The Shrinking Soul: An Examination of the Eating Disorder Addict
Anorexia nervosa is an eating disorder that affects many women and a small percentage of men in this country. It is characterized by an acute reduction in weight, an intense fear of weight gain, and body image disturbances. Bulimia nervosa is characterized by recurrent and frequent episodes of binge eating (i.e., unusually large amounts of food consumed in a short time) and a feeling that one lacks control over eating. Compensatory behavior such as purging, obsessive exercising or consuming diuretics to offset the potential weight gaining consequences of the food consumed typically follows the binge. Much is known about the development and treatment of these conditions, but the way in which clinicians, health care workers, and well-intentioned loved ones conceptualize these complex diseases widely differs—meaning the purported cause of these conditions are as diverse as the available treatments. Thus, it would be useful to have a more stringent paradigm to conceptualize these intricate diagnoses. This particular investigation of eating disorders seeks to borrow and utilize the concepts of addiction as a way to further elucidate what these conditions are, where they come from, and how to potentially treat and/or prevent the inception of these traumatic diseases.
Addiction is defined by tolerance, withdrawal, and craving. We recognize addiction by a heightened and habituated need for a particular substance; by the intense suffering that results from discontinuation of its use; and by a willingness to sacrifice all (to the point of self-destructiveness) in order to gain access to the coveted behavior. Typically we think of alcohol and/or drugs as the object of obsession in this scenario. The need to escape painful reality numbed by the blur and haze provided by one’s drug or drink of choice is how we regularly think of the unrelenting jaws of addiction. Meanwhile, we tend to struggle with how to think about and categorize eating disorders. We have certainly borrowed from the world of addiction when it comes to overeating; the existence of Overeaters Anonymous makes this very clear. Eating can be an obsession, an addiction. Eating can be an activity that placates, that numbs, that soothes, that is a gateway to denial, escape, and disconnection.
Let’s consider using this same paradigm as a way to clarify the onset and prolongation of the remainder of the key eating disorder diagnoses: anorexia nervosa and bulimia nervosa. We borrow from a lot of sources to try to understand why people would intentionally starve themselves or binge and purge to the point of gravely compromising their physical, mental, and social health. Let’s consider media influences; is this an attempt to fit in gone wrong? Are these individuals striving to adhere to the thin and fit ideal presented in various mediums and losing their way? What about familial influences? Is this someone who came from a family that “fat shamed” or a family that overemphasized the value of the perfect exterior? Is this someone who came from a family environment that caused pain and uncertainty and now uses food to soothe or distract? How about social influences? Is this someone who feels pressure from peers to look a certain way and is using extreme measures to get there? Finally, let’s not forget biological influences; is this someone who has a particular brain chemistry that is more vulnerable to developing this type of disease? Its evolution is multilayered, multifaceted, quite complex, and even confusing. There is a case to be made that indeed some or all of the above dynamics influence the existence and continuance of an eating disorder.
But maybe there is a way to mobilize all of this information into a single archetype. Perhaps all of the above dynamics fit into the addiction paradigm. If addiction is indeed defined by tolerance, withdrawal, and craving, how might these tenants of addiction help us understand eating disorders better?
This is the notion that over time, a tolerance is built for the desired substance and related activity. With eating disorders, like alcohol, this is consistently true. At first, anorexics have a low and inconsistent tolerance for self-starvation. They can skip dessert or maybe a second helping. But then it starts to feel good. They challenge themselves to endure more. They skip breakfast, now breakfast and lunch, now just a small bite for dinner. Eventually they reach total elimination or minimal consumption of food. The tolerance for the physical and emotional ramifications of starvation grows. In fact, it starts to feel good. Many anorexics report that achieving intense levels of starvation feels empowering, almost like a high—the ultimate control. They feel strong and otherworldly. Meanwhile, it’s making them sicker both physically and mentally, they are withdrawing more and more from friends and family, and they are obsessed with calorie counting, weight loss, and skipping meals. Sounds a lot like what happens when individuals who use drugs and alcohol achieve higher and higher levels of tolerance. Their lives, like the lives of anorexics, become dedicated to the substance. They spend all their time thinking about it, craving it, and figuring out how to get it at any cost.
This brings us to the next tenant of addiction: withdrawal. Withdrawal alludes to the mental and physical symptoms experienced when the coveted substance is not ingested. With alcoholics and drug addicts, the withdrawal can be physical as well as mental. Individuals can experience physical illness, shakiness, and intense malaise during a respite from their drug of choice. They can also become gripped with unrelenting angst that can only be restored by consumption of the substance. Anorexics and bulimics often have the same type of experience if they are unable to participate in their food rituals. If anorexics can’t starve (because they are at a mandatory social event during which they can’t escape eating or can’t restrain themselves from eating) or bulimics can’t binge and purge (because of lack of access or privacy), intense anxiety and discomfort ensues. These individuals become consumed with when they can engage in the addiction again and they feel an invasive sense of upset and imbalance that can only be restored by resuming eating disorder type activities, just like addicts who don’t feel okay until they get a drink. The eating disorder withdrawal is painful and distracting and individuals often becomes highly irritable, anxiety-ridden or depressed in the wake of refraining from the targeted behavior. The behavior has come to serve as a way to provide order, calm, relief, and escape. All other coping mechanisms are dropped or underutilized or undeveloped.
These people are at the mercy of their eating disorder. How thin they are, how much control they have over their food intake, and how much food they are able to consume during a binge becomes paramount—akin to survival. Any interruption in this crucial sequence of disordered behavior causes extreme mental anguish. This dynamic only serves to renew the importance and dependence on the eating disorder behaviors. These individuals start to invest in the narrative that, with the eating disorder behaviors firmly in place, they are contained and sometimes even strong, and without them they are lost or left yearning for the return of the activities. It is the very same terrifying dialogue that rules the mind of “typical” addicts.
Craving is a key component of addictive behavior and also plays a key role in the world of eating disordered individuals. Alcoholics are known for constantly craving the drink to feel calm, to escape pain, and to feel in an altered state. Anorexics and bulimics crave the same disconnect and achieve it through starvation or bingeing and purging behavior. In fact, there is a deep, all-encompassing craving to be thin and to engage in all activities that will achieve this state. However, note that it is not really about the thinness. At a psychological level, it is not the state of thinness that soothes. It is the state of calm, disconnection, and escape that people achieve in the pursuit or achievement of thinness. All else is sacrificed in pursuit of altering the body; it becomes an obsession and a compulsion. No longer is the psychic pain that is actually at the root of despair accessible or known. It is too painful to keep at the surface. These individuals instead use the “drug” of eating disorders to bury the pain deep inside. Their days, hours, minutes, and seconds are consumed with food and losing weight. There is no longer room for feelings of abandonment, vulnerability, worthlessness, and loneliness. Anorexics unconsciously prefer the swirl of eating-disordered thoughts versus the painful reality of the consideration of the true sources of pain. So the food addiction, like the drug and alcohol addiction, subvert the pain.
This analysis underscores the complex and dangerous nature of eating disorders. These conditions are not just about a desire to be trendy and trim. They are multilayered psychological disturbances that require comprehensive, collaborative treatment plans. Given the similarities between addiction to substances and addiction to eating-disordered behavior, it seems reasonable that exploring the application of treatment protocols for substance addictions for eating disorders is paramount for an increased understanding and potentially enhanced treatment of these devastating diseases.