Facebook Pixel

Number One Reason for Developing an Eating Disorder

 
Rate This

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

This is an interesting good-sized study that looks at childhood sexual abuse and eating disorders.
http://archpedi.ama-assn.org/cgi/content/full/162/3/261
The results suggest that childhood sexual abuse is a risk factor for bulimia, but not for anorexia nervosa.

June 7, 2009 - 5:55pm
EmpowHER Guest
Anonymous (reply to Anonymous)

Thank you for this contribution. I hope others will share related research as well.

I followed the url to the study.

It stated:

Conclusion Childhood sexual abuse seems to be a risk factor for the development of bulimic syndromes, not necessarily mediated by psychiatric morbidity or severe dieting.

Childhood Sexual Abuse and Eating Disorders in Females

Findings From the Victorian Adolescent Health Cohort Study

Lena Sanci, MBBS, PhD, FRACGP; Carolyn Coffey, BSc, Grad Dip Epi; Craig Olsson, PhD; Sophie Reid, PhD; John B. Carlin, PhD; George Patton, MBBS, MD, FRANZCP

Arch Pediatr Adolesc Med. 2008;162(3):261-267.

June 7, 2009 - 6:20pm
EmpowHER Guest
Anonymous

too bad that we can't have names here, it's a bit confusing to reply to "anonymous" when most of us have that name.

so this is isabella mori again. i agree with the last commenter that it would be nice to have some evidence. do you have it, joanna? perhaps from your case notes?

however, it is interesting that the last commenter asserted that ED patients have had horrific childhoods "but only in the same percentage as the general population". i personally haven't seen any evidence of this, either. and if that evidence comes only from maudsley supporters then, with all due respect, i am inclined to take that with a grain of salt.

reading that first the daughter said her parents were horrible and now she says she's had an ideal childhood ... hmmm ... in my experience, many recovered people would not swing that far.

why can't we just say that we don't know (yet) what causes this condition? psychology is such a young science, we really don't know that much yet. and in humans, there is really rarely something that is THE cause. we are infinitely complex, and events interact in ways that are often hard to untangle.

what we DO know, in individual cases, is what seems to work. so why not concentrate on that for now, helping people with eating disorders heal one person at a time ...

June 7, 2009 - 5:49pm
EmpowHER Guest
Anonymous (reply to Anonymous)

Hi! I am the one whose daughter did the big swing from being very angry with us, thinking we were horrible, to an adult who appreciates fully everything we did for her in the past and for our strong relationship today. It has been my experience that people with EDs are a study in extremes. When in the depths of their illness, sufferers lives are completely, extremely different from what they were before manifestation. If they are lucky enough to get the treatment they need, then everything swings completely in the other direction, towards health. My daughter's realization that her previous thinking was totally out of line with reality doesn't seem that far-fetched to me.

June 7, 2009 - 6:35pm
EmpowHER Guest
Anonymous (reply to Anonymous)

Yes, I see similar responses in young girls who get their recovery in residential treatment centers. If they truly get some recovery they are amazed at how off track they were in their illness.

The touching part of this story is that they often have great compassion for others who are still stuck in the disorder.

At such times the recovered person may need help and support so she doesn't devote more energy and time than she can afford in trying to be therapist
(or Maudsely parent) to her friend.

Have you seen this?

Joanna

June 7, 2009 - 6:41pm
EmpowHER Guest
Anonymous

Joanna, your statement indicating that “the number one cause of eating disorders” is either consistent penetration or neglect during childhood of a person’s “physical, emotional, psychological, intellectual, sexual and creative boundaries” is problematic in a number of ways. First, there is no evidence that your statement is true. It would be big news to eating disorder professionals and researchers if it were. Second, by trumpeting this false statement, you perpetuate old stereotypes and lead people astray from the really important new and evidence-based information about eating disorders that could actually help sufferers and their families.

The good news is that in most cases when family-based Maudsley therapy is used, there is full recovery-not the nebulous half-life of being able to function but not at a truly healthy weight and with all the disordered thinking still present. We should all be shouting this from the rooftops instead of spending any time on statements such as yours. And, yes, it is more difficult to treat adult sufferers, precisely because they are independent and in most cases cannot be forced into treatment that their eating disorder doesn’t want. So let’s catch it early, cure it early, when parents are around and are indeed legally obligated to do the heavy lifting when their children are ill.

There is increasing evidence that malnutrition for any reason in genetically predisposed people is what triggers an eating disorder. It was certainly the case with my daughter. She was about to enter puberty, wasn’t happy with her body and decided to “go on a little diet and lose a few pounds” (without telling her parents, of course). She didn’t go through puberty for another 7 years. The current culture’s definition of beauty includes increasingly thinner body types. So more people go on diets, become malnourished, and those who are predisposed to manifesting an ED are at grave risk of getting one.

And, Joanna, I would be very careful about believing everything your adult clients say about their childhoods. ED sufferers are known for their twisted thinking and perceptions. You say that your clients are medically cleared for outpatient therapy and that all eating disorder sufferers are not malnourished. My daughter had outpatient therapy with a BMI of 11. Adults are not going to seek treatment unless they are desperate and unhealthy. And all people with eating disorders are malnourished, unless they are already on the big upswing, have been fully restored to optimal weight, continue to get full, daily nutrition and are in a stage where their recovering brains and thinking are catching up to their well-nourished bodies. My own daughter complained for years about how horrible we treated her and how much she hated us. Now, she will testify to anyone about just what an ideal childhood she had and how my husband and I are the greatest parents ever. I am not saying that some ED patients didn’t have horrific childhoods, but only in the same percentage as the general population.

June 7, 2009 - 4:24pm
(reply to Anonymous)

Your comment "And, Joanna, I would be very careful about believing everything your adult clients say about their childhoods. ED sufferers are known for their twisted thinking and perceptions." is extremely close-minded and made me feel highly offended.

Talk about sterotyping! You are obviously not someone who suffers from any type of eating disorder (you'd be referring to yourself as being "manipulative" and having "twisted thinking").

I can assure you that I am in no way "manipulative" and everything I say about my own childhood is true. God, I hope I'm not "known for [my] twisted thinking."

Good grief. I happen to be honest, clear-headed, intelligent, successful, a great mom, and many, many other positive things. To place such terrible, negative labels on people with eating disorders is a disgrace.

Shelley

June 8, 2009 - 5:53pm
EmpowHER Guest
Anonymous

hi joanna, this is isabella. as you know, i have a lot of respect for your work. i wonder about two things here:

you say that boundary violations is the number one "theme". are you implying that boundary violations are the cause? or was boundary violations simply something that you wanted to focus on for the purpose of this article?

the other thing is that you refer to the person with eating disorders as "she". this goes a bit with what alysiak said. granted, more woman than men have eating disorders but i think the fact that men suffer from them as well needs to be discussed more often. remember when there used to be this idea that only women had experienced childhood sexual abuse? it makes it so hard for men to come to terms with these things when there is an implication that they don't count. i'm sure you didn't want to imply that.

having said all this, i think it's important for all of us parents to look the fact in the eye that sometimes our behaviour, or our lack of doing something, CAN have serious consequences for our children. as you said, it's not a popular thing in parents boards to talk about.

we ALL need to heal. and we all CAN heal. how can we help BOTH parents and their children to do that?

June 7, 2009 - 4:03pm
EmpowHER Guest
Anonymous (reply to Anonymous)

Dear Isabella,

Thank you for your questions. I'm glad for the opportunity to respond.

What clearly comes through in this passionate discussion is the love, fear, anger, agonies and grief of so many parents. I can well imagine the heartache and feeling of helplessness in seeing the most precious person in their lives, a young child, waste away and risk death before their eyes.

I have children in my life and I would do anything necessary, sacrifice anything to keep them out of harm's way.

Finding a way that actually restores health to a child has got to be a glorious feeling that
stirs relief, gratitude, and respect for everyone involved, loyalty to the system that made it possible and incredible appreciation for having their child healthy.

Boundary violation is the topic of this particular article. In my experience as a clinician adults developing the ability to recognize boundaries is an essential theme in eating disorder recovery work.

Knowing what boundaries are, which ones to respect, which ones to negate and which ones to build and honor for their own well being is vital to recovery and healthy functioning in life. In my experience women with eating disorders are unaware of healthy
boundaries. They can’t set them and don’t know how to use boundaries for self protection.

My article is about women. That doesn't mean men don't exist. It simply means that I am writing about women.

At the risk of setting off another controversy let me say that in my experience the few adult men who have consulted with me about an eating disorder present a different clinical picture than women. I don't have enough knowledge or experience to discuss the issues men have to deal with in eating disorder recovery. I refer them, when possible,
to resources that can better serve them than I.

In terms of children, I see young anorexic girls (not in my practice) who are adamant about maintaining their eating disorder and who speak and write from a mind distorted by starvation.

I think most people involved in this discussion know the horrors of the pro anorexia sites where such distorted thinking seems to be rock solid.

And I see young girls come out of residential treatment centers (where they were admitted despite high protest) with a deeper appreciation of health and a generous and loving support for their friends who have gone through the program with them.

Yes, people also report that extreme dieting can trigger an anorexic mind set that propels the person into a sense of power through food deprivation. Perhaps nutritional deprivation stemming from certain illnesses can do the same.

Love, generosity and care coming from wisdom and knowledge compose the foundation of eating disorder recovery. If parents can provide that to their children, I think that's wonderful.

Some parents can't. Some parents are abusive and life threatening. Some parents are neglectful. Some parents are loving and don’t recognize how they neglect a child. Some are too ill or need to focus most of their time on earning a living to support their child. Some parents don't exist, either because they abandoned their children or because they died. Some parents are children themselves and don’t know how to care for a child. I wish all parents loved their children and were willing to provide whatever it takes to help them be well and strong and capable of living a healthy life.

Some children come from healthy and loving homes but meet with harsh and tragic
circumstances in life that can elicit an eating disorder response.

None of the above environmental conditions create a straight line to the development of an eating disorder. I’m not going from cause to effect. Many effects can arise from such conditions. I’m looking at what the adult woman with an eating disorder has to face
and reinterpret so she can develop a sturdy sense of self and become competent as she moves into a healthy life.

Blame is not a recovery issue. Recovery issues are based on what is, now, in the person’s experience. Yes, I listen to what my patients say. I don’t listen as a judge or prosecutor.
I don’t even listen for accuracy. I listen as a psychotherapist, with my mind and my heart, to how my patient sees, feels and understands her own experience. I am always looking for the pathway that will help my patient develop beyond her (and the people I see are women) current limitations and find health.

Yes, there is much we don’t know about eating disorders, both cause and cure. I feel such
joy when a person comes to me for recovery work. I know she usually has to draw
on personal courage to bring herself to treatment. She’s about the enter the unknown and
that can be frightening for someone whose defenses have so much to do with control.

I also have a sense that the people who do NOT seek treatment far outnumber the people who do. The pro anorexia sites have vast followings. Lately I’ve been feeling that the
people who seek treatment are like refugees escaping a harsh totalitarian system.

And please, readers of this discussion do not interpret that last statement as an indictment of parents. The harsh totalitarian system consists of the demands, rules and regulations of the eating disorder itself. An adult woman doing her recovery work is very much like a
revolutionary, rebelling against a system that is intolerable yet requires courage to combat or leave.

Thank you for entering the discussion, Isabella. My hope is that a continual airing of as many issues as possible, with all the passion that may involve, will help all of us
Get a more complete picture of the issues involved in eating disorder recovery.
If we can do that then we have a good chance of being able to work together.

Recovery work is not a one size fits all. The more dimensions we can see the more
compassionate and capable we all will be. I know I’m learning through this discussion.
I hope others are too.

Warm regards and by all means, Isabella, write again if more occurs to you.

Joanna

June 7, 2009 - 5:56pm
EmpowHER Guest
Anonymous

Dear Joanna

I appreciate that as a therapist, and as a caring human being, you want only to do what is best for your patients. That is why I read and re read your column trying to understand your perspective. However, in the end, I came away saddened and disheartened. I am the Mother of a young women who is in recovery from restricting anorexia. Without taking anything away from her bravery and courage in her recovery I can tell you with 100% certainty that what she said when she was in the grips of this terrible disease often bore little resemblance to reality. Her interest and ability to regain her health in order to lead a full and independent life was almost non-existent. You point out that all your patients have been cleared medically for outpatient care and that their perceptions are not altered from malnutrition. I can tell you for my daughter it took many months, and a weight well above the minimum defined as medical stability for her thinking to clear up.

Your premise that children develope anorexia because of abuse, boundary invasions and failure to recognize the child as a unique individual is insulting and without scientific evidence. The fact that children who are abused are more likely to develop mental health issues does not mean that the majority of those who suffer from mental illness have been abused. You assume that the involvement of parents in the well being of their young adult children is evidence for the assumption that these parents were over-involved. I can assure you that I, and most of those I know whose children have suffered from this horrible disease, want nothing more than for our young adult children to be able to lead healthy and independent lives. Parents of adolescents and young adults with cancer, severe heart disease, and other life threatening illnesses also assist their adult children in the search for appropriate medical care. And, like myself, they will step in to assist their adult child if their child starts to relapse. You may call it it invading a boundry--I call it saving a life.

I encourage you to look at the research done at Stanford and the University of Chicago on parental roles in recovery; Dr O'Toole of the Kartini Clinic would also be a good resource for you. There is also a lot of good recent work on the genetics of restricting anorexia.
I do not discount the fact that your patients may, in fact, experience their parents as over involved. Their families probably run the usual gamut of parents who had different levels of capability of dealing with a child or young adult with very unique medical and psychological needs. Most parents I have met would be very open to looking at anything they could do to help create an environment that was healthy for their children; working from that perspective might be much more fruitful than working from a perspective of blame.

Given that your work is with adults and not children and adolescents you may believe that most of what I have to say is not relevant to your patients. You may also be assuming that it comes from a defensiveness on my part. Most research has shown that coming from a close and loving family actually supports, rather than hinders, the ability of adults to function independently and to create their own intimate adult relationships. Your patients, and our children, deserve that opportunity. By vilifying the Mothers as both having initially caused the disorder, and then as having helped to maintain the disorder may be creating a family situation where future positive relationships are difficult. If the worst should happen, and the patient starts to relapse, it could also create a situation where the parents are unable to provide needed assistance leading to tragic results. The statistics for recovery from restricting anorexia using traditional psychotherapy and leaving patients to make their own decisions about food and recovery are grim. Only a slight majority fully recover, between ten and fifteen percent die, and the rest live a half life between sickness and health.

Maudsley treatment and other forms of intensive support which also include the family and emphasize full nutrition (such as the Kartini Clinic) have a much higher recovery rate. I hope you will take the time to learn more about them as well as to study some of the recent work on genetics and eating disorders.

I wish you the best in your important work.

sc

June 7, 2009 - 12:47pm
Image CAPTCHA
Enter the characters shown in the image.
By submitting this form, you agree to EmpowHER's terms of service and privacy policy
Add a Comment

We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

Active Adult

Get Email Updates

Health Newsletter

Receive the latest and greatest in women's health and wellness from EmpowHER - for free!