We consider that a person suffers from one of the Eating Disorders (ED) when he/she generates a major eating disorder motivated by a lack of self-acceptance. EDs arise when an attempt is made to use weight control and intake manipulation to obtain the desired relational security.
How to detect that a person in our environment may be suffering from an ED, how to help him/her recognize it and ask for help?
In order to detect a possible ED, it is very important to be attentive not only to the person’s eating behaviors but also to his or her emotional state. The non-acceptance of their own image is a gateway to the TCA, therefore, we must be alert to what is the relationship of this person with themselves, with their body image and also the appreciation of themselves.
In general they tend to be very self-demanding people who, in general, obtain very good results in their studies or work and, often, this leads us to mistakenly believe that in their life everything is going well. Once we have detected any sign that makes us think of an ADD, it is important to turn to a professional who can help us to summon that person to begin treatment. It is important to make them see that they are not alone, that we want to accompany them and that the person should never be blamed for what is happening to them. We must know how to listen to what is happening to them and dedicate the necessary time for them to express their anguish so that they can identify what it is that leads them to relate inappropriately with food.
EDs are not the result of a lack of willpower on the part of the person who suffers from it, as is often believed, but are the consequence of some emotional deficit for the proper resolution of difficulties.
Therefore, although the first warning sign is usually in the relationship with food, the environment must be attentive to how that person is affectively to be able to detect the problem, even before it develops.
What types of eating disorders exist and how do they differ?
Although EDs are usually identified only with anorexia and bulimia, since they are the ones that have the greatest impact, these are not the only variants. We also find binge eating disorder, orthotoxia, vigorexia and other disorders where dissatisfaction with weight and/or image is not present, such as food phobia or morbid obesity.
To understand the differences between them, it is important to make a brief definition of them:
- Anorexia nervosa is characterized by a significant weight loss resulting from excessive and continued reduction in eating, pursuing to achieve thinness. Regardless of their weight, these people feel fat and do not recognize their thinness even in extreme cases. In the case of women, this lack of intake usually leads them to lose their menstrual cycle. Generally, they are patients with a lot of self-demanding, who pursue excellence in everything they do and who need to have excessive control over everything. There are variations of anorexia nervosa, such as unspecified anorexia (where there is no loss of menstrual periods or the weight lost is within the normal range) or athletic anorexia (with an addiction to physical exercise).
- Bulimia nervosa, on the other hand, is characterized by a binge-purge cycle that begins with the ingestion of large amounts of food followed by purging (self-induced vomiting), in order to eliminate the calories eaten. They are people with a great insecurity in themselves and who depend exaggeratedly on the approval of others. In many cases both disorders can be confused, since one develops with symptoms of the other. It also happens that some patients start with one of the two disorders and derive in the other. It can even be thought that they are not two different pathologies, but two differentiated positions in the same disorder.
- Binge eating disorder, on the other hand, is defined by the repeated ingestion of large amounts of food in a short period of time until the person feels full, but it is not followed by purging behaviors, as in the case of bulimia. They are usually people who are excessively overweight and attribute their professional or sentimental failures to this.
- Regarding vigorexia, people who suffer from it do not have an excessive obsession with their physical appearance, to such an extent that their diet is reduced only to proteins, carbohydrates or anabolic steroids. They are also obsessed with physical activity, in order to gain muscle, and neglect the other aspects of their lives (such as social, professional, etc.). This disorder is also known as muscular dysmorphia.
- Finally, orthotoxia is a disorder characterized by an obsession with eating healthy food. People with orthotoxia feel obliged to follow an extremely healthy diet where they exclude foods that, although they are necessary nutrients, for them represent fats or bad foods, which they directly exclude. It is important to clarify that orthotoxia is not yet recognized as an ED, since it is not included in the official psychiatric classifications, but due to its high occurrence in clinical consultations, we cannot fail to consider it.
How to approach an eating disorder therapy?
We must take into account that treatments that tend to chronify the patient are based solely on control, without facilitating cognitive development or including emotional aspects. So, if we start from the premise that ED is multidimensional, the appropriate treatment will be one that includes all dimensions in the therapeutic process. We refer to the emotional, social, family, etc. and not only the control of habits.
It is important to avoid the battles that usually appear between parents, patient and therapist. The battle must be of all against the disorder, helping the patient to strengthen his/her healthy part, which surely is the one that has allowed him/her to accept the therapy. It is mandatory to involve the person in making decisions about his/her recovery and treatment process.
The treatment must expand the patient’s capacity for self-knowledge, so that, by observing and understanding the meaning of his or her behaviors, he or she can transform the way he or she defines and solves his or her problems. It is also important to adapt the treatment to the stage of evolution of the disorder. If symptoms are detected early, it will be possible to work directly on the distress that this is generating to produce a change of direction, but if the disorder is in a more advanced stage, interventions that generate more impact, such as a hospital admission or a day center program, will have to be considered.
Many young people come to the psychology office when they have already overcome the most critical phases, but there is still much to be solved. It is important that they feel listened to, and to orient the treatment towards an autonomy that allows them to strengthen their healthiest parts, as well as to reestablish everything that the passing of the disorder left devastated. In many cases, and according to the stage of the ED also, it is important to include the family or the closest environment.
Will recovery be complete, or do ED patients tend to suffer “relapses”?
It will depend exclusively on how the treatment is approached. If it is only approached from a place of control, when what we are dealing with is the relationship with food for physical well-being, relapses are most likely to occur.
That is why it is important to address the psychological aspect. Once the person is stabilized on a physical level, since in some cases they even put their life at risk, it is essential to work on the emotional issues that have led the person to develop an ED. These disorders should not be underestimated assuming that they are only a matter of fashion, or of wanting to imitate model bodies from social networks or television. The person with ED experiences a great emptiness that they feel they can fill with food or by taking their body to an extreme (of thinness or muscularity, for example). If only the physical aspect is treated, it will surely be repeated or will derive to another type of disorder, such as anxiety.
Source consulted: FOCAD (general council of colleges of Psychology) Eating disorders. 2nd updated edition (Rosa Calvo Sagardoy)