Recovery is Possible
This original version of this article was written 17 years ago. It was the first in a series of columns which appeared four times a year in the Capitol Region Association for Eatings Disorders newsletter. As I pondered what to write about back then, several aspects of eating disorders came to mind; i.e. etiology, body image, nutrition, society, feelings... The list was endless. I finally concluded that what I wanted to offer most in this first column was hope. I wanted to spread the message that recovery is possible.
Until 30 years ago I did not know this. I've learned a great deal through working with patients who struggle with eating disorders as well as from my own experiences. Seeing patients experiment, learn, grow, change, and finally become free of the obsession of eating disorders or negative body image has been extremely gratifying.
What do I mean by an eating disorder? There are a broad range of behaviors which can be considered eating disorders. Anorexia and bulimia are the most commonly recognized. Someone who is anorexic refuses to maintain a minimal normal body weight, is intensely afraid of gaining weight and exhibits a significant disturbance in the perception of the shape or size of his or her body, Someone who is bulimic goes on eating binges and then uses some form of purge to compensate for the food consumed. Purges include self-induced vomiting, laxatives, diuretics, fasting, and compulsive exercising.
There is another group of behaviors which also constitute disordered eating. Unfortunately, these behaviors have no neat diagnostic labels and very often go unrecognized. I am referring to the vast number of people who use food for emotional reasons but do not purge and are not severely underweight as in bulimia or anorexia. Many people use food for reasons other than hunger. For some food acts like a drug. It anesthetizes feelings of depression, loneliness, anger, resentment, and low self-esteem. In all eating disorders food becomes an obsession. This is true regardless of whether the symptom is eating for the wrong reasons or being obsessed with not eating at all. Many also suffer from a negative or a distorted body image regardless of their actual body size, shape, or weight.
What does recovery entail? The origins of eating disorders are multifaceted and so recovery must be as well. Family, psychological, societal, and physiological factors all come into play. The first step in recovery is acknowledging that there is a problem. If you feel out of control around food, can't stop eating, can't stop thinking about food or can't bring yourself to eat, most likely there is a problem.
Recovery involves slowly and systematically examining what factors are involved in the onset and maintenance of the disorder. If family issues are present family work may be in order (family work can be done with or without the presence of the family). Psychological issues may involve self-esteem, assertiveness, dependency, sexuality, career, marital, family, parenting, adolescent, or a host of countless others. Everyone is different and everyone's issues are different. It is a mistake to assume that because you have an eating disorder that you are like everyone else with an eating disorder.
Societal factors also play a role. More so than ever there is pressure on all women to conform to a certain body type. For many women this "ideal" body is thinner than their biological set point. This breeds a chronic discontent and negative self-esteem for those who base their self-esteem on their physical appearance. Reevaluating standards rather than changing your body is usually helpful here.
Last, there are physical reasons which can predispose or maintain an eating disorder. Restrained eating (dieting) almost always leads to binge eating. Recovery always involves relearning how to eat.
Putting these together takes time, effort, and very hard work. Sometimes it may feel like recovery is impossible. The good news is that even when it feels that way there is a light at the end of the tunnel. Recovery is possible!
Until 30 years ago I did not know this. I've learned a great deal through working with patients who struggle with eating disorders as well as from my own experiences. Seeing patients experiment, learn, grow, change, and finally become free of the obsession of eating disorders or negative body image has been extremely gratifying.
What do I mean by an eating disorder? There are a broad range of behaviors which can be considered eating disorders. Anorexia and bulimia are the most commonly recognized. Someone who is anorexic refuses to maintain a minimal normal body weight, is intensely afraid of gaining weight and exhibits a significant disturbance in the perception of the shape or size of his or her body, Someone who is bulimic goes on eating binges and then uses some form of purge to compensate for the food consumed. Purges include self-induced vomiting, laxatives, diuretics, fasting, and compulsive exercising.
There is another group of behaviors which also constitute disordered eating. Unfortunately, these behaviors have no neat diagnostic labels and very often go unrecognized. I am referring to the vast number of people who use food for emotional reasons but do not purge and are not severely underweight as in bulimia or anorexia. Many people use food for reasons other than hunger. For some food acts like a drug. It anesthetizes feelings of depression, loneliness, anger, resentment, and low self-esteem. In all eating disorders food becomes an obsession. This is true regardless of whether the symptom is eating for the wrong reasons or being obsessed with not eating at all. Many also suffer from a negative or a distorted body image regardless of their actual body size, shape, or weight.
What does recovery entail? The origins of eating disorders are multifaceted and so recovery must be as well. Family, psychological, societal, and physiological factors all come into play. The first step in recovery is acknowledging that there is a problem. If you feel out of control around food, can't stop eating, can't stop thinking about food or can't bring yourself to eat, most likely there is a problem.
Recovery involves slowly and systematically examining what factors are involved in the onset and maintenance of the disorder. If family issues are present family work may be in order (family work can be done with or without the presence of the family). Psychological issues may involve self-esteem, assertiveness, dependency, sexuality, career, marital, family, parenting, adolescent, or a host of countless others. Everyone is different and everyone's issues are different. It is a mistake to assume that because you have an eating disorder that you are like everyone else with an eating disorder.
Societal factors also play a role. More so than ever there is pressure on all women to conform to a certain body type. For many women this "ideal" body is thinner than their biological set point. This breeds a chronic discontent and negative self-esteem for those who base their self-esteem on their physical appearance. Reevaluating standards rather than changing your body is usually helpful here.
Last, there are physical reasons which can predispose or maintain an eating disorder. Restrained eating (dieting) almost always leads to binge eating. Recovery always involves relearning how to eat.
Putting these together takes time, effort, and very hard work. Sometimes it may feel like recovery is impossible. The good news is that even when it feels that way there is a light at the end of the tunnel. Recovery is possible!
