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Understanding Eating Disorders

Long Island, NY appears to be a region of susceptibility to eating disorders. One of the reasons for may be that, in addition to the biological factors that can predispose one to an eating disorder, the demographics, lifestyles and community expectations found throughout the area often place significant pressures on individuals to strive for unusually high levels of perfection and success. These types of expectations combined with a fear disappointing and being judged by others can trigger behaviors and thoughts associated with eating disorders.

In my office, perhaps the greatest comfort that patients find is an understand from our team about what their eating disorder feels like to them. Understanding and empathy for an eating disorder is often rare from individuals who have never had an eating disorder. Eating is a realatively uncomplicated process for most people in society. However, for a person who suffers from an eating disorder, the process is like asking a person with a fear of snakes and spiders to get into a box filled with snakes and spiders, even if they are non-poisonous and don’t bite. It can be a paralyzing task.

An eating disorder is a medical/psychiatric condition that consists of disordered eating patterns that cause significant psychological distress and leads to impairments in an individual’s life in areas such as personal relationships, academics, work, and/or social interactions. However, an eating disorder can also be thought of as a dysfunctional coping mechanism similar to other dysfunctional coping mechanisms such as alcohol and substance abuse. And while many individuals with an eating disorder may seem resistant to changing their behaviors, they usually wish they never had the eating disorder to begin with, and they suffer incredibly when working on the recovery process.

Often, the general public and misinformed individuals believe that an eating disorder is about one’s preoccupation with wanting to “look good” and a desire to be thin. This is akin to saying an alcoholic drinks because he is thirsty. The causes are multi-factorial including biological predispositions and environmental triggers. An eating disorder numbs and preoccupies an individual’s thoughts to the point where there is an “escape” from reality. As a result, patients often lose connections with friends and family and suffer setbacks in work and academics. It not only effects the individual, but can consume the family.

An eating disorder takes the intangible emotional world, that at times can make someone feel they have no control over, and refocuses their thoughts on more tangible things. One cannot pick-up and physically hold emotions. One cannot visually see emotions and they cannot be dodged or avoided. There are no numbers or units associated with emotions so one cannot measure them. People often feel they cannot control what emotions “come in,” and what emotions “go out.” The emotional aspect of stressors in life can often not be planned. But with an eating disorder one can look at foods, hold them, see them. They can measure calories or their weight and attempt to regulate those numbers. They can decide what food goes in, and even what comes out. They can avoid certain foods, and plan around events, picnics, and restaurants and control their workout schedule. There is no need to, nor time to, focus on the stressors in life that can create pressure. An eating disorder alters how a person feels. They do not feel sad, they “feel fat.” A false perception is formed that happiness can be achieved by reaching their eating disorder goals. Frustration occurs because there is no true happiness when a goal is reached. No true control exists and the cycle continues.

Still, an eating disorder, despite its harmful and even potentially lethal effects, serves a purpose: it acts as a coping tool. Granted, not a healthy one, but none-the-less, to the individual it is an escape from dealing with life stressors that cause pain to a person’s ego. An eating disorder is a way to “self-medicate” just as alcohol, illicit drug use, gambling, sex, shopping addictions and other harmful behaviors are for others. Unfortunately, the “side effects” of self-medicating with eating disorders are what makes them have the highest mortality rate (even greater than depression, bipolar disorder, schizophrenia, etc…) in all of psychiatry. Fortunately, recovery is possible.