Eating Disorders - A Sufferer's View
On this page you will find a view of eating disorders from the point of view of someone who has experienced the pain of suffering one. This piece has been written specifically for the Somerset & Wessex Eating Disorders Association web site.
Writing about one's view of eating disorders from the less than objective position of someone who has suffered and recovered from one is not that easy, however I have decided to have a go at presenting my views of eating disorders rather than providing them in a 'My Own Story' format.
It may not work!
Firstly I must provide the mandatory disclaimer come 'Health Warning' notably that what appears in this piece of writing is a personal view only and not a qualified medical opinion. The views expressed here are solely my own based on, and formulated during, my personal experiences of suffering both anorexia nervosa and bulimia nervosa and through much discussion (in support groups, hospital etc.) with fellow sufferers and their carers and supplemented with a fair degree of reading. Consequently this article should not be considered 'fact' or used as such. It is a personal view of 'Eating Disorders' which I hope might enable people to start to understand what it is they are struggling with.
Somerset & Wessex Eating Disorders Association would probably like me to remind you as well that the views expressed here are my own and not necessarily representative of their own or endorsed by them!
A huge amount has been written about eating disorders and strict diagnostic criteria have been drawn up to define what is and (however similar they might appear) what isn't Anorexia Nervosa or Bulimia Nervosa and what belongs in the category of convenience - Eating Disorders Not Otherwise Specified (EDNOS) - i.e. things that obviously are eating disorders but don't quite fit with the existing diagnostic criteria.
Despite this it is still far from clear what eating disorders are. There exists no universaly excepted theory or model of 'Eating Disorders' indeed there are many competing theories (genetics, the fashion industry etc.) and equally numerous treatment approaches.
Diagnostic criteria are very clear on what symptoms must be identifiable for Anorexia Nervosa or Bulimia Nervosa to be diagnosed and the distinctions between them but these in no way explain the 'what are' and 'whys' around eating disorders.
It's hard to know quite where to start when discussing ones views around eating disorders as it is all too easy to be drawn off into any number of different directions. Perhaps then the best place to start is a simple, solid statement of belief - a foundation if you will - that, in my view, Eating Disorders are Coping Mechanisms, a way of protecting oneself (often the only perceived way) from distress. In other words (someone else's in fact) "eating disorders are an expression of psychological and emotional problems in which sufferers use food, albeit in different ways, in an attempt to cope with and manage their distress".
Personally I am also uncomfortable with the distinct separation of eating disorders into anorexia, bulimia and EDNOS. My view is that any inappropriate use of food to manage distress is an eating disorder and that within the eating disordered 'condition' sufferers may exhibit varying degrees of anorexic, bulimic or compulsive behaviour and that it is the degrees to which specific symptoms present that define where the individual is placed on the anorexia - bulimic - compulsive continuum. In my experience people with eating disorders exhibit many of the same behavioural symptoms, what varies is the frequency and degree.
For example many people with anorexia will at some point binge (at least in their view) and employ 'compensatory behaviour' in addition to their ongoing pursuit of thinness. They will be classed 'anorexic' due to the extended periods of starving and infrequency of bingeing allowing the required weight conditions to be met. Were the episodes of bingeing to increase such that the weight conditions for anorexia were not maintained bulimia might be diagnosed (my extreme anorexia slowly shifted over time as bingeing increased to be eventually 'become' bulimia). Likewise someone 'with bulimia' might employ periods of starvation both as compensatory behaviour and in an attempt to attain the same thinness desired by someone with anorexia but remain 'bulimic' as body weight excludes their classification as anorexic. Many people describing themselves as Compulsive Eaters describe 'good days' and 'bad days' where 'bad days' relate to periods of bingeing and 'good days' to periods of minimal or no eating to compensate (note too that starving can considered a purging mechanism in bulimia). In such instances the 'bad days' outweigh the 'good' so that body weight is often high and the 'good days' are not perceived to be purging or compensatory behaviour. Many people struggling with compulsive eating also express a desire for thinness. In all three examples starving (both as a purging mechanism and as a result of a desire for thinness), bingeing and a variety of purging behaviours may be present in varying degrees. Along with these shared symptoms comes the desire of thinness and fear of fatness that I feel is common in all, although often disregarded at the 'compulsive eating' end of the spectrum (probably adding to the distress of those suffering). Most importantly, however distressing a particular eating behaviour is to someone experiencing it, it provides (sometimes subconsciously) a mechanism for suppressing their emotional pain.
This in not to say that everyone with 'an eating disorder' should be treated exactly the same and obviously someone's physical condition as a result of their disordered eating behaviour and the associated risks is a vitally important consideration. However it is also vitally important not to loose sight of the underlying reasons by which the eating disorder (in whatever form) exists, by focussing exclusively on the eating behaviour and physical symptoms.
This is probably a good point to re-state that this is my own personal and medically unqualified opinion and not a factual description as it will be at variance with much of the conventional medical view.
So if eating disorders are 'coping mechanisms' why do some people get them and not others, what of the genetics, the fashion industry's influence, protracted suicide attempts and numerous other theories as to the nature of eating disorders. For example if someone has an eating disorder as a response to a specific distress and maintains it to 'cope' then what role can genetics, learnt behaviour, environment and all the other theories play?
One model which fits well and the one I feel best describes my understanding of eating disorders suggest that two criteria must be met for an eating disorder to develop. Firstly an individual must be predisposed to an eating disorder, i.e. there is something in the person's being that will, under the appropriate conditions, allow an eating disorders to develop. This category of predisposition may include genetics if indeed there is a genetic link, environmental factors, learnt behaviour, possible gender considerations etc. or many other possible factors, indeed perhaps a combination of several. This predisposing factor does not mean that someone will develop and eating disorder, for that to happen the second criteria, a precipitating factor needs also to be present.
A precipitating factor is something that, in the presence of a predisposing factor, allows an eating disorder to develop - a trigger if you like. A precipitating factor can be many things and can be very personal to the individual; they can include anything that causes the individual significant emotional pain. Bullying, abuse, depression, relationship problems/break-ups, self-esteem issues, exam pressures etc. are all examples (although only a few of the many) as is a combination of less specific events that never the less causes significant distress to the person experiencing it. Quite often sufferers will describe the precipitating factor as being the 'cause' or 'root' of their eating disorder although not everyone will necessarily recognise a precipitating event.
This is not to say that people without the predisposing factor are able to cope better than those with it, but that in the event of finding themselves subjected to a level of emotional pain that they are unable to successfully manage they resort to other means of survival (some, such as alcohol or drugs misuse may be equally or even more inappropriate that an eating disorder). There may even turn out to be predisposing factors for alcoholism, drug dependency, aggressive behaviour etc.
Although both predisposing and precipitating factors must be present for an eating disorder to develop a third 'P' is also often considered important. Perpetuating factors are conditions which allow an eating disorder to be maintained and perhaps worsen. For example, a significant perpetuating factor might be the sense of a 'high', achievement and self-esteem boost that starvation can provide or the addictive qualities of other eating behaviours as might, in some situations, congratulations from peers on weight loss or many other things. The perpetuating factor often deemed most significant though is the continued presence of the precipitating factor.
It stands to reason that if someone's eating disorder is providing protection from emotional pain (albeit in a less than ideal way) that if the source of the pain remains present and/or its consequences unresolved the eating disorder will harder to resolve and apt to recur. This precipitating factor is of key significance with regards to a persons recovery and requires that the underlying emotional component of the eating disorder be dealt with along side any 'eating behaviour' work that is needed.
As I have said before, this is a personal view of eating disorders, not a medically qualified or necessarily accepted one (although the Predisposition - Precipitating - Perpetuating model exists in a number of forms), but one which feels 'right' to me and my own experiences and seems to be consistent with the experiences of others shared with me in support groups that I have used as part of my recovery.
I felt that a non-medical view from the point of view of someone who has suffered with an eating disorder might be more useful than just the 'story' of my experiences (although that might come later) in helping people start to think about and understand their disorder and struggles. I may have failed entirely but I hope that people will at least find something here that helps in their own understanding and recovery.
I hope too that perhaps carers and therapists might be helped to see the benefits a sufferer might perceive or actually gain (however awful their disorder actually is) from their eating disorder in terms of coping with and surviving their 'precipitating factors'. I feel that the failiure to realise this often leads to a misunderstanding of the resistance that a sufferer may present to recovery even when they have expressed a hatred of their eating disordered position and a strong desire to change.
In any event, whether you have found something useful here or not I would like to finish by saying that recovery is possible and, above all, worthwhile, good luck in yours if you are suffering and good luck too to all of you providing the love and support to enable it to happen!