How Do Eating Disorders Happen?
Eating disorders can occur due to a number of factors including biological, psychological and
social. Although no exact reason can be pinpointed, eating disorders are often a coping skill for overwhelming or unpleasant emotions and stress. When an individual is experiencing stress and anxiety, an eating disorder often gives the person a sense of control.
Some factors that can contribute to the development of an eating disorder include having a close relative with an eating disorder or mental health condition, a history of dieting or having a close relationship with a chronic dieter, a negative energy balance (burning more calories than taking in), and in some cases abnormal levels of certain chemicals such as cortisol which influence processes such as appetite, sleep, stress, and mood.
There are also some psychological factors that can contribute to the development of an eating disorder. Factors included are traits like perfectionism, which can be accompanied by critical self-evaluations and concerns about others’ evaluations; body image dissatisfaction or the individual's negative subjective evaluation of their weight or size; a personal history of an anxiety disorder, and behavioral inflexibility, meaning the person feels there is a “right” way to do things.
Finally, some social factors that can contribute to the development of an eating disorder include weight stigma, whether it is discussed in the presence of the individual or observed socially. The negative view that our society currently holds against people in larger bodies can lead to a fear of being stigmatized. Teasing or bullying can often lead to disordered views on food or weight as well.
Trying to achieve an “ideal” body type can be mentally straining on an individual, there is no size fits all when it comes to body shape, nor should there be. Acculturation to western culture can create issues for those who feel as though they don't fit within a Westernized “thin ideal”. It's a natural desire to “fit in” and feel included, but it shouldn’t require someone to give up their individuality. A limited social network will create a narrow view on what one should look like. Following diverse individuals on social media platforms will open up a world of possibilities and hopefully show that we are not all built the same and that is amazing!
Lastly, a history of trauma can be a significant trigger for an eating disorder. Trauma can cause us to feel as though we do not have control over ourselves or our experiences. Often an eating disorder is a way to cope with a trauma and provides an individual with a sense of control over themselves or their environment. However in this scenario, the eating disorder is the one who is really in control and receiving treatment will give the individual their power back.
It’s important to understand that eating disorders are mental illnesses, rather than a series of choices. They can affect anyone, no matter their gender, age, or weight.
How Long Is the Recovery Process?
Unfortunately, recovery can be a long process and it varies between each individual. There is no set timeline in which a person follows or a definite amount of time one can expect to be recovered by. Eating disorder recovery can be a difficult road filled with uncertainty. As a family member or friend of someone who struggles with an eating disorder, know that your loved one is going to need your love and support throughout this process. The recovery process is not linear, it’s often filled with ups, downs, and setbacks. Often these behaviors are coping mechanisms that we fall back on in times of stress or transition. Don’t be discouraged or feel as though your loved one isn’t progressing correctly if they experience a setback or struggle to let go of a behavior, it is normal in the recovery process which is why your continued support and understanding is so important.
What is a Treatment Team?
Eating disorders are complex illnesses that require a multidisciplinary team. The eating disorder treatment team for an individual who struggles with an eating disorder often includes a physician, therapist, and dietitian.
Eating disorders can take a huge toll on physical health. A physician plays a critical role in eating disorder treatment and diagnosis. Physicians will most likely see the patient during the first physical symptoms of an eating disorder. By asking the appropriate questions and providing relevant information, they may be able to catch an eating disorder early and recommend the appropriate treatment for that individual. Physicians can rule out any other medical complications and can monitor necessary lab values during treatment.
Seeing an eating disorder therapist will largely impact the effectiveness of recovery. Therapists help the individual work through any underlying issues that may be enabling the eating disorder and help guide the individual and family through the recovery process. They also help the individual find healthy coping skills to remove the eating disorder behaviors and assist with uncovering the individuals self-esteem. Specialized eating disorder therapists are essential to treatment. They will be able to help the individual find their true self that has been buried by the eating disorder.
The eating disorder dietitian will assist the individual in building a positive relationship with food and educate them on proper nutrition to adequately fuel their bodies. They will challenge the disordered and irrational thinking that surrounds food and weight and explore the feelings related to hunger, fullness and metabolism. All members of this team play a crucial part in recovery and will work cooperatively to provide the best care for your loved one.
What Can I do to Support Someone Working on Their Recovery?
Directing the conversation away from food is helpful in both meal time support and when speaking with someone who struggles with an eating disorder. The eating disorder part of the mind loves to misinterpret comments that may be seen as “normal”, so be mindful of your comments when around your loved one. Some topics that can be triggering include talking about food choices, portion sizes, and labeling foods and “good” and “bad” foods, and any conversation about appearance or weight. These topics can cause shame and guilt, which should never be felt around food or our bodies. It is not a determinant of health therefore it is irrelevant and should not be up for discussion with anyone who is not an individual's primary healthcare provider.
To put the eating disorder brain in perspective, if someone says “I’m not eating carbs this month”, the eating disorder brain may hear “Carbs are bad, don’t eat them”. The eating disorder brain is looking for any excuse to exclude food or food groups. It looks for any reason to restrict, binge, or compensate for intake in any other way. As a family member or friend, we don’t want to encourage the eating disorder, so remember to be mindful.
What is Meal Support and How Do I Do That?
Another way to support your loved one is to assist in meal support. Meal support is defined as the provision of emotional support during meals, specifically helping the individual consume their food and redirecting any eating disorder behaviors. This may sound difficult, however it can be as simple as directing the conversation to be about anything other than food.
Engaging in a meaningful and positive conversation can encourage your loved one to focus on the social aspects of meal times and encourage the completion of their meal. It’s best to discuss this support with the dietitian first to confirm what the supporters' roles will be. It’s possible the individual might interpret an attempt at support as an attack on them, so make sure boundaries are set prior to providing this support.
Examples of topics appropriate for meal time are:
Movies, shows, books
Positive family stories
An interest your loved one has that is not food or exercise related
Planning activities for the future
If you cannot think of a topic, ask your loved one!
If you notice your loved one not engaging in conversation or struggling to complete their meal, offering gentle words of encouragement and recognizing the disordered eating behavior can be helpful. Some examples of how to appropriately bring up a topic are:
“I’m noticing you seem to be having a hard time, how can I help?”
“I’m noticing you seem to be struggling with [a behavior] (cutting food into small pieces, pushing food around the plate, ect.), what has helped you not do that in the past?”
“I see how hard this is for you, and I know you have been doing a great job handling hard things recently.”
The eating disorder recovery process is difficult, but your love and understanding of your loved one will make a huge difference in their recovery. Be mindful, recognize their struggles, and provide the support they desperately need during this time.
If you or someone you know is struggling with disordered eating or an eating disorder, please contact us at Austin Counseling and Nutrition. Call or text (512) 655-3878 or use the contact form on our site to send an email.
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