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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

Hi Anne,

Oh boy, I cannot imagine the desperation you were feeling when your daughter was so ill - in crisis - and how overwhelming you must have felt at the time, to save your daughter's life!!! What a horrible nightmare you went through!!! The only way I can even come close to relating to what you must have been going through at that time was when my youngest son was unexpectedly hospitalized for a serious, life-threatening staph infection in his leg at age 9. He could have DIED!!! I remember being in the hospital with him and thinking what my life would be without him in it. It was so devestating and heartbreaking (thank goodness he fully recovered and is now 16 - during that same time his daycare teacher died from a staph infection, which magnified the seriousness of his illness even more to me).

I most definitely agree with you that parents must be allowed to choose the treatment that they think is best for their child - after being fully informed of all of their options!!! I am so sorry that you had to face decisions that had to be made, basically on the spot, in order to save your daughter's life! That was so wrong of the professionals to not take you aside, and calmly fully explain out all of your options available. And I'm sorry for the trauma you daughter, you and your family went through by putting her in a facility that would not let you see your child, or participate in her therapy sessions. I don't know if their way is right, or wrong, but I would have felt exactly like you and wanted to go in there and drag my daughter out of that place! I don't know if that would have been the best thing for my child, but it's what I would have done if I'd been put in your position at that time. It's in the past now, and it sounds like everything has turned out good for your daughter and your family, so far. I hope your daughter's recovery continues, and that her eating disorders to not come back. 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? I hope it doesn't, but please be aware that maybe it could (at least in my opinion).

I have an ex-sister-in-law who was in a treatment center for 4 weeks when she was in college for anorexia. She is now 45 years old, and her anorexia has reared it's ugly head again in her life, just in the past two months. All that time, and it's back. She has been through so much in her life over the past few years, and I think it's subconsciously her only way of coping. Even though she lives in another state, I am in close contact with her (we relate well to each other, both single moms, etc. - she opens up to me and shares about her ED struggles - we consider each other "soul sisters"). I'm loving her and giving her all the support I know how to give. But I cannot "cure" her. She is an adult. Besides therapy, where else is she supposed to turn? She has children to raise! Oh, I feel her pain... I have been there, too. I know that pain and desperation, always hoping and praying that I do not emotionally "damage" my children in any way because of my disease. (As far as I know, my boys do not know about my bulimia. They're kids and I don't want them to "worry" about their mom.)

Personally, for me, it helps to know that my "helpers" (therapist, nutritionist) have also suffered from eating disorders themselves. As the adult patient, it is such a relief to have someone else there who has "been there," and who knows exactly what I was feeling and going through! These two women that I was so blessed to be led to have shared so much of their own personal stories with me, and that actually helps me in my healing and recovery process. No, my situation and "story" is not exactly the same as theirs, and I do not always agree with everything they say! That is my right not only as their patient, but as a human being! I take what resonates for me, and leave the rest (and I tell them that!). :)

I've always used my strong intuition when I need to, especially as a mother. When my older son went through so many tests as a young toddler and into his elementary school years, I remember thinking, "I cannot ever give up! I must continue to educate myself, learn everything I can, learn all of my options, and then make the best decision I can for my son." I know that learning disabilities cannot compare to any life-threatening illness of a child! I'm just trying to express to you that I do know what it's like to be a good mom, the best mom I can possibly be for my two boys, always only wanting the best for them, and feeling so heartbroken to see them suffer and struggle. We'd all, as parents, trade places with our children in their sufferings if it were possible!!!

These women who I refer to as my "helpers" are stable professionals, personally experienced in my disease, and open up to me with their own personal stories. I feel so blessed (I know I just used that word - but it's how I feel!) to have them in my life, helping me to get well. And they have both shared the struggles they still, personally have with their own disease. For instance, they know their food "triggers" as do I, and they stay away from those triggers in order to stay well. It gives me "hope" to learn from them. They are wonderful, strong examples to me. This is what works for me, and it probably would not work in the same way for a younger person, adolescent or child - I don't know for sure. I just have to keep looking forward and relying on the support that I have in them!

Anne, I owe you an apology. It's been nagging at me all day. I was pretty hard on you yesterday in my original post to you about Joanna. I feel very defensive of her because she, too, has helped me so much because of her knowledge and her own personal experiences. I "reacted" and I should not have done so in the manner that I did. It was disrespectful of me to act like that towards you, and the others who I felt were "attacking" her. Please accept my humble apology (that goes for everyone else, too). I still love Joanna and support her (she's an adult, like me, and her experiences give me "hope" also, like my other "helpers"). I personally relate to her and appreciate her and the help she's given me.

Love and Light,
Shelley

June 9, 2009 - 6:42pm
EmpowHER Guest
Anonymous

http://maudsleyparents.org/bulimianervosa.html Books on the approach should be available at your local library for loan if you're interested.

June 9, 2009 - 5:52pm
EmpowHER Guest
Anonymous (reply to Anonymous)

The above was meant for Shelley, who asked about bulimia.

June 9, 2009 - 5:59pm
(reply to Anonymous)

Thank you so much for your response back to me.

I saw that there were a few books that they recommend. Doesn't it seem like they're really about treating anorexia in adolescents? And not much about bulimia? That's what I thought, anyway, when I went to their site. And what about treating the "adult" with eating disorders? I feel like I'm in a very small minority, sometimes. It's been very, very difficult for me to find much information for those of us who develop out of control eating disorders in their 40's, 50's, 60's, etc.

Although I've had eating disorders since I was very young, bulimia became completely out of control, and life threatening, two years ago - when I was 44. Talk about feeling like a minority! I know there has to be more people like me. Maybe they don't seek out treatment/help to get better? I don't know. I just know that sometimes it's hard for me to relate to others who experience ED's. I can remember what it was like as an adolescent (with no help or treatment) and into my 20's and 30's - but I always managed to keep it a "secret." And I survived, both physically and emotionally.

If I lost weight and was "thinner" everyone commented on how great I looked. They didn't know I'd starved myself to get that way. Even two years ago, when I lost way, way too much weight from starving, and purgeing (throwing up) ANY food I ate, SEVERAL people (especially the women) I work with would tell me how GREAT I LOOKED!!! I looked like a walking corpse. My own mother did not recognize me when she came to visit - she was so shocked by my awful appearance. I was dying. I was literally gray. My hair didn't grow for over a year and then started falling out - and the women at work were telling me I looked great! How SICK is that? How sad...

Shelley

June 9, 2009 - 6:56pm
EmpowHER Guest
Anonymous

Several thoughts flashed through my mind as I read the last few posts.

First and foremost, as is evident by the many posts, people have varying views on how best to treat ED's. As a parent, when you first go for help, this dichotomy of approaches should be fully explained. Parents need to be made aware of the differing viewpoints and ALLOWED TO CHOOSE their path of treatment. This didn't happen for me and my family and I think that's a very common experience. As for 'different approaches work for different people'--Richelle, these were the EXACT WORDS a highly regarded ED nutritionist said to me when I first sought help and asked about evidenced based practice for adolescents. Perhaps in a highly theoretical way this is true, but I needed specific, concrete help in a big hurry--we were in a huge crisis. I needed RESEARCH driven information. I needed phone numbers. I needed a how-to manual. I needed support. And I needed to know specific options. I am certainly smart enough to figure out what is best for my family. When I asked questions (and they were good questions)the answers seemed so vague. And, it left me reeling...was ED treatment really this fuzzy? (FYI, this was back in 2003)

Second, I have heard (and Shelley, you've verified through your own personal experiences for me) that therapists and nutritionists often have a history of past ED's themselves. If this is the case, I think it's an extremely important piece of information they should share with parents seeking services. Why, you might ask? (and you might say that this is a 'boundary violation' itself). However, having had a past ED might strongly predispose a person to one viewpoint of cause and treatment over another. And, while such a person might indeed be a dedicated, caring therapist or nutritionist and very sympathetic with their clients, it could also be that they share only their personal perspective on cause and treatment. And, I'd certainly want to know that they had no lingering illness themselves. Sort of a case of "full disclosure".

a late dinner is calling...

anne

June 9, 2009 - 5:42pm
EmpowHER Guest
Anonymous (reply to Anonymous)

Anne,
Thank you for all you have shared about your experience. I have a few comments:

"As for 'different approaches work for different people'--Richelle, these were the EXACT WORDS a highly regarded ED nutritionist said to me when I first sought help and asked about evidenced based practice for adolescents. Perhaps in a highly theoretical way this is true, but I needed specific, concrete help in a big hurry--we were in a huge crisis. I needed RESEARCH driven information. I needed phone numbers. I needed a how-to manual. I needed support. And I needed to know specific options. I am certainly smart enough to figure out what is best for my family. When I asked questions (and they were good questions)the answers seemed so vague. And, it left me reeling...was ED treatment really this fuzzy? (FYI, this was back in 2003)"

I completely agree. I understand your comment is in reference to a nutritionist (for whom my comments are even more applicable), but I'd like to speak from my experience as a recent medical school graduate. Unfortunately in my medical training we received one 50 min lecture on eating disorders from a psychiatrist who does not specialize in EDs, were tested on the acid-base/electrolyte and other homeostatic imbalances that can result from vomiting, laxitive abuse and starvation, and perhaps some comments about EDs may have been made during a pediatric lecture. In clinical rotations, I found the same lack of up-to-date knowledge among many practicing doctors and often patient-doctor communication could have been improved. Obviously, we must be taught a vast amount of information and skills in a limited time, however I think this is grossly insufficient given that ~50% of my school's graduates go into primary care. Many people start with their family physician or pediatrician for referrals or if the ED is unknown, it is the doctor's responsibility to notice signs. We do get a lot of additional training in residency, but on the whole, knowledge about EDs and mental illness in general needs to be emphasized and valued more in the medical community. Recovery is "vague" because different things do work for different people, but we should be able to give you a list of options and the most current research just as we might give you statistics for any other illness.

"As a parent, when you first go for help, this dichotomy of approaches should be fully explained. Parents need to be made aware of the differing viewpoints and ALLOWED TO CHOOSE their path of treatment. This didn't happen for me and my family and I think that's a very common experience."

Again, I agree. Unfortunately, for a number of reasons I assume, patients are not informed of the "dichotomy of approaches" for many illnesses. Often, you are not told why we chose one antibiotic over another or are referring you to one specialist over another. Of course, it is impractical to explain the reasoning behind every decision and for decisions that can have a very significant impact, the patient must be informed. I think you bring up very good points, and in my opinion, we need better training on how to create a partnership with patients rather than the traditional doctor-knows-all model. Again, all of my comments come from a medical training perspective.

I also agree with you that professionals need to be aware of their own biases and if they favor one approach over another standard approach the patient should be informed. I think mental health professionals do receive a good deal of training in this area. It has also been discussed a number of times in my training. Disclosure of personal experience with an eating disorder cannot be enforced, just as you are not required to inform your employer, clients, customers, etc of your medical history. Obviously treating eating disorders while not in recovery is an ethical issue. From my limited knowledge, most ED treatment centers require a certain length of recovery for those working in contact with patients. I am sure the other professionals contributing to this thread have more knowledge and experience in this area than I do.

Richelle

June 9, 2009 - 7:40pm
EmpowHER Guest
Anonymous (reply to Anonymous)

It was interesting to hear your experiences as a medical student, Richelle. As a parent, I started out fully expecting the experts to lead the way and know the answers. That didn't entirely happen. I found myself forging my own way.

Unlike other illnesses, anorexia nervosa is one where parents often meet with exclusion or blame...we are in the waiting room while our children have nutrition appointments, doctor appointments, therapist appointments. We can feel very dis-invited and disempowered in our role as parent. It can leave us so in the dark.

I think if I were to ask the 'why' of a particular antibiotic, most doctors would give me a logical answer. The protocol would be standard and published. The 'why' of ED treatment seems a lot less clear and upfront as well as less uniform across care providers.

And, when the bills are what they are (my daughter's illness cost well over $100,000), parents need to have rights--to know what is going on, what services we are getting for our money, and how effective are those services.

anne

June 9, 2009 - 8:04pm
EmpowHER Guest
Anonymous

Hi Richelle,

You raise a very interesting point. Unfortunately, relapse after discharge from inpatient programs seems common. There's more to family-based treatment than refeeding. I think a lot of attention is given to the first phase of Maudsley treatment, perhaps because parental control of nutrition contrasts with other treatments for anorexia nervosa. But weight restoration is only the first of three stages of treatment, and even in the early part of treatment there are psychological factors at play (parents present a united front, there is a non-critical stance toward the ill child, the illness is externalized.) The final two stages of treatment revolve around re-establishing independent eating and getting back on track with healthy adolescent development. Lock and le Grange's Treatment Manual for Anorexia Nervosa and Help Your Teenager Beat an Eating Disorder are the best resources for people who'd like to learn more about family-based treatment, but this article offers a brief overview. http://maudsleyparents.org/whatismaudsley.html

Jane Cawley
http://maudsleyparents.org/

June 9, 2009 - 4:55pm
(reply to Anonymous)

Hi Jane,

Until this blog, I had never personally heard of the "Maudsley Approach." I went to their web site, read through everything, and came away feeling like it all seems pretty vague to me (but that's just me). It was difficult for me to "relate" to what I read because my main eating disorder is bulimia, and I am an adult, not a child. It seems like they don't really say much about the indepth specifics of their entire program. I guess I would have to pay money to learn more about it? Their web site seems like a short summary of their approach to treating adolescents with anorexia (very little is mentioned about bulimia, and for some of us the two go hand in hand).

I think that when I was a teenager (and I did have eating disorders at that time), if my parents forced me to eat food, I would still find ways to purge it. Most of us with bulimia are extremely adept at hiding it from everyone.

I understand that their "Phase I" is to make the child eat like a "normal person." But, what happens when that child goes back out into the world (school, friends' houses, etc.)? How do these parents know for sure that they're not throwing up? There is no way to know if their child is bulimic. The vast majority of bulimics are either of "normal" weight, or even slightly overweight.

Just a thought that came to mind...
Shelley

June 9, 2009 - 5:24pm
EmpowHER Guest
Anonymous

Lydia,

Excellent points you make!

......................................

Richelle,

I don't claim to be an expert on the Maudsley Method, but from what I have read, it's origins began in Great Britain when parents adopted the refeeding approach at home being done by
compassionate nurses in the hospital.

Many parents in different parts of the world simply do not have the money nor the insurance coverage to pay the hefty fees of treatment centers and therapists.

I have read that Maudsley has a very high success rate and most of the children that are treated with Maudsley recover completely.

Fortunately, many of those children do not grow up to being adults who require lifelong therapy nor are they subjected to toxic therapists who tell them that their parents were/are their problem.

Those children did have (and do have) very caring parents!

June 9, 2009 - 4:49pm
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