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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)
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
[email protected]

Add a Comment206 Comments

Here is a link to a Time magazine article that came out today called "A Genetic Link Between Anorexia and Autism" http://www.time.com/time/health/article/0,8599,1904999,00.html?xid=rss-topstories
""[Anorexia is] highly heritable, it runs in families, and it's clear now that it's affected by a cluster of [early life] vulnerabilities like anxiety and perfectionism. If you don't have those vulnerabilities, you are very unlikely to develop anorexia," says Dr. Walter Kaye, director of the eating-disorders program at the University of California, San Diego.'

"Essentially, Treasure and her colleagues have abandoned the idea that family dysfunction causes eating disorders and instead enlist the family to help guide patients' recovery. Most recently, the Maudsley method has also incorporated a new type of cognitive behavioral therapy, based on the autism connection, which aims to broaden the narrow thinking routines of people with anorexia. "

"Treasure's colleagues at the Maudsley Hospital say current treatments are equally obsolete. In the late 1980s, the British researchers published the earliest studies describing what has become known as the Maudsley method of treating anorexia in teens — and it remains the only therapy that has proved effective in controlled trials. Unlike traditional treatment, which assumes that anorexia is caused by environmental factors and low self-esteem and often involves intense therapy at residential treatment centers, the outpatient Maudsley method does not focus on psychological therapies or on "parent-ectomy" — removing the teen from the home."

My D had anorexia and has a different ED now. My sister's S has autism. As far as we know, no one in our family before us or contemporary with us has had an ED or autism. Don't know where these disorders came from, but one thing is very clear -- we have both done everything in our power to love, support and help our kids, and we have never in any way been either neglectful nor have we inflicted pervasive boundary penetration on our children.

June 19, 2009 - 12:35pm
EmpowHER Guest

Sorry, I didn't mean to repeat post the above. Not sure how to undo it now.

June 19, 2009 - 12:26pm
EmpowHER Guest

OMG, say it's not so!

Joanna has a book coming out.

From her Twitter blog:

"Tweaking my book contract with publisher. Yes, my eating disorder recovery book sold and will come out in 2011. Hooray!"

Heaven help us!

Well, she has garnered some publicity for her book, for sure, but I am not sure that it is really the type of publicity that a professional would want.

June 18, 2009 - 11:42am
EmpowHER Guest

Anne, great info! Thank you for posting that.

June 18, 2009 - 10:12am
EmpowHER Guest

Here are two pertinent quotes off the Mayo web site concern their Maudsley treatment approach:

"Children who have eating disorders are typically from loving families. They are very responsible, accomplished, and well-behaved. That's what makes their eating disorders so baffling to the people who love them," says Leslie Sim, Ph.D., clinical director of Mayo's Child and Adolescent Eating Disorders Program. "We don't know what causes eating disorders, but we do know that parents play a huge role in helping their children recover."


"For those who commit to family-based therapy, the treatment success rate is excellent. Nearly 96 percent of patients treated with FBT at Mayo since 2004 (about 50) have successfully recovered. Less than 5 percent have needed to re-enter treatment programs. This compares to a long-term recovery rate of about 50 percent for patients in standard treatment programs, which commonly include multiple hospitalizations and long-term treatment. The FBT program often eliminates the need for follow-up programs and helps patients adjust more quickly to their outpatient program."

I commend Mayo for offering parents this treatment option. I hope others follow suit.


June 18, 2009 - 9:57am
EmpowHER Guest

For those of you who continue to suffer from ED, you need NOT be subjected to therapists who feed into your 'victim' mentality.

Erin Gates, a recovered anorexia sufferer, talks openly and candidly about her journey through ED and to recovery and a successful life.


This, too, can be you.

Do not waste your time trying to find 'cause' and placing 'blame'.

Getting the right help early on seems to be the key to successful recovery and a fulfilling life free from ED.

June 18, 2009 - 8:29am
EmpowHER Guest

While I know nothing about the program other than it exists, Mayo Clinic uses Maudsley and reports a very high success rate.


Also, I totally interpreted the comment to Shelley about daughters differently than you all apparently did. I did not interpret any hint regarding her being an abusive mother, period. I took from the question that the writer was asking because of the genetic risk of passing on traits that predispose towards these illnesses. That, certainly, no one is in control of or blamed for. When I read it, I felt the writer was simply trying to make a point about genetics, not accuse anyone.


June 18, 2009 - 4:44am
EmpowHER Guest

Carol-THANK YOU! You summed up what i wanted to say so succinctly that I'm not going to bother responding. You're right and thank you for standing up for many voiceless people.

Shelley-I've been enjoying your contributions to the discussion. For the record, I think you sound like a wonderful mother (definitely NOT abusive) and if you had had daughters, I believe that you would have raised them well and been able to keep them out of the whole ED mess.

I'm disgusted by whoever it was who said that an eating disordered mother is "abusive" by virtue of having an ED. Shame on you. An eating disorder does not make an abusive person, rather eating disorders are likely to be responses to abuse. People do what they have to in order to survive abuse and sadly that can include an eating disorder. A person with an eating disorder is more than likely a survivor, NOT an abuser. An abuser is someone who would throw around such inflammatory and false comments about mothers with eating disorders. I have known mothers who suffer from eating disorders and they are wonderful, caring parents who would do anything to prevent their sons/daughters from falling into EDs and have been successful. These parents are not only more likely to notice early signs of depression/EDs/mental distress in their children but also more likely to believe their kids and take quick action. Their kids feel that they're able to confide in their parents and find acceptance and understanding. All of these mothers I have known have been actively seeking healing and how inspiring is that for a child to witness. A child eventually has to accept the humanity of their parents-to be able to see them as flawed, see them cry/feel scared or vulnerable/struggle with problems-and come to terms with it and see them as people as well as Mom or Dad. Similarly, parents must come to terms with and accept the humanity and personhood of their kids. A parent who struggles with an ED or mental illness shouldn't lie about it or go to great lengths to deny it despite evidence to the contrary because the kid knows something is wrong and its better for them to know the truth. Watching this parent struggle and move forward is probably one of the best lessons they could ever learn and if it keeps them from falling into that path or prompts them to come forward and ask for help if they became depressed themselves then all the better.



June 17, 2009 - 11:33pm
EmpowHER Guest

Mayo Clinic

Causes of Anorexia


It's not known specifically what causes some people to develop anorexia. As with many diseases, it's likely a combination of biological, psychological and sociocultural factors.


Some people may be genetically vulnerable to developing anorexia. Young women with a biological sister or mother with an eating disorder are at higher risk, for example, suggesting a possible genetic link. Studies of twins also support that idea. However, it's not clear specifically how genetics may play a role. It may be that some people have a genetic tendency toward perfectionism, sensitivity and perseverance, all traits associated with anorexia. There's also some evidence that serotonin — one of the brain chemicals involved in depression — may play a role in anorexia.


People with anorexia may have psychological and emotional characteristics that contribute to anorexia. They may have low self-worth, for instance. They may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which means they may never think they're thin enough.


Modern Western culture often cultivates and reinforces a desire for thinness. The media are splashed with images of waif-like models and actors. Success and worth are often equated with being thin. Peer pressure may fuel the desire to be thin, particularly among young girls. However, anorexia and other eating disorders existed centuries ago, suggesting that sociocultural values aren't solely responsible.


For those of you who are interested in causes of eating disorders, it is best to check with EXPERTS on the subject.

June 17, 2009 - 9:51pm
EmpowHER Guest

Here's a research article well worth reading:

Family therapy in the treatment of adolescent anorexia nervosa: current research evidence and its therapeutic implications. June 2008
Cook-Darzens S, Doyen C, Mouren MC.

Department of Child and Adolescent Psychiatry, Hôpital Robert Debré, Paris, France. [email protected]

From the outset, the systemic and family movement has expressed an interest in eating disorders, more specifically anorexia nervosa, establishing causal links between family functioning and aetiology and advocating family therapy as the treatment of choice for this disorder. Because of high consistency between its explanatory and therapeutic dimensions, this model continues to dominate our conceptualizations and clinical practice, IN SPITE OF A LACK OF EMPIRICAL EVIDENCE. This article summarizes present empirical evidence concerning both family functioning (explanatory dimension) and the effectiveness of family therapy (therapeutic dimension) in anorexia nervosa, and describes resulting changes in theoretical and clinical perspectives. A model of evidence-based family therapy is presented and several unresolved issues are raised. Overall, this overview of the literature supports the use of therapeutic models that are more flexible and normative, less guilt-inducing, more diversified (eclectic and integrative), and more rooted in the empirical literature.

PMID: 19169071 [PubMed - in process]

Caps are mine because I can't underscore or italize


June 17, 2009 - 8:34pm
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