Eating Disorders

by Alan Brandis, Ph.D.

Our relationship with food begins with the first drops of milk we swallow, and continues all of our lives. Because food becomes closely associated with the people who feed us, and who come to be seen as offering or withholding love and emotional sustenance, food becomes a powerful unconscious symbol of our relationships to our families, to ourselves and to the world.

Food and our relationship with it is also connected to our self-image, since in our culture we place so much emphasis on physical appearance and have a horror of obesity. Food can become our best friend (due to the comfort it offers us) and our worst enemy (because by enjoying it too much it we can lose control of the image we present to the world).

Compulsive Overeating is a disorder which results in obesity but which is so much more than just being "fat." Food is used, in essence, like a drug, to alter one's mood and as a method of escape much like an alcoholic uses alcohol.

Anorexia is a disorder which is characterized by compulsive dieting and exercise. The anorexic believes that she or he (90% of anorexics are female) is too fat, even at 90 pounds. This disorder seems to be characterized by an obsessive need to exercise self-control, as these patients exult in the triumph of eating less than 200 calories a day and running 5 miles or doing calisthenics for hours. In the later stages of the disease, a fine white hair appears all over the body of the anorexic and her period stops completely. These patients are in real danger of dying of malnutrition.

Bulimia is a disorder in which a cycle of repeated bingeing and purging is engaged in. The bulimic may buy bags full of groceries, bring them home, lock the doors and unplug the phone and engage in an orgy of eating (a binge), even eating raw cake mix because they can't wait to cook it, eating even to the point of passing out. They may then purge by forcing themselves to vomit up the food or may take huge quantities of laxatives in order to "make up for" the binge.

The bulimic believes that she or he is "beating the system" because they get to enjoy the pleasure of eating without "paying the price" of weight gain. However, they pay the price later because bulimia causes many medical problems such as heart disease (the vomiting upsets the balance of chemicals in the body, weakening the muscles including the heart), ulcers and hemorrhage from the acid and pressure on the esophagus of repeated vomiting, and various dental problems (the acid from the stomach weakens the enamel of the teeth).

By the time the eating-disordered person comes in for treatment, their eating patterns are deeply ingrained and they are as reluctant to give them up as a smoker is to quit or an alcoholic is to get sober. Usually, the first step is to conduct a study of their eating patterns to begin to assess how their pattern needs to change, as well as to gather a thorough personal history and look over any available medical records.

Often, a physical medical exam is useful to determine if their eating disorder has caused any reversible or permanent damage to their bodies.
Then, a trained eating disorder specialist helps the patient set up a plan for systematically altering their eating pattern. This may involve developing a specific eating plan which they commit to follow, or working out a looser set of guidelines which the therapist, the patient and their physician agree on. Psychotherapy is then directed to assisting the patient to follow the plan, as well as to discover and explore any underlying issues which trigger the eating behavior and interfere with the intention to follow the plan.

If you think you may have an eating disorder, or you know someone who does, by all means get professional help if possible, since these conditions can be life-threatening if left untreated.