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What causes eating disorders?

 "Why don't you just stop?" 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, gains weight, or loses weight 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 her stomach hurts so badly that all she can do is lie down and fall asleep, as often happens for compulsive overeaters? 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.

• A single traumatic event:
  
  • This is an occurrence that causes extreme emotional pain for a person. Another person may have minimal difficulty facing the same situation, but for this person the pain is to intense, and she doesn't know what to do with it. Examples of such an event include death of a close relative or friend, divorce of a parent, leaving home for the first time, rape, abortion, rejection in a relationship, divorce, first sexual experience, or a degrading comment.
    
• A two- to three-year period of unusual stress or pain:
  
  • This person would have been able to manage adequately had only one thing happened, but too much happened too fast, and the stress/pain level became too great. An example of this would be the person who leaves home for the first time, has her first sexual experience, is rejected in a relationship, and her mother dies, all within a two- to three-year period.
• An extended period of emotional pain:
  
  • The person has lived in a painful situation for a period of years and finally reaches the point where she can no longer tolerate the pain. Examples include growing up in an alcoholic family, growing up with physical, sexual, or emotional abuse, and living in an unhappy marriage.
• The onset of a mood disorder:
  
  • All of a sudden, the person begins to experience depression or mood swings at a level of intensity she has never before experienced. She is not able to control the feelings because they are due to bio-chemical changes. Usually, the person does not understand what is happening, feels scared and out of control, and does not know how to or is afraid to ask for help.
    
• Having been a very sensitive child:
  
  • This is a case of a very sensitive child growing up in a family in which there was emotional pain that was not acknowledged or discussed. The family outwardly appeared to be "perfect" and problem-free. Frequently, the family is very religious and spends a significant amount of time attending church or synagogue activities. The source of the family's pain is often very subtle, thus difficult to identify. This child acted like a sponge for the pain and absorbed it, but did not know what to do with it after that.
    
• A controlling environment:
  
  • The person either grows up in, or marries into a situation in which she has a relationship with a parent or spouse who is a very controlling person. The only way she is able to survive is by giving up her own identity while trying to please the other person. Finally, she reaches a point where she finds this too painful and is no longer willing to do it any more, but does not know how to change.
    
• Lack of validation of feelings:
  
  • The people with eating disorders who have the most difficulty identifying a "reason" why they developed an eating disorder are those who grew up in families and/or married into relationships in which there was no overt abuse or problem, but rather a very subtle undermining of self-esteem. The person whom this describes is someone who repeatedly experienced lack of validation of her thoughts or feelings. She was given the message that she shouldn't feel that way, or that it was wrong to feel that way, or that she was selfish to feel that way. Since she did feel that way, the only explanation she could find as a child was that she must be bad or crazy. Over time, she learned to direct her negative emotions inwardly or to take them out on herself, since direct expression was not allowed.

The common thread in all seven scenarios is that a person is experiencing emotional pain at a level of intensity that she/he does not know how to manage in a healthy way, mainly because he/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/he 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 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.

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Ron Vick, MA, LPC
Counselor / Academic Advisor
Int'l Student Advisor