Eating disorders: They’re not about food and all about food

Dear Readers,

                We’ve often heard people say, “Eating disorders aren’t about food at all. They’re about depression, anxiety, or low self-esteem.” This takes away some of the stigma that an eating disorder sufferer feels because it means she’s not just self-involved and superficial for being obsessed with appearance and weight. There are deeper things going on here, which merit doctor’s visits and hospital stays, not to mention insurance reimbursements.

                Another way to telegraph what eating disorders are is a saying that Marcia sometimes uses: “Genetics loads the gun, and environment pulls the trigger.” This refers to current scientific understanding, which holds that eating disorders originate through an interplay of genetic (your mother had an eating disorder, so you are more likely to develop one) and environmental (incessant schoolyard taunting about your size led you to self-starvation) factors.

                These handy  aphorisms are true, but the reason they bear repeating is that when it comes to making an eating-disordered person better a lot of the hard work, fear, pain and suffering the patient has to go through in order to recover revolves around, well, food. Which can be confusing.

                It may help to view eating disorders through the addiction model. An alcoholic or a drug addict drinks or takes drugs as a self-soothing measure. Ingesting them can take the edge off a tragic loss, a blow to one’s confidence, even a bad day.   Walter Kaye, the highly respected director of UCSD’s Eating Disorder Research and Treatment Program, says of the anorexia patient, “These are very anxious people. Not eating is the one thing that makes the anxiety go away. Whereas most people feel pleasure when they eat, the anorexic feels uncomfortable.” Instead of taking something in order to reduce anxiety, as the alcoholic might, the anorexic’s self-soothing trick involves not taking the substance, or not eating.

                Another way to think of an eating disorder is in the context of various fears or phobias, such as fear of flying, fear of public speaking, or if you are Indiana Jones, fear of snakes. The way to overcome such fears is to make oneself face them, over and over.

                As Alicia Hirsch, Psy.D., director of clinical services at Mt. Sinai Eating and Weight Disorders Program in New York City says, there is an “exposure component” to treating eating disorders. “You’re asking a patient to do something incredibly uncomfortable,” which is eating. Repeated exposure to the feared thing, in this case something edible, makes the patient’s anxiety and discomfort level come down.  “The food is the medicine,” Dr. Hirsch explains.

            So, to sum up: It’s not about food. It’s about genetics and environment. Food makes the eating disordered person anxious. Food is the medicine. Any questions?

            Both the UCSD and the Mt. Sinai programs educate families about the complex mix of biological and environmental factors that are involved in the creation of eating disorders. This is an important component of any treatment program, so if you are in the market for one now, make sure it includes this piece. The more you learn, read and understand about eating disorders, the better armed you will be to help your child or loved one recover.

Take care,

Nancy