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Number One Reason for Developing an Eating Disorder

 
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Hundreds of people have asked me why someone develops an eating disorder. Of course many issues are involved, but from my exploration of this field over the years, I have concluded that there is one outstanding theme that runs through every person with an eating disorder whom I have encountered.

Early in their lives, people with eating disorders have experienced, on a sustained basis, relentless boundary invasion on every level.

When their physical, emotional, psychological, intellectual, sexual, and creative boundaries are consistently ignored and penetrated, people experience total boundary invasion. With no control and no way to end, protest, or, often, even acknowledge such invasions, these persons feel helplessness, despair, and a certainty that they are worthless to themselves or anyone else.

The consequences of such total invasion are vast. One consequence is an eating disorder. Having had so many boundaries disregarded, a person has no knowledge or skills in recognizing or honoring boundaries herself. She will eat or starve for emotional relief.

She may eat vast amounts of food for comfort value alone. She may deprive herself of food until her life is in danger. She has no internal regulator that tells her when she has reached her limit and experienced enough. Being oblivious to any boundaries means being oblivious to limits of any kind.

The compulsive overeater eats whenever and whatever she likes. She bases her choices on self-medication issues, not feelings of physical hunger.
The anorexic will not eat. There is no limit to her not eating. She will starve herself to death in search of relief from her emotional pain. She knows nothing of the experience of having enough. She couldn't say, "Enough," to an invader of her boundaries, and she can't say it to herself. The concept of enough has no meaning to her. She often feels that if she "disappeared," she might find some permanent relief.

I have heard countless anorexic young women talk ethereally, with a lost-in-a-beautiful-world-of-angels smile, of how wonderful it would be to become a vapor or a light dancing spirit in the clouds. Ah, such spiritual bliss, they imagine. In reality, it's the final self-protective act, to destroy their bodies and their lives completely. Then they can truly escape the complexities of being alive.

The bulimic will binge grotesque amounts of food. She will assault herself with more food than her body can tolerate.

The compulsive overeater will, at last, have to stop eating if only because of the pain in her distended stomach. Her body sets a final limit. The bulimic has no such limit. She experiences (in her mind) no consequences of the food assault on her body. When her body cannot bear more, she will vomit it all out. Then she will resume her binge. She may reach her body's limits many times. Each time she does, she can throw up again and continue.

Eventually she stops, because she is completely exhausted, or she is in danger of being discovered. "Enough" has no meaning to her. There are no limits and no consequences for her disregard of her boundaries.

Realistically, of course, there are plenty of consequences. Her behavior inflicts serious damage to her body. And each time she attacks herself with a binge-and-purge episode, she destroys more of her spirit, soul, self-esteem, sanity, health, and value to herself and others.

Each violation deepens her ritualistic behavior, and she becomes more entrenched in her disorder. The consequence is increasing anguish and despair. Yet the eating disorder is not the cause of that anguish and despair. The eating disorder exists to numb her from her already existing psychological agonies.

For a while, maybe a few years, the eating disorder successfully blocks her awareness of pain too difficult to bear. But eventually the protective device of the eating disorder becomes just another boundary invader, this time self-induced, that weakens and damages her even more.

What do I mean by a history of boundary violations? Blatant and extreme boundary violations involve sexual molestation, sexual abuse, and physical abuse. Much has been written about these areas now, especially in material exploring Post Traumatic Stress Disorder (PTSD) and Dissociative Identity Disorder (DID). Use your search engines to find some quality information posted on the Internet in these subject areas.

However, there are other kinds of boundary violations, and these are less dramatic, less discussed, more prevalent, and just as devastating to a persons psyche. When, in the name of caretaking, people in authority take over a young person's life, it constitutes boundary invasion.

When others deny her privacy, read her diary, borrow or take her things without permission, or use their ideas or goals or personalities to overwhelm her efforts in school or sports, that is a violation of her boundaries.

When others disregard or disdain her choices or deny her any control over her personal life, clothes, food, friends, and activities, they are invading her boundaries.

An invasion of boundaries also takes place when, in the name of caretaking, people give her no responsibilities of her own and attach no consequences to her actions. When the child or adolescent can have all the things she asks for without putting forth effort to earn such gifts, she learns nothing about personal effort, limits, consequences, or the meaning of enough. If she wants something, she gets it. That's all. If someone picks up her clothes, does her laundry, fixes her car, pays her bills, lends her money or things without expecting them returned, she experiences no boundaries and no limits.

If she doesn't have to keep her promises, if she doesn't reciprocate with caring actions for people who care for her, she learns nothing useful about herself in relationship to other people. The only thing she learns with certainty is that there are no limits to her behaviors or desires.

These boundary invasions are not loving acts, nor are they "spoiling" a child through overindulgence. Quite the contrary, they are acts of neglect. The child's taste, mind, capacity to learn, and ability to grow and function as an independent agent in the world remain unacknowledged.

When others, even well-meaning others, ignore her identity as a unique, developing, and competent individual and flood her with their personal agendas, she feels as if a steamroller had flattened out her psyche. She may learn to please, to manipulate, to compete, or to control, but she is unable to learn to be fully present in the world as her genuine self.

She doesn't learn that she has meaning and value. She doesn't learn that she can put that meaning and value within her to work to accomplish goals.
For example, if she breaks something, whether it is a lamp, a car, her word, or someone's heart, it is possible and healthier to give her the responsibility for making necessary repairs using her own resources and her own creativity. In such a process, she learns what effort means. She learns what responsibility and consequences for actions mean. She learns reasonable limits and reasonable expectations. She develops resources to make healthy and caring decisions in the future.

Without such lessons, she learns are the tricks involved in adapting quickly to the expectations of others or being manipulative to get what she wants. These are poor and insubstantial tools to rely on when building an adult life.

Somewhere inside, over time, she may gradually realize this. But without a sense of boundaries, she will only become bewildered and anxious. She will accelerate her practice of using her eating disorder as a way to numb her feelings of anxiety. She will use her manipulating skills to get what she wants from whomever she can exploit.

As time passes, fewer people in her life will allow themselves to be manipulated. The quality of her circle of associates will decline as she seeks people she can control with her inadequate methods of functioning in the world. She will find herself in bad company.

This becomes all the more reason to rely on eating disorder behaviors for comfort. The people around her are less reliable all the time. And finally, they tolerate her presence only because they can manipulate her.

She arrives at the total-victim position. Her manipulative skills backfire. People exist in this world who are better at manipulating and using than she. She has found them. She becomes their target and then their prey. Her dependence upon her eating disorder becomes her most valuable and trustworthy relationship.

Early in her development, she learned through massive boundary invasions (which perhaps seemed ordinary and unimportant at the time) that she was helpless to assert herself. She learned that she had no private or sacred space to cherish and respect. She could not acknowledge, even to herself, that she was being thwarted, invaded, controlled, manipulated, and forced to deny large aspects of her natural self. She had no recourse except to comply.

To succeed at being unaware of her natural tastes, curiosities, and inclinations and her pain in restraining her natural tendencies, she developed an eating disorder. Now that she's older and her manipulation skills are failing her, she only has her eating disorder to rely on. This may be the most crucial time in this person's life.

If her pain and despair are terrible enough and she is certain she cannot bear this way of living anymore, she still has choices. She can continue to rely on the eating disorder and by so doing take the path to self-destruction. Or she can reach out and get help.

This is a tough position for her. She's never known what enough was. Yet to choose to get help, she has to recognize that she has had enough pain. She's never known what a limit is. Yet she has to recognize that she has reached her limit and must choose between death and life. She has only known about pretense and manipulation. Yet she has to be honest to reach out for genuine help.

She feels massive anguish and pain before she stretches beyond her life pattern into what might bring her healing and recovery. She's reaching for something she can't imagine. It's difficult for a person with an eating disorder to decide to get help. She would have to allow herself to trust someone with knowledge of her real personhood.

She doesn't yet know that people who do respect and honor boundaries actually exist in this world. She doesn't yet know that there are people who can and will honor and cherish her most private and sacred inner spaces. She doesn't yet know that someday the trustworthy, respectful, steadfast, and competent caretaker she needs so badly can be herself.
Her first move toward recovery requires all the courage she can muster. Her recovery begins when with fear or rage, she rallies her courage to reach out for help.

Difficult, yes. But what she doesn't know yet is that she has been courageous all her life. She makes a grand discovery when she learns that she can apply her strength and courage to her own health. She can use her gifts to, at long last, be free of her eating disorder, be her genuine self in the world.

Professional Resources for Finding Help
Academy for Eating Disorders (AED)
American Anorexia and Bulimia Association (AABA)
Anorexia Nervosa and Related Disorders (ANRED)
Edreferral.com
International Association of Eating Disorders Professionals (IAEDP)
Joanna Poppink's Eating Disorders Resource List In-Patient Treatment Programs
National Eating Disorders Association (NEDA)
Joanna Poppink, Los Angeles psychotherapist, licensed since 1980 (MFT #15563), is deeply committed to bringing recovery to people suffering from eating disorders.

Her specialized psychotherapy practice is designed to allow clients to progress through anxiety situations to ongoing recovery from bulimia, compulsive eating, anorexia and binge eating. Her primary goal is to provide people with a way to achieve thorough and long lasting healing.
Eating Disorder Recovery book in progress through Conari Press
10573 West Pico Blvd. #20
Los Angeles, CA 90064
http://www.eatingdisorderrecovery.com
[email protected]

Add a Comment206 Comments

EmpowHER Guest
Anonymous

OMG this is beginning to sound like the fms foundation. I know this is a different organization. but really?????????/ we are going to deny that some eating disorder sufferers have been sexually abused? they are making it UP?? . SHAME ON YOU parent organization. it is YOU who is doing great to harm sufferers. ANd Joanna I want to thank you personally. I have not in the past. but your words have been invaluable and validating to me. thank you

April 22, 2015 - 10:23pm
EmpowHER Guest
Anonymous

thank you for the article. I have over a decade of recovery that followed 18 years of severe anorexia. only when I dealt with the sexual trauma and learned healthy boundaries did I recover from the hell of eating disorder. genetics loads the gun but environment pulls the trigger.

April 22, 2015 - 6:09pm

I've had anorexia since I was 8, now weigh 84.8 lbs at 19 years old and 5'4'', and I have yet to find out the cause or "reason" for my E.D. though I would love to know. When I was in the hospital, they told my parents and I that it was "because I wanted to stay a little girl". And that was highly untrue in my mind. They also said that my parents are "making me feel like I have to stay a little girl". Which is also very untrue, my parents were and are great parents. I don't believe they had anything to do with it, and the doctors definitely made them feel guilty as well as myself. It's hard to believe how doctors will blame anyone and anything..especially when you've explained to them all your struggles and they totally eliminate everything you said, and then try to mentally feed you why they think you have it, and when you tell them they are wrong, they insist YOU are wrong.
The whole thing, is WRONG.

September 9, 2011 - 7:36am
EmpowHER Guest
Anonymous

I agree with the comments that the family should not be blamed. Our experience with out daughter was that she lost 20 pounds over a period of time and was at a healthy weight. But something biologically must have happened because it started to become an obsession and led to anorxia and then bulimia. We used the Maudsley method to refeed and fortunately she returned to a weight that medicine (fluoxetine-60mg which is effective amount for this disorder according to studies) would benefit her. It was a miracle. This was very biological. We wondered often if we were in any way the cause and she repeatedly told us and the counselor and the dietician that it was not the case. I think she had gotten an inbalance in her brain due to not enough fats, or hormones or something we may never know but it turned her obsessive about calories, exercise, and everything else associated with an eating disorder. Her personality was lost and the eating disorder controlled her. After medicine which went from 20mg to 60mg fairly quickly we saw the daughter we had really lost 2 years prior to that. Looking back there were signs that we would never have associated with an eating disorder but realize now they were just the beginning. I think saying that borders have something to do with so many eating disordered patients is harmful to the parents and also may keep them from seeing how very important the biological part of it is. I need to add though that it is very important they are not underweight when given the medicine as studies have shown it is not as effective in underweight patients.

December 3, 2010 - 11:07am
EmpowHER Guest
Anonymous

I agree with the comments that the family should not be blamed. Our experience with out daughter was that she lost 20 pounds over a period of time and was at a healthy weight. But something biologically must have happened because it started to become an obsession and led to anorxia and then bulimia. We used the Maudsley method to refeed and fortunately she returned to a weight that medicine (fluoxetine-60mg which is effective amount for this disorder according to studies) would benefit her. It was a miracle. This was very biological. We wondered often if we were in any way the cause and she repeatedly told us and the counselor and the dietician that it was not the case. I think she had gotten an inbalance in her brain due to not enough fats, or hormones or something we may never know but it turned her obsessive about calories, exercise, and everything else associated with an eating disorder. Her personality was lost and the eating disorder controlled her. After medicine which went from 20mg to 60mg fairly quickly we saw the daughter we had really lost 2 years prior to that. Looking back there were signs that we would never have associated with an eating disorder but realize now they were just the beginning. I think saying that borders have something to do with so many eating disordered patients is harmful to the parents and also may keep them from seeing how very important the biological part of it is. I need to add though that it is very important they are not underweight when given the medicine as studies have shown it is not as effective in underweight patients.

December 3, 2010 - 11:07am
EmpowHER Guest
Anonymous

Instead of arguing about WHY eating disorders happen ... what/who causes them ... isn't it better to focus on and educate oneself and others on HOW people can best recover from them?

Most of the experts agree that they really don't know what causes eating disorders, so what is the point of arguing?

"Boundaries" ???

So if one gets a 'fix' on how to set 'boundaries', that is going to be what SOLVES their eating disorder issues?
I think NOT. So what is the point of talking about 'boundaries'?
If well-meaning parents (particularly mothers) deprived their child at any early age in some way, so it's best that one separates themselves from their mother and other family members? And that's going to help - HOW?

I spent years blaming my mother for my eating disorder and other problems, until I finally figured out that my eating disorder and other issues had more to do about ME and how I was 'wired' than anything to do with what she did or did not do.
As far as her being 'controlling' in any way, nothing could have been further from the truth. My problems with my mother began when at an early age, I was so let down to find out that she did not meet my definition of 'perfect mom'.
Poor me. Now I realize that my mom had (and has) the right to be who she is. If who she is didn't match up to my expectations, too bad. She worked her butt off to do the best she could to give her kids a good life and never turned her back on us once when we went through difficult challenges. She was always there for us. Now that she is old, I realize how much she loved (and loves) me.

I am recovered now and have a daughter who has an eating disorder. Was I, in some way, the cause of that?
Sure. Genetics played a role and likely my 'less than perfection' at motherhood did, as well. Lucky for me, my daughter cuts me a lot more slack than I did my mom. And like my mom, I will never turn my back on my daughter. I will support her recovery in any way that I am capable of doing.

I read all the latest research, buy the latest books, listen to smart researchers and attend as many conferences as I can to learn as much as I can about what I can do to help myself, my daughter and others.

Here is an example of a conference that sounds interesting upcoming on Dec. 3 at in Corning, NY.
If I lived in or near NY, I would attend.

"Inside the Brain/Outside the Box"

"The goal is to better understand how starvation affects the brain and explore alternative therapies and how they maximize the brain's inherent potential to heal, said registered dietitian Carolyn Hodges Chaffee, the owner of the Elmira eating disorder treatment centers.

Robarge died in 2000 after a long struggle with an eating disorder. She was 13.

Dr. Richard Levine, the keynote speaker, will discuss the impact starvation has on the functioning of the brain. Levine, a nationally recognized expert, is a professor of pediatrics and psychiatry at the Pennsylvania State University College of Medicine.

Levine is also chief of the Division of Adolescent Medicine and Eating Disorders at Pennsylvania State Children's Hospital and the Milton S. Hershey Medical Center in Hershey, Pa.

Jeannetta Burpee, an occupational therapist at St. Joseph's Hospital in Elmira, will discuss the role sensory integration -- the neurological process that organizes sensations from one's own body and the environment -- plays in the treatment of eating disorders.

Psychotherapist Andrew Seubert of Corning will highlight recent findings about the functioning of various areas of the brain in eating disorder patients. He will also discuss nutritional and non-pharmacological interventions that can restore brain balance and health.

Clare Brown, program director of the Sol Stone Center, will discuss and demonstrate the use of art therapy, yoga, meditation and other alternative therapies in the treatment of eating disorders.

A panel of patients who have used alternative therapies will talk about their experiences to conclude the seminar, according to a news release.

The seminar begins at 8 a.m. Dec. 3 with registration and concludes at 4 p.m. Registration is $75 before Nov. 26 and $100 after Nov. 26. Family and group rates are available upon request."

http://www.stargazette.com/article/20101018/NEWS01/10180340/1113/Seminar-in-Corning-to-explore-mind-body-connection-in-eating-disorders

October 18, 2010 - 9:27pm
(reply to Anonymous)

Thank you so much for sharing this information. Part of the problem, in my opinion, is that eating disorders are as varied as the people who have them. Each sufferer is different, each of the families is different, and that means while dynamics may have commonalities from person to person the cause and solution is specific to the person. There have to be many modes of treatment, because there are many differences among people with eating disorders.

It is wise of you to keep up on all the new information. You never know what kernel you grab from something is going to be just the thing that clicks for you and your daughter. I wish you both the best. Thank you so much for writing.

October 19, 2010 - 6:24am
EmpowHER Guest
Anonymous

See Dan Siegel's wonderful talk on the developing mind and how issues of early attunement and connection affect a child's development and ability to cope in their adult life.

http://fora.tv/2009/06/30/Dan_Siegel_The_Brain_and_the_Developing_Mind

October 18, 2010 - 5:22pm
EmpowHER Guest
Anonymous

Cary Cook,
I am healing and I can thank many people for that - including good therapists, wonderful doc/psychiatrist, nurses, RD, my parents' dedication - and God.

I am sending you healing vibes, too, with hope that your challenges with RA become less.

Regards!

October 15, 2010 - 6:28pm

Back one last time with evidenced-based research to support family-based therapy as the intervention of choice in most instances. As MOST eating disorders start in adolescence or the teen years, this information is critical to get into the hands of families. It is also critical that families ask for it as only then will clinicians begin to offer it on a more widespread basis.
--ANNE--
The Wall Street Journal
OCTOBER 5, 2010

Parental Role Aids Anorexia Recovery
By SHIRLEY S. WANG

Anorexia patients' families, once considered partly to blame for adolescents succumbing to the dangerous eating disorder, are increasingly being incorporated into the solution.

In the strongest evidence to date to suggest families should be involved in treatment, a 121-patient study published Monday found that a therapy in which parents remain present at each meal until an anorexic child eats appears to be more effective in fostering recovery than when a child works solely with a therapist.

The so-called Maudsley model—developed at Maudsley Hospital in London more than 20 years ago—calls for parents to take charge of feeding a severely underweight child, "making it impossible not to eat," said Daniel Le Grange, one of the study's authors and director of the Eating Disorders Program at the University of Chicago.

Patients with anorexia nervosa, a sometimes deadly disorder, often refuse to eat because of a fear of gaining weight and develop abnormally low body weight as a result. The condition was once thought to be related to a patient's desire for independence and it was believed that treatment required separation from parents.

Even now, a popular criticism of the Maudsley method is that it "runs roughshod" over adolescents' need to develop independence, according to Dr. Le Grange.

While anorexia tends to develop in teenage girls, the illness can also affect males and people of other ages.

The study, conducted by researchers at the University of Chicago and Stanford University, showed that one year after treatment ended, patients who received family therapy were more likely to reach and stay in recovery compared with those treated one-on-one by a therapist.

The difference in effectiveness became more pronounced over time. At the end of the year-long treatment regimen, about 42% of patients in the family-therapy group were considered in remission—that is, within 5% of their healthy body weight—compared with 23% of those in the individual-therapy group, though the difference wasn't deemed statistically significant. But 12 months later, nearly half those in the family-treatment group were in full remission, which was significantly better than the 23% in the professional-therapist group.

The study appeared in the Archives of General Psychiatry.

"This is additional evidence that involvement of the family can be a very effective way in helping kids overcome their problems," said B. Timothy Walsh, an eating-disorder researcher and professor of psychiatry at the New York State Psychiatric Institute, Columbia University Medical Center, who wasn't involved with the study.

When Rina Ranalli began using the Maudsley approach for her then-13-year-old daughter in September 2008, she was skeptical. But Ms. Ranalli and her husband tag-teamed to sit with her through three meals and three snacks daily. For the first two months "it was hell," said Ms. Ranalli, who said she told her daughter over and over, "This is your food, this is your medicine, this is what you're eating, no question."

By November, her daughter was gaining weight consistently, the meals weren't as prolonged and Ms. Ranalli started "seeing sparks" of her daughter's personality again. The girl was able to reach her target weight by January.

"It's just a very difficult thing to endure emotionally," said Ms. Ranalli, a stay-at-home mother in Chicago, but "when you can actually be part of the solution, it empowers you."

Write to Shirley S. Wang at [email protected]

October 15, 2010 - 5:43pm
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