This piece is the first of five pieces I am writing for the CPTSD Foundation I’ll be posting this month (February 2020) about eating disorders.
The term eating disorders conjures in the minds of many pictures of boy crazy teenagers who want to slim down for a prom dress or something only women have. However, the reality of EDs is much, much more insidious than that.
Eating disorders affect millions of people of all ages and 25-40% (depending on the disorder) are men.
This article is the first in a series tackling the topic of eating disorders. This piece includes; what EDs are, what causes them, who is affected, and how they are related to complex post-traumatic stress disorder.
What are the Eating Disorders and Who Gets Them?
Anyone under the correct circumstances can develop an eating disorder whether it be eating too much or too little. Severe illness may be such a traumatic experience that in order to feel in control once more over one’s own life a person might use the control over their food. However, more commonly people who develop an eating disorder may have inherited it through genetics or suffered early in life at the hands of an abuser.
The answer to what are eating disorders may surprise you as some forms may seem ordinary. Eating disorders are among the top ten leading causes of disability among young women and anorexia nervosa has the highest death rate of all the mental health disorders (Mathers, et. al., 2000). There are actually six types of eating disorders, however, the most common of disordered eating problems include bulimia nervosa, anorexia nervosa, and binge eating disorder (Millar, et. al., 2005).
Bulimia Nervosa. Characterized by binge eating followed by forced vomiting, abuse of laxatives or diuretics and excessive exercising, bulimia nervosa affects both men and women. The protagonist is a fear of weight gain, profound unhappiness with his or her body size and shape. People diagnosed with bulimia nervosa have a cycle of binge eating then purging the food from their stomachs that is done in secrecy and that creates an intense feeling of shame, guilt, and lack of self-control. Some negative effects of bulimia nervosa include gastrointestinal problems, heart problems, and severe dehydration all conditions that can result in death.
Some famous people who have come out as having been affected by bulimia nervosa include Paula Abdul, Dennis Quaid, and Lady Gaga.
Anorexia Nervosa. People who are affected by anorexia nervosa will commonly have an obsessive fear of gaining weight and an unrealistic self-body image. Many will strictly limit the amount of food they eat and see themselves as overweight even when they do not weigh enough to remain healthy. Anorexia has many severely damaging effects including brain damage, organ failure, heart problems, infertility, and gone loss. Out of all the eating disorders, anorexia nervosa has the highest mortality rate.
Some famous people who have admitted to having anorexia nervosa include Alanis Morissette, Princess Diana, and Elton John.
Binge Eating Disorder. People who are affected by binge eating disorder will often lose control over their eating. Binge eating disorder is different than bulimia nervosa in that there is no follow up of purging, exercise, or vomiting after eating copious amounts of food. Because of the excessive weight people with binge eating disorder gain, they are at high-risk for obesity driven problems such as diabetes, heart disease, and stroke.
There have been no celebrities who have come out into public stating they have binge eating disorder, but it is a fact that they must exist.
Eating Disorders are a Form of Self-Harm
Many are familiar with self-harm as being when someone cuts, burns or otherwise injures themselves not to die by suicide but to alleviate inner turmoil. However, few would recognize over or under eating and purging as part of that spectrum.
Unfortunately, eating disorders are a form of self-harm known as non-suicidal self-injury (NSSI) (Klonsky et. al. 2015). Up until the early 2000s NSSI was mostly ignored as a serious diagnosis even though it first appeared in the DSM-IV and thus has only recently received the attention it needs.
People who practice NSSI in eating disorders aren’t trying to die, although there is always the chance of this happening, they are simply trying to control their inner pain.
Eating Disorders and Complex Post-Traumatic Stress Disorder
To understand the relationship between eating disorders and complex post-traumatic stress disorder (CPTSD), one must first understand the causes and effects of CPTSD.
CPTSD is the result of a prolonged series of abusive events often during childhood involving the child’s parent(s) or guardian(s). One of the symptoms of complex post-traumatic stress disorder is emotional dysregulation which is also a symptom of the three eating disorders listed above. People living with CPTSD also have a negative self-image and the inability to cope with strong feelings such as anger or sadness.
The link between CPTSD and eating disorders has become well-established. Also, the correlations between eating disorders and complex post-traumatic stress disorder are a form of self-medicating to dull the overwhelming sense of powerlessness and hopelessness that many survivors feel. This sense of powerlessness is leftover from childhood when they were trapped in abusive situations from which they could not escape (Green, et. al. 2010).
Eating Disorders and Sexual Abuse
It was Dr. Vincent Felitti in 1985 who first noted the strong correlation between sexual abuse and eating disorders. At the time, he was the physician chief of Kaiser Permanente leading a weight loss clinic. Dr. Felitti noticed that for five years more than half of the people in his obesity clinic dropped out.
When confronted, it became obvious to the doctor that their decision to regain their weight was linked to feeling their body size shielding them from harm (Anda, Felitti, et. al. 2006).
Men and women survivors of sexual abuse who develop eating disorders often become adults but without help live in fear anchored solidly in the past. As children, they had no control over what happened to them and had no way of escaping the trauma they endured often in their own beds.
To keep from feeling the overwhelming sensations of hopelessness, abusing one’s own body becomes a way to exert control where they feel they have none. It is also true that in binge eating disorder women feel the copious size of their body will protect them from ever having to face a sexual abuser again even though the danger has long passed.
How To Know If You Have an Eating Disorder
As with any problem, recognizing you have one is the vital first step to recovery. Knowing the signs that one may have an eating disorder can help determine if or when one should get help.
Below are five of the leading warning signs that you may have an eating disorder.
- Constantly Dieting by Eliminating Foods. Many people are forced to remove foods from their diet due to health problems. However, when one is constantly removing foods to gain control of their body it’s worth noting and watching closely.
- Losing and Gaining Weight Quickly. When one has an eating disorder, it is difficult for their body to retain the nutrients it needs to maintain a healthy weight. To make matters worse, fluctuations in one’s weight can trigger people into further dieting because they are already dissatisfied with how they look.
- Struggling to Eat in Front of Others. Having an eating disorder makes it difficult to engage in eating in a healthy way. This means people with Eds have a challenging time eating in public and feeling the need to eat in secret.
- Ritualized Eating. The need for control over one’s body of those who live with an eating disorder forces them to form routines and rituals around meals such as always, always starting with the salad and being upset if that ritualistic behavior is not followed to the point where one cannot eat without following the ritual.
- Body Dysmorphia. Body dysmorphia is an obsession with perceived flaws in how you see your body size and shape. Body dysmorphia is often the leading trigger for eating disorders. One might look in the mirror and although they only weigh 100 pounds see themselves as huge and in desperate need to exercise, diet, and lose weight.
There is Hope
After reading a piece like this where it may seem one is stuck with a condition they did not create, it is important to infuse some hope.
Eating disorders are not something to feel guilty about any more than having a virus or cancer. They are medical emergencies that need to be dealt with before someone becomes so ill as to harm themselves further.
There is help available. To find a therapist or clinic near you that offers help for eating disorders you can follow this link to the National Eating Disorders Association where you can enter your location and search assistance near you.
Also, there is a Helpline for discussion about support, resources, and treatment options. This particular helpline is available Monday-Thursday from 11 am to 9 pm eastern time and Friday from 11 am to 5 pm eastern time. The phone number is (800) 931-2237.
Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, et al. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience. 2006;256(3):174–186.
Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Archives of general psychiatry, 67(2), 113-123.
Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Nonsuicidal self-injury: What we know, and what we need to know.
Mathers, C. D., Vos, E. T., Stevenson, C. E., & Begg, S. J. (2000). The Australian Burden of Disease Study: Measuring the loss of health from diseases, injuries and risk factors. Medical Journal of Australia, 172, 592–596.
Millar, H. R., Wardell, F., Vyvyan, J. P., Naji, S. A., Prescott, G. J., & Eagles, J. M. (2005). Anorexia nervosa mortality in Northeast Scotland, 1965–1999. American Journal of Psychiatry, 162, 753–757.