There are three main classes of eating disorders, and all of them can sentence you to a life of misery. The first is anorexia, which is an obsessive-compulsive attempt to achieve a “perfect” weight by restricting food or increasing exercise. The second is overeating, including binge eating and obesity. Finally, there is bulimia, in which a focus on food alternates with a focus on weight. In that sense, it combines aspects of the other two categories.
In all eating disorders, the essential issues are emotional. In the case of anorexia, they generally entail a powerful conviction that thin is beautiful, and that there is a perfect level of thinness that, once achieved, will guarantee a life of love and happiness. In a sense, weight, for anoretic individuals, is a means to an end, and this end is pursued with obsessional focus. Often, the conviction that “thin equals happy” can reach delusional levels, in which the sufferer never feels thin enough and continues to lose weight far beyond what is healthy. Sadly, this can result in severe physical problems, even death.
With overeating, weight is less important than the food itself, which often serves as a self-soothing mechanism or as a substitute for love. The act of eating can feel intensely rewarding, and the individual’s mind may become preoccupied with thoughts of food: what to eat, where to go to find it, how much to eat, how good it will taste, etc. In extreme cases, dissociative eating binges may have a drug-like quality that sends the individual, literally, into an altered state of mind.
In the case of bulimia, food and weight have a complex relationship. Anxiety prompts an obsessional wish to be thin, as in anorexia, but thoughts of restriction set up frightening feelings of deprivation, which trigger binges. The act of bingeing is followed by intense feelings of guilt and shame, which call for purgative measures (vomiting, laxatives) to restore a sense of order. Unfortunately, the calm doesn’t last long before the obsessional thoughts begin, and the vicious cycle resumes again.
A common factor in all three cases is that food and weight are being used to achieve emotional ends, which most often entails not feeling difficult, painful, or frightening emotions. For better or worse, however, life triggers all feelings, positive and negative. The key to treatment, therefore, involves learning to live in a world of feelings. Once that happens, problematic eating behaviors can be replaced with other, more productive solutions to life’s emotional challenges.
One important note: before any emotional exploration takes place, any immediate threat must be addressed. This is especially so in cases of anorexia. If you or someone you know is severely underweight, emergency medical treatment may be indicated. Please contact a physician immediately.