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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
To the parent of the college student eating noodle dishes, google 'amino acids' and read about the essential 8 in particular and their role in brain health. The '8' can not be stored; they must be consumed daily.
If one is predisposed for eds and has a slipshod diet, look out. And, of course, many college students, active teenagers, new moms, busy adults, athletes, work-a-holics, etc etc. have incomplete nutrition.
I so identify with the 'forgot to eat' comment. 'Forgetting' is so common and yet can not be afforded by our predisposed kids. About a month ago, I 'forgot' to eat lunch one day. I had made a beautiful roast beef & cheddar toasted sandwhich and set it on the counter to cool. Suddenly, life exploded in our busy household of 3 teenagers. An hour or so later, I went to the kitchen hungry enough to eat a table leg and discovered the sandwich and commented out loud that I had "forgotten" to eat it. While I was eating it, there was another interruption, and my recovered daughter came into the room and told me 'I've got it; you need to eat your lunch.' Music, sweet music :-)
Z
June 10, 2009 - 6:31pmThis Comment
Shelley wrote:
"I have a very large family on both sides. I am the only one I know of who has struggled with EDs. If my EDs are genetic, I do not know where they come from."
From what I understand, and I am no scientist or clinician, one can be 'predisposed' and never trigger. It was only after my daughter's illness that my sister told me she experienced bulimia as a teenager & very young adult (she purged w/laxatives); our family never knew this, and my sister said she didn't realize that was ed behavior until more than a decade later.
To deny that there is a biological component to eating disorders - and I'm not saying Shelley is because she was 'speaking' to her situation specifically - is to deny current, up to date research. The genetics aren't fully understood yet (someday?), but I would think that understanding that malnutrition is the trigger for eds vs eds triggering malnutrition would be received as good news....because surely we all know the proper treatment for malnutrition is full nutrition.
And a well nourished brain can reason and work through any possible comorbid 'issues' more readily than one that is starved/semi-starved.
Anyway, parent prepared, served & supervised full nutrition and healthy weight restoration saved my daughter's life where 'traditional' therapy failed. She is, once again, a total delight to all who know her, living her own life, preparing for university in the fall, and she has on more than one occasion thanked me and her dad for saving her life. We were grateful to be God's Hands in the situation.
For an adult who is still struggling w/an eating disorder, I would encourage them to read the newer studies and find a physician who embraces evidence based treatment and work with them. Perhaps the adult has family or friends who can help with food shopping and meal prep to relieve some of the anxiety?
Being the loved one trying or wanting to help an adult recover can surely be complicated....which is additional motivation for parents with ill children to seek out evidence based treatment and recover your child ASAP.
I hope my post is helpful to someone, and I offer my very best wishes to all.
June 10, 2009 - 6:15pmZ
This Comment
http://www.shanguisinger.org/wp-content/uploads/2008/03/guisinger-an-pr-2003.pdf
An excellent piece of work by Shan Guisinger on the development of Eating Disorders. Well worth the read with many theories and much scientific evidence presented.
MS
June 10, 2009 - 4:45pmThis Comment
The point about malnutrition as a trigger is interesting.
My daughter's anorexia began while she was away at college and got her own apartment.
She said that it was common for the students to live on Rami noodles and light snacks for meals as they studied away - and that is what she did.
Her mini-meals became such a departure from the substantial meals we served up at home.
In IP, she told the doc that she basically "forgot" to eat .... and frankly, there is some truth to that.
Whether the start up was all about 'forgetting' to eat or numbing herself to the stresses she was coping with ... probably a combination of both and so much more ... malnutrition definitely played a role in triggering the start of this horrid anorexia.
It didn't help, either, that she inherited the anorexia gene, in that I, too, suffered from anorexia during my college years.
June 10, 2009 - 3:13pmThis Comment
This is in response to the Anonymous, unsigned post above, 10 June, 8:37 am.
The 17 years I've been in therapy/counseling (off and on, mostly on) were not for EDs. I was learning how to conquer other issues that I'd had in my life (survivor of childhood sexual abuse, raised in a religious cult that demanded perfectionism, many fears and phobias, the daily/normal stresses of being a divorced single mom of 2 young children, not being able to live near any family for emotional support, rejection/trust issues, the trauma of witnessing a plane crash at age 9, being date-raped as an adult). Then, in 2007, I developed serious, full-blown bulimia - that was when I began therapy for EDs with the therapist I'd already established a relationship with (who is a recovering anorexic). She, along with my other "helpers", literally saved my life. During this time, I was extremely successful and functional. I received 3 promotions at work and was given much higher responsibilities. I also took 2 college classes, 2 nights a week and received A's. Not many people knew how sick I was during that time.
I have a very large family on both sides. I am the only one I know of who has struggled with EDs. If my EDs are genetic, I do not know where they come from.
I am a great mom, always doing the best I know how for my children. I have 2 boys, now ages 16 and 18 (no daughters). I've raised them on my own for 15 years. I've been told many, many, many times over the years (by school teachers, school counselors, school principals, family members, close friends, therapists) that I am a great mom.
You asked, "How will you feel about your motherhood skills should one of your daughters become a suffer of an ED?" I would still believe that I am a great mom, and I would seek out the best treatment possible for her. I would look to myself, to see where I possibly made mistakes that could have caused this disorder for her. While I know that I am a great mom - I am in no way a perfect mom (none of us are - it would be completely unrealistic to believe we were). I would be open to how I could have (unknowingly and unintentionally) contributed to her ED. And I'd want to know what else could have contributed to her development of an ED.
You then asked, "If your daughter developed ED, would you then question your motherhood skills? Would your opinion of yourself as a GREAT MOM suddenly shift to your thinking of yourself as an abusive mom?" Again, while I am in no way a "perfect" mom, I am still a great mom. Looking to myself to see how I could have possibly contributed to her ED is a far cry from being an "abusive mom." I'm not an abusive mom, just because I unknowingly and unintentionally make mistakes in the raising of my children.
We, as parents all make mistakes with our children! Children don't come with an owners manual! Most of us do the best we know how and only want the best for our kids. Even so, we could still possibly contribute their development of an ED.
In response to your last sentence: I've repeated stated in other posts that I cannot imagine what parents of a child with an ED (a life-threatening illness) go through. I don't know how else I can say it! If you were to read some of my other previous posts, you will see where I've repeatedly stated just that. How is it that you want me to put myself "in the place of mothers who thought they were great moms until ED came on the scene with one of more of their daughters" when you know I have not experience it myself as a mother? You most respectfully have my sympathy and compassion! Unless I've lived through something you have lived through, exactly like you did, that's all I can do - sympathize and attempt to show my compassion for you.
Please understand that I mean no disrespect whatsoever! I admire all parents who has had to endure the awful tradgedy of having a child suffer with a life-threating illness. Thank God so many of them have gotten better!!!
Shelley
A note to all: I posted last night I am feel like I should "pull out" of this discussion, which seems to be mostly made up of parents with adolescents who have EDs. The fact is, my situation and perspective is different from yours. Honestly, I have felt challenged, attacked and judged by many of the posters on this blog. I have in no way meant any disrespect to anyone, by anything I've said. I've stated my opinions, told what worked for me, stated that I support Joanna Poppink 100%, and that's really all I can say. Anything else would be just repeating myself. Everyone, respectfully, has a right to their own opinion.
With that I will now "bow out". I respect myself too much to allow to be a participant in this discussion any longer. I'm so glad, because of Joanna, I have found this wonderful web site! Maybe I'll run into some of you on other discussion blogs.
Peace, Blessings, and Healing Light,
June 10, 2009 - 3:01pmShelley
This Comment
From Z "with causes of that malnutrition being myriad and often inadvertent."
One can become malnourished in many ways, sickness, trauma, dieting, rapid growth, purging, drug or alcohol abuse, bariatric surgery, uncontrolled malabsorption issues, and I'm sure I've missed some.
The point is that Eating Disorders are triggered by malnutrition, many of the paths to malnutrition are not a choice, being genetically susceptible to an ED is not a choice.
***********These are diseases not choices************
June 10, 2009 - 2:58pmThis Comment
I left off, but may I add that all forms of abuse, violence, and loss could certainly cause loss of appetite, and haven't we all read/heard of some people experiencing abusive nutritional deprivation? Not all go on to 'trigger' eds; there is an as yet not completely understood biological (genetic) element.
Mounting evidence is pointing to malnutrition as the 'trigger' for underlying eating disorder predisposition....with causes of that malnutrition being myriad and often inadvertent.
June 10, 2009 - 2:34pmZ
This Comment
From one of Shelley's posts:
"Does the Maudsley Approach teach that recovery is permanent, and that your daughter does not ever have to be on guard, or be aware, if her eating disorder starts creeping back into her life?"
Shelley (and others), many of your questions can be answered by reading about the subject. Information is widely available. Please read 'How to Help Your Teenager Beat and Easting Disorder' by Drs. Lock & LeGrange and 'Eating With Your Anorexic' by Laura Collins. You can also check out the websites of the Universities of Chicago and San Diego and the work of Dr. Walter Kaye. The work of Dr. Ancel Keys with the Minnesota Starvation Study is also eye opening and a summary can be read here http://gunpowder.quaker.org/documents/starvation-kalm.pdf
Anything that causes malnutrition could 'trigger' an eating disorder in one who is predisposed. In the case of my own 18yo daughter (recovered for more than a year now), she understands that full nutrition for life is necessary to keep her healthy.
What does that practically mean? She must take extra care not to become malnourished. Think of all the situations where one might become malnourished....a growth spurt, 'losing the appetitie' for whatever reason, stomach bug, oral surgery, pregnancy/recovery from pregnancy, too busy schedule which doesn't allow for proper nutrition & rest, traveling or relocating to an area where the 'diet' is different to what one is accustomed, 'making weight' for a particular sport/activity, dieting, adjusting to chronic illness such as diabetes.....the list is probably endless.
We consider our daughter completely fully recovered from her bout with a triggered eating disorder; so does she. HOWEVER, we fully understand she could 'trigger' (or 'trip the wire') again if she becomes malnourished and loses weight; she understands this as well. But our family refuses to be held hostage by this disorder; it can clearly be treated with full nutrition, so we will not be afraid of 'it' again. Once it is understood that it's malnutrition that triggers the ed vs the ed triggering malnutrition, parents/caregivers can more confidently intervene nutritionally.
We do not look at eds as boogey-men that jump from behind bushes or beneath beds. My husband and I believe triggering eds is preventable, and we (now) confidently parent accordingly. We have children other than the daughter who became ill, and considering there is a biological element to this disorder (although not fully understood) and since there is no genetic testing at this time of which I am aware, we are assuming all of us (mom, dad, children) have the predisposition for eds and live accordingly....meaning we take extra care to avoid malnutrition....which basically means we enjoy meals & snacks together, and we support one another during times of illness and/or stress. Sounds pretty loving and 'normal', don't you think? ;-)
I hope this has made sense and is helpful to someone.
Best wishes.
p.s. I don't mean to post as 'anonymous', but, technically challenged as I am, I don't know how to change that. So, I'll sign here: Zeri
June 10, 2009 - 1:52pmThis Comment
Assesment of social support dimensions in patients with eating disorders.Quiles Marcos Y, Terol Cantero MC.
Departamento de Psicología de la Salud, Universidad Miguel Hernández, Alicante, Spain. [email protected]
The aim of this study is to assess social support dimensions (providers, satisfaction and different support actions) in patients with eating disorders (ED), looking at diagnosis, socio-demographic and clinical characteristics, and self-concept. METHOD: A total of 98 female ED patients were recruited. The ages of participants ranged from 12 to 34 (Mean = 20.8-years-old, SD=5.61). Patients have a primary DSM-IV-R diagnosis of anorexia nervosa (61.2%), bulimia nervosa (27.6%) or an unspecified eating disorder (11.2%). Social support was assessed using the Escala de Apoyo Social Percibido (EASP). This scale measures social support providers, satisfaction and specific social support actions, which can be grouped into informational, emotional and practical support. Self-concept was assessed using the Cuestionario de Autoconcepto (AF-5). RESULTS: The two most frequent providers for these patients were mothers (86.7%) and partners (73.1%). Patients' satisfaction with social support was high and they reported that they received informational support more frequently than emotional and practical support. Family self-concept showed positive relationships with social support dimensions. CONCLUSION: These results show the importance of the family network in connection with these disorders and its relation to self-concept.
PMID: 19476235 [PubMed - in process]
Looks like the evidence is mounting that families are not to be rejected but embraced, with all their quirks, into aiding ED recovery.
June 10, 2009 - 9:48amMS
This Comment
To the person who posted above me.
My apology.
You are so right. Sons do get ED, too.
My concentration on talking about mother/daughter is based on my own experiences in the multi-family therapy group.
But no doubt about it - we need to all remember that males get ED, too.
And ED can come into one's life - either gender and at any age.
My brother, who is 57 years old, has developed an eating disorder. He lost a great deal of weight after my dad had a stroke and they both gave up drinking. Dad died and that put a great deal of stress on my brother. He seems to have taken on ED as a way to cope with this stress. People have told him OK Carl, it is time to stop losing weight. But he shrugs those comments off and continues to diet strictly/lose weight.
Much has been learned and needs to be learned about ED.
June 10, 2009 - 8:06amThis Comment