Eating disorders represent a emotional and cognitive struggle of some kind, be it trauma, low self-esteem, poor body image, bullying….clients present with many different root causes of their disorder. A client’s spirit is suffering and a person tends to have a breakdown in their spirituality. The one underlying theme is the difficulty in managing the most uncomfortable feelings. The eating disorder and one’s spirituality are often at competing ends. The eating disorder serves as a coping method that presents as a friend, a confidant, a powerful secret, or a god that needs to be obeyed and the eating disorder appears at the time the client needs it most. In a storm of chaos and fear and inconsistency, the eating disorder swoops in and appears to give the feeling of rescue that the client feels temporarily from the distress.
Michelle Lelwica (2010) shares that while the client is focused on creating a “good” body or engaging in eating disorder behaviors like restricting or purging, the inner life is being ignored. No matter how thin the client gets, no matter how filling the binge, there is an eternal sense of emptiness and hunger that is never satisfied. All of the crises that pile up in life, all of the hurts and trauma, drive a wedge through the true self. Big questions like “What is important in my life” and “How do I understand my life’s purpose” cannot be answered when the soul is entrenched in an eating disorder. There is simply no energy left for living. Recovery becomes a spiritual journey as clients attempt to access their pain and face it with the help of a higher power.
Randy Hardman and Michael Berrett (2015) explain that many people with an eating disorder have had some degree of personal spirituality in their lives. Some have participated in religious observations and others may have felt connected to yoga or nature or a meditation practice. Despite this, during the course of the eating disorder these connections were lost. Feelings of unworthiness creep in as the eating disorder, which at one point served a purpose, becomes harder and harder to sustain. Indeed, eating disorders cause sufferers to chase false pursuits that ultimately replace spiritual connection. Hardman and Berrett list these false pursuits:
- False sense of control
- False form of communication about pain and suffering
- False sense of being the exception or exceptional
- False crusade for evidence against self
- False pursuit of perfection
- False form of comfort and safety
- False identity
- False compensation for the past
- False attempt to avoid personal responsibility
- False pursuit of approval
Eating disorders may represent some or all of these falsehoods for clients. Richards et al (1997) state that eating disorder clients often have difficulty letting go and having faith, despite their spiritual background, leading to a worship of these falsehoods in pursuit of a sense of control and well-being. Along the way the eating disorder gains control of every aspect of their lives, rendering clients powerless when all they were seeking all along was a powerful sense of being good enough.
Not all clinicians work with spirituality in treatment with their clients, but it is a significant aspect of recovery that should not be avoided. Clients who wish to regain their spiritual connections, or foster connections for the very first time, can do so in the safety of the therapeutic alliance. Eating disorders are very hard to give up because it is difficult to remember what life was like beforehand and next to impossible to consider what life might be like in recovery. There is so much unknown and that is often one of the biggest barriers to recovery. Spiritual exploration during treatment can help clients resolve any negative impacts their spiritual pursuits had in the past and move forward with new resolve to take care of their physical, emotional, and spiritual selves.
Lelwica, M. (2010). The Spiritual Dimensions of Recovering from an Eating Disorder. Psychology Today, www.psychologytoday.com
Hardman, R. and Berrett, M. (2015). Eating Disorder Recovery: A Spiritual Perspective. BYU Idaho Counseling Center, www.byui.edu
Richards, P., Hardman, R., Frost, H., Berrett, M., Clark-Sly, J., and Anderson, D.
Spiritual issues and interventions in the treatment of patients with eating disorders. Eating Disorders: Journal of Treatment and Prevention, 5(4), pp. 261-279
Surviving and Thriving With an Eating Disorder: Skills for Holiday Celebrations
Holidays are for celebrating, and whether it’s creating traditional dishes in the kitchen with family or gathering around with friends for a summertime barbeque, food takes center stage. For people with eating disorders, holidays can be very difficult times. The combination of large amounts of food, family dynamics, and feelings of anxiety and loneliness can be overwhelming and too much to bear. If you are facing down an upcoming holiday with fear or dread, take hope. There are things you and your family can do to prepare for challenges and still enjoy the magic of holiday seasons.
Make a Plan!
If you are struggling with an eating disorder, you know that part of recovery means learning about yourself, setting boundaries, and asking for what you need. Your treatment team can help you to develop a plan for dealing with the holidays that fits your goals. Cognitive behavioral and dialectical behavioral (CBT/DBT) treatment modalities, which are used in all levels of eating disorder care, are great for developing coping skills and self-soothing techniques for distressing situations. Psych Central (www.psychcentral.com) suggests some great, soothing tips based in the mindful approach of DBT:
- Find meaning in the season
- Take a vacation! Muscle relaxation, baths, snuggling with a favorite pet, reading a great book….give yourself a break and enjoy the moment!
- Give back. Get out of your head and into the deeper purpose of the season by volunteering or helping neighbors.
- Breathe deeply and stay in the moment
Take Care of YOU!
This is where knowing your limits and honoring them comes in. During the holidays we are usually surrounded by people we haven’t seen since the last family gathering. Inevitably, tensions flare as tricky family dynamics rear their heads. When you’re struggling with an eating disorder, even the most well-intentioned comments from long-lost family members can be triggering and downright hurtful. When all you want to do is make it through the day, these uncomfortable conversations can leave you feeling trapped.
Even if it’s hard to honor your needs, the holidays are a prime time to practice. Enlist a trusted friend or family member to help you slip away for a few moments and regroup when it all becomes too much. If you know that there is a particular gathering planned that will be super triggering, it’s ok to sit it out. Trust yourself, and when in doubt ask to talk it out.
In the Kitchen
Food is a centerpiece of holiday celebrations, and for people with eating disorders just being in the kitchen can create tremendous stress. Many treatment programs work to prepare clients for food-related challenges by offering kitchen skills groups and experiential activities designed to decrease anxiety and increase confidence. At Center for Discovery, for example, clients spend time in the kitchen preparing meals and snacks, participating in food challenges, and learning to plan meals and grocery shop. Anxieties around food are faced and challenged in the moment so clients can put coping skills into action and finally begin to experience comfort around food.
The National Eating Disorders Association (www.nationaleatingdisorders .org) suggests baby-step challenges at holiday gatherings. Review the food offered and make mindful choices. To take the challenge a step further, take a portion of a food you love but wouldn’t normally allow yourself to have. Then, stay in the moment and savor the tastes. Notice your surroundings and focus on the parts of the season you enjoy. Breathe.
A Note For Families
If your loved one suffers from an eating disorder, you may stand by and watch helplessly as another holiday season threatens their joy and well-being. How can you help when you don’t even know how to begin? First and foremost, get educated about eating disorders. Be involved in your loved one’s treatment. Learn about and make every effort to understand what they are struggling with and why. Then, be patient. Ask how to help. Express your love and concern.
The National Association of Anorexia Nervosa and Associated Disorders (www.anad.org) suggests being flexible and willing to start some new traditions that don’t focus on food. Your loved one has interests and hobbies. Tap into those at holiday time. Does your loved one like to sing? Go caroling together. Is crafting a favorite activity? Create beautiful holiday-themed treasures together.
Holidays are challenging for people with eating disorders, but they don’t have to be a time filled with fear and isolation. Shifting perspective and coming together as a family to celebrate with love and support has the potential to help your loved one feel joy and comfort again- even around the foods that create anxiety.
Matta, C. (2008). Holiday Stress Survival Tips. Psych Central, www.psychcentral.com
McLaughlin, A. (2013). Lessons in Self-Care: 5 Ways to Survive and Thrive Through the Holidays When You Have an Eating Disorder. National Eating Disorders Associations,www.nationaleatingdisorders.org
Surviving the Holidays With an Eating Disorder. The National Association of Anorexia Nervosa and Associated Disorders, www.anad.org
When an eating disorder strikes an individual, his or her entire family is affected. According to an article by Abigail Natenshon, MA, LCSW, GCFP, 87% of eating disorder patients are children and adolescents under the age of 20. As many in this age group still live at home, the eating disorder develops and plays out within the family dynamic. It often takes on a life of its own and can be the cause of many battles at meal times, family gatherings, holiday events, and can even affect extended family and school environments. Family therapy is an essential part of eating disorder treatment and is necessary to ensure everyone who is a part of the family system is cared for.
The Family System Theory
Developed by Dr. Murray Bowen, family systems theory posits that the family is a unit and the emotional connections fostered by thoughts, feelings, and actions create an interdependent environment. This interconnectedness helps the family to become cohesive and supportive of its members. If there is unrest and tension, emotional connections can become more stressful. If there is a member of the family who tends to take on the emotions of the other members and may take on an accommodating role, leading to overwhelm and isolation. This is the family member who may become more susceptible to addictions, depression, anxiety, eating disorders, and illness.
There are eight concepts to the family systems theory:
- Triangles: A three-person relationship system
- Differentiation of self: Variation in how people are susceptible to pressures to conform to the group
- Nuclear family emotional system: Four basic relationship patterns (marital conflict, dysfunction in one spouse, impairment of children, emotional distance)
- Family projection process: The way parents transmit their emotional issues to children
- Multigenerational transmission: Differences in differentiation across generations
- Emotional cutoff: Managing emotional issues by cutting off family members
- Sibling position: Impact of sibling position on behavior and development
- Societal emotional process: Emotional systems govern behavior on the societal level
Family systems theory can be used to help clinicians understand the dynamics of the family presenting to work through one member’s eating disorder.
Family Involvement in Eating Disorder Treatment
Comprehensive treatment plans at all levels of care will involve family therapy. Center for Discovery residential programs involve the family weekly in a therapeutic way, not only in family therapy but also at meal times by facilitating therapeutic family meals. The purpose of these activities is to observe family dynamics at meal times and in social situations in order to best prepare the family for realignment and a return to balanced interconnectedness.
Some clients benefit from a type of family therapy called Family Based Therapy (FBT, also known as Maudsley). This outpatient approach, which places the refeeding process in the hands of the parents and moves the family through phases of treatment as recovery develops, has proven to be very successful for adolescents with anorexia.
In outpatient settings, family therapy is usually recommended in conjunction with individual therapy, nutrition services, and group work. As the eating disordered member reintegrates back to the system after being away at treatment, therapy is needed to help the family adjust once again. An eating disorder has the potential to isolate family members from one another, create discord in the system, and indeed can be either sustained or eliminated depending on the dynamics of the family system. It is important for clinicians and parents to know that parents do not cause eating disorders. The entire system needs attention and support to thrive again.
Natenshon, A. Family Treatment is Cornerstone of Effective Care for Eating Disordered Children. Treating Eating Disorders, www.abigailnatenshon.com
The Bowen Center for the Study of the Family. www.thebowencenter.org