Read an Excerpt
Chapter 1 Gaining Perspective
What You See
The Behavioral Aspects of Eating Disorders
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 almostlike 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
When Eating Habits Become 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.
