Colman Noctor: An eating disorder is all-consuming
Picture; Istock
When we hear of terms like ‘eating disorder’, ‘anorexia’ or ‘bulimia’ many immediately think of a headline in a glossy magazine with a cover image of an emaciated model.
The common belief is that eating disorders must be part of a pursuit of the ideal body, or the result of a fad diet that has gone wrong. Sometimes these behaviours are seen as deliberate, suggesting that the young person with the eating disorder ‘has done this to herself’. Sadly, our empathy with the sufferer can be short in supply.
But the stories I have heard from young people with eating disorders that I have treated are vastly different. This condition is never driven by a desire to be more attractive. Instead, it is an emotional and psychological condition driven by a desperate attempt to cope with poor self-worth through unrelenting control. In some cases, the driver of the weight loss might deliberately be to be less attractive, to avert the gaze of others, and avoid being seen.
I have worked primarily with young people with eating disorders since 1998. I was involved in the design and development of eating disorder recovery programmes in Great Ormond Street, Edinburgh Young People’s Unit and St Patrick’s Mental Health Services. Over the years I have learned that the eating behaviour is not the problem, it is often the child’s response to an emotional problem.
If we examine our relationships with food over our lifetime we can see where food is used as something comforting, rewarding and nurturing, as well as something punitive, guilt ridden and negative. So, it’s not surprising that many of us have associations between food and emotion that could be considered ‘disordered’.
From our childhood experiences of getting ice cream when we cut our knee, to cakes for our birthday and selection boxes at Christmas, we have a long, positive association with food. The flip side is we are often told that ‘if we do not behave, we will not get a treat’ or ‘if we don’t finish our dinner, we will not get a dessert’, which suggests a connection between food and our value as a person.
The eating disorder conflates these emotional experiences and convinces the sufferer to define their self-worth solely in terms of food, weight and shape. There are many who will say contemporary media is to blame for this, and although images of reed-thin models do not help, the root of the issue lies elsewhere.
The ‘triggers’ and ‘causes’ of eating disorders are often confused. A trigger might well be seeing a picture of ourselves where we believe we look overweight, or lecture on healthy eating in school which demonises ‘bad foods’, or a hurtful comment about our appearance. But the cause of eating disorders often run deeper and concern a feeling of being overwhelmed and losing control. This can often arise when a young person feels alone, disconnected and powerless in their lives.
Could this explain why we have seen such a spike in these presentations over the past 18 months? The pandemic has made many of us feel we have little control over our choices and our lives.
This feeling of powerlessness may not be specific and may involve something as subtle as an anxiety about growing up and getting older. These vague but significant fears can be hard to articulate. Young people with eating disorders traditionally struggle to voice their emotional worries or concerns and end up internalising them. Typically, these children tend to be bright, high achievers. It is assumed their emotional vocabulary is as extensive as their intellectual one, but this is not true. They are completely different trajectories.
Following an experience of exclusion, stress or trauma, the combination of being overwhelmed, voiceless and disconnected can leave the child feeling vulnerable and out of control. It is during this feeling state that the eating disorder will arrive with an attractive offer to fix everything. It promises more emotional control, loyal companionship, praise and accomplishment. It is also a way of communicating uncomfortable feelings without ever having to say a word. To a vulnerable person, this can amount to an attractive deal.
You feel better and in more control. However, the intense relationship between you and the eating disorder soon becomes toxic. The relationship is less about praise and encouragement and is more about persecution and hostility. Like most controlling relationships, the young person feels trapped. They are repeatedly told that they will be nothing without the eating disorder, and if they do not comply with the rules they face psychological and emotional punishment.
Like when we flippantly wonder why someone in an abusive relationship doesn’t ‘just leave him’, a similar dynamic can be observed when we suggest to the child with the eating disorder that they should ‘just eat’. The reality is that the relationship with food, weight and shape is a lot more complex. Also, the damage to your self-worth means you start to believe you might deserve the persecution and that you do not have the strength to beat the eating disorder.
An eating disorder could not be more removed from its common association with vanity. Most young people with eating disorders feel worthless and trapped. They pursue thinness fervently not because they want to look good, but rather because if they don’t, they will be subjected to the most vicious psychological assault imaginable.
Recovering from an eating disorder is more than just eating and restoring weight. It involves summoning up the courage to withstand the most vicious tirades of psychological torment and facing down the most fearsome of tyrants. Although it takes bravery beyond belief, it is ultimately possible. There will be good days and bad days on that recovery journey but ultimately it is a journey to a new self.
As parents and supporters, we must first understand what an eating disorder is, and perhaps more importantly what it is not. We must appreciate that at the core of the problem is a deficit in self-belief, self-worth and self-value, and the eating behaviour is an attempt to communicate, control and cope with emotional distress.
I remember having an epiphany of sorts one morning when I was trying to feed my young child some breakfast on a Saturday morning. As I moved the spoon of baby rice through the air, while making airplane noises, he pushed the spoon away. The first thing I thought was that he was sick, so I took his temperature, and it was fine. Then I assumed it was the baby rice, which was less than appealing, and so I changed up the menu and offered him toast. But he pushed it away. In an act of desperation, I prepared some Coco Pops and offered a spoonful to him. Once again, he refused.
As I sat flummoxed in the kitchen, I noticed his eyes were locked on a Peppa Pig toy on the shelf behind me. I reached over and handed it to him - instantly his whole demeanour changed. As he played with the toy, he ate the baby rice, the toast and the Coco Pops. He had got what he wanted. The refusal wasn’t about the food, it was about him trying to tell me something. In many ways, this mimics the dynamic of the eating disorder.
If a child can find their voice and assert what it is that they need, then the eating disorder becomes redundant. So, if you have a child who is struggling with their relationship with food weight and shape. Instead of asking ‘how can I get you to eat?’, maybe instead ask 'what is the eating disorder telling me that my child can’t?'.