Eating Disorders
by Michele Siegel, Ph.D.,
with Margot Weinshel, M.S.W.
and Judith Brisman Ph.D.
I looked over at my 14-year-old daughter, Lara, as the internist spoke to us
about the causes of Lara's recent fainting spells. "Anorectic. Your
daughter is anorectic." I watched Lara cross her sticklike arms in reaction
to these words. Her face suddenly looked old to me, bony, unpleasantly pointed.
My heart sank. I have failed her, I thought. What did I do wrong? Lara was a
straight-A student. She never seemed like she had any problems on her mind. How
could she be anorectic? No, this is a mistake. Someone has made a mistake. --
Barbara L., 39-year-old mother
I came home early from work with flowers, thinking I'd surprise my wife. When
I put the key in the door, I was met with a frantic cry, "Wait, who is it?
Ben? Don't come in yet! Wait!" I panicked -- I thought the worst and raced
into the apartment. And there was Nina, standing in the middle of the kitchen.
Several boxes of cakes, cookies, and a pie were opened and half eaten. Candy
wrappers were strewn over the floor. The refrigerator door hung wide open. A
puddle of spilled milk rested in the middle of the table; ice cream was melting
in the container beside it. Nina looked at me angrily. "Why didn't you
call?" she demanded. "Why are you home so early?" A moment before
I had been so sure I would find her with another man -- but this? This didn't
make any sense to me -- in a frightening way, it felt worse. What had I walked
in on? What was happening to my wife? I remember not knowing what to do with the
flowers. -- Ben, 27-year-old husband
It's getting harder and harder living with Jennie. It's almost like living
with two different people. Half the time she is on some diet or other, following
it to the T, not an inch of leeway. Then suddenly she's eating like a madwoman,
and it's possible that at any time all the food in the house can disappear.
During these times she won't go out, she'll break plans with me continuously and
will look miserable and depressed. All she wants to talk about is what she's
eaten, how "good" she's been, or how different life will be at a low
weight. She could stand to lose weight -- she's about 180 pounds. But even when
she does get thinner, which happens periodically, it seems that starts the whole
cycle over again. Jennie's my best friend but I've had enough. Is there
something I can do? -- Pamela, 24-year-old roommate
Eating Habits & Eating Disorders
The mother, husband, and friend in the above examples knew that something was
wrong. What they were seeing was not normal behavior. The people they were
involved with were in trouble. In all three cases, there were clear signs that
the person they cared about was eating disordered.
When an eating disorder exists, it is recognized by certain behaviors, the
most noticeable being an obsession with food and weight. This obsession can take
the form of binge eating, starving, vomiting, compulsive exercising, or other
behaviors focused on eating, getting rid of, or avoiding food.
Eating disorders, however, are not merely problems with food. They are
psychological disorders, many aspects of which are not apparent to an outside
observer.
It is often not easy to tell who is and who is not suffering with an eating
disorder. Dieting, exercising, fasting, and a preoccupation with food and weight
are so much a part of our culture that it is unusual to find a teenage girl or
woman who is not or has not been concerned with weight. It only takes a glance
at the covers of women's magazines to see the relentless focus on staying slim.
Fashion, advertising, and entertainment idealize a female body that only 1
percent of women can hope to achieve. However, the value of slimness is not the
only message these magazines communicate. Alongside the messages to be slim are
ads and recipes for rich, enticing desserts. Our culture seems to encourage us
all to "have our cake and eat it too."
Almost everyone is susceptible to our culture's messages. Comments like
"You look so good. Did you lose weight?" perpetuate the importance of
being thin. There are few people who don't enjoy these compliments. In fact,
thinness is such a desirable attribute that, in a large research study at
Harvard University and Radcliffe College, it was found that body dissatisfaction
and the desire to lose weight are the norm for 70 percent of young women.
It is not just women who are being affected by the culture's messages. Men
are also becoming increasingly food and weight conscious. We have only to look
at the advertisements, cosmetics, and fitness magazines directed toward men to
see that they are no longer excluded from society's emphasis on good looks and
slim physique.
The focus on body, dieting, and weight is particularly acute among teenagers.
Teenage girls are constantly vying to be the thinnest or skipping meals to lose
weight. Talking about eating, overeating, or even group "pigouts" are
communal experiences. More troubling is the fact that this dissatisfaction with
one's body is occurring at even younger ages. In a recent research study, a
questionnaire was given to 650 fifth- and sixth-graders regarding their
attitudes toward food and their bodies. Seventy-three percent of the girls and
43 percent of the boys wanted to be thinner. In this group, 58 percent had
already tried to lose weight and 11 percent expressed disordered eating
attitudes.
Regardless of the age group, it seems food and weight are on everyone's mind.
Does this then mean that everyone in our society has an eating disorder? No.
An eating disorder exists when one's attitude toward food and weight has gone
awry -- when one's feelings about work, school, relationships, day-to-day
activities, and one's experience of emotional well-being are determined by what
has or has not been eaten or by a number on the scale. Most of us know what it
is like to comfort or reward ourselves with food, to allow ourselves an
indulgent meal after a particularly difficult day, to have the extra calories
when we feel disappointed. Most of us know how it feels to wish we looked a
little thinner in that bathing suit or to want to look particularly good for an
important occasion. However, when these wishes or rewards turn into the basis of
all decisions, when the pounds prevent us from going to the beach, when our
looks are more important than the occasion itself, then there are indications of
a problem deserving attention.
Eating problems usually start out with the common wish to lose weight and
maintain a certain body image. These are concerns that most of us have
experienced. Often people can go through a period of intensive dieting,
obsession with weight, or overeating that will be short-lived and end without
outside interventions. However, a potentially short-lived bout with food control
becomes an eating disorder when the eating behaviors are no longer used merely
to maintain or reduce weight. An eating habit becomes an eating disorder when
the primary need it satisfies is psychological, not physical. The eating
behavior then becomes a vehicle for the expression of problems outside
the arena of calories.
Someone who is eating disordered does not eat because she is physically
hungry. She eats for reasons unrelated to physiological needs. That is, the
eating may temporarily block out painful feelings, calm anxiety, subdue
tensions. Or she may starve, not because she is full, but because she wants to
control her bodily needs.
Consider Corey's situation for a moment. Corey is a 28-year-old who came to
us for help. When Corey was a teenager and became upset because of a school
event or a canceled date, she found it comforting to sit in front of the
television and slowly savor a piece of chocolate cake or other dessert from her
mother's well-stocked kitchen. During this time, she was of normal weight. While
she always enjoyed her late-night snacks, they were certainly not the focus of
her thinking or plans.
When Corey left home to go to college, however, she began to have more trying
times. She felt somewhat overwhelmed by the demands of living on her own in a
new environment. Frequently, she felt homesick. More and more often, she looked
forward to the late-night snacks (which actually began to occur earlier and
earlier in the evening). She found the food soothing and she could block out her
thoughts when she ate. As the school year progressed, Corey found herself
thinking about and looking forward to eating as soon as she woke up. Her
thoughts started to revolve around what she would eat at mealtimes and what
snacks she could buy throughout the day.
She was soon feeling that the rest of her life was secondary to eating. The
consequent weight gain accelerated Corey's withdrawal from her social life to a
world of food. At this point, Corey could no longer be considered a normally
"food-obsessed" teenager; her focus on food, her social withdrawal,
and the bingeing were all signs that her eating habits were now part of an
eating disorder.
 This
article is excerpted from Surviving An Eating Disorder, by Michele
Siegel, Ph.D., Judith Brisman, Ph.D., and Margot Weinshel, M.S.W. Reprinted with
permission of the publisher, HarperCollins Publishers (Imprint: Perennial). http://harpercollins.com
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this book.
About the Authors
 Michele
Siegel, Ph.D., who initiated the idea for this book, was co-founder, with Judith
Brisman, of the Eating Disorder Resource Center. She died in 1993.
Judith Brisman Ph.D. is the director of the Eating
Disorder Resource Center in New York City.
Margot Weinshel, M.S.W. is a family therapist on the faculty of the Ackerman
Institute for the Family in New York City.
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