Find balance to deal with eating disorders

Perhaps more than any other mental health problem, eating disorders such as anorexia nervosa and bulimia are tied to culture and society.

Many people have noted the irony of living in a world where millions of people are malnourished, while millions of others struggle with obesity. There is similar irony in the fact that more than 1 million Americans will, at some time in their life, try to starve themselves, while many others simply wonder whether or not they will get their next meal.

The basic characteristics of anorexia and bulimia are increasingly well-known. Anorexia nervosa involves an unrealistic fear of gaining weight, distortion of body image and restricting food intake.

Weight loss often reaches the point where serious medical problems begin to develop. Yet, even though a person with anorexia may acknowledge the medical problems, this acknowledgement is not enough for them to quickly reverse the pattern.

Bulimia involves eating large amounts of food in a short period of time – a binge – followed by purging through vomiting, using laxatives or, in some cases, exercise. People with bulimia usually feel out of control when they eat and try to keep their eating secret from those around them.

When I talk with people who have eating disorders, we spend a lot of time talking about how food – and dealing with food – is inescapable.

“Think about it!” people tell me. “What else do you have to do every day of your life?”

Food is everywhere – on TV, in advertisements and in most stores. You get together with friends and family and what do you do? You eat.

Now, imagine for a moment that each encounter with food involves intense anxiety, guilt, shame and ambivalence. If I eat, I’m bad. If I don’t eat, other people will say something. This is supposed to be a normal part of everyone’s day. But it isn’t easy or normal for me.

On a personal level, most people with eating disorders hope they will just figure it out on their own and that the problem will eventually go away.

There is often a strong wish that the whole thing can be kept a secret and that most people will never know. However, anorexia and bulimia usually require a focused effort, including counseling and medical supervision, to be properly addressed.

While treatment is important for people with anorexia or bulimia, the larger question is how to address the tensions and expectations in our society that lay the groundwork for the development of eating disorders.

As problematic as I find media images about how we should look, how big our bodies should be, and how our self-worth is linked to our appearance, realistically those things are unlikely to change any time soon. Is there anything to be done other than hope mass media will change?

One short-term step in the right direction is to find balance along a narrow path.

We need to promote healthy eating habits without becoming preoccupied with every bite. We need to have the ability to accept a compliment about our appearance without thinking that we should judge our self-worth solely on physical traits.

We need to be aware of how often our interactions with friends and family focus excessively on food, weight or how someone looks. And when we know someone with an eating disorder, we need to balance the message that it is important to change with the knowledge that changing an eating disorder takes time.

Support over the long run, gentleness around the embarrassment of having an eating disorder, and sensitivity to the daily struggle with eating disorders can help all of us find balance along a difficult path.

Psychologist Dr. David Prescott is the director of psychology services and clinical research at The Acadia Hospital. He writes a monthly column as part of Acadia’s Because Your Mental Health Matters Campaign.