can help us understand what someone with an eating disorder is going through.
References
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