The Psychological Causes of Eating Disorders
(A psychodynamic perspective on the psychological causes of eating disorders and/or disordered eating)
Practically, too little or too much food will result in a change in weight. This input-output formula is HOW a person gets too thin or overweight. For example, the person with anorexia nervosa who purges may use various methods of maintaining a low weight (see identifying anorexia nervosa and clinical features of anorexia nervosa). This may include excessive exercise, binges followed by purging (or vomiting), or the use of laxatives, diuretics and enemas. Certain high-grained cereals have a laxative effect. The purging and the excessive exercise are manifestations of a deeper problem and there are a number of psychological and/or historical factor which contribute to this eating disorder. The same applies to someone with bulimia, binge-eating disorder, or obesity. (Click on the problem which you want to understand more about). Psychological “causes”, refer to an individual’s personal dynamics which contribute to how s/he uses food. Historical causes refer to events and or experiences in a person’s life, such as the loss of a parent or a loved one, the birth of a sibling, changes in schools, leaving home for the first time, sexual abuse, trauma, etc. In other words it can be any number of life-changing experiences or a single event that continues to trouble the person. Everyone of us needs a way to deal with this.
THE CONCEPT OF A DEFENSE MECHANISM
Every one of us needs to control our external environment. We need to control our internal environment (or psyche) too, but sometimes this is difficult. Perhaps we do not understand what we are feeling, or what has caused the feeling. In order to create a balance in the psyche the individual copes with what can best be managed. Most people will create balance in the external environment, or the world in which they live because this is easier to manage than the internal world of emotions. For all of us, but certainly for individuals with eating disorders and/or disordered eating, if we feel out of control internally, we will try to compensate externally and this will manifest in our behaviour. Behaviour, therefore, becomes the tapestry of the psyche and from it we can deduce what is happening on a deeper emotional level. What you see on the outside is often not what the true picture is on the inside. That is, do not be deceived by what you visibly see! The more out of control you feel, the more rigid the defense mechanism will become. You cannot permanently change what is on the outside (i.e. behaviour) without working with what is on the inside. That is, you need to understand emotions before you can change behaviour because emotions and feelings drive behaviour.
“A defense mechanism is an adjustment made, often unconsciously, either through action or the avoidance of action to keep from recognizing personal qualities or motives that might lower self-esteem or increase anxiety”. (Hilgard & Atkinson, p 624)
The origin of a defense mechanism is always unconscious. It is a psychological adjustment that our unconscious mind makes to assist us with life. Often the adjustment occurs in the form of an action or the avoidance of an action. This adjustment stops us from recognising feelings, experiences and/or motives which would either make us feel better or worse about ourselves or which would increase our anxiety.
We all have defense mechanisms. None of us can escape that. The fact that we are unaware of the unconscious mind does not mean that it does not exist. It is there, despite the fact that you are not always aware of it. A lot of the time we live in the part of our minds that we are consciously aware of. The part that we are unaware of is where we deposit our memories, feelings and experiences. Sometimes we deposit them there because we do not want to know about them. At other times we are preoccupied with other thoughts or activities and do not have enough mind power to think about everything simultaneously. The content of the unconscious mind always impacts on the conscious mind and the way that we keep the conscious mind separate from the unconscious mind is to create a barrier. This barrier consists of our defense mechanisms. A few examples of defense mechanisms are denial, somatization, intellectualization, humour and acting out (i.e. in the form of behaviour such as rebellion, excessive exercise, food, etc). I see an eating disorder and/or disordered eating as a form of defense mechanism. That is, the excessive exercise, the perceived control over food, the purging, the weight are therefore ways of keeping some form of perceived control, balance or even imbalance. For some individuals, feeling good can be uncomfortable and the imbalance, even if it is makes them unhappy serves a purpose. This is a way of keeping what is in the unconscious mind from surging through to the conscious mind.
Defense mechanisms do not have to be intricate and they often manifest as basic behaviour. A common defense mechanism with students during exam times is what I call “tidy-the-cupboard syndrome”. I am sure many of you can relate to the feeling that although a job needs to be done you feel compelled to use an avoidance tactic like tidying up or spring cleaning! Exercise too can be a defense mechanism if it is used to avoid, say work. I knew somebody who used to train every time they were studying for an exam. Every time they were nervous, they would just go and put on their running shoes and run!
Somatization is a very important defense mechanism for personal trainers to know about. Somatization happens when someone presents his/her emotions in a physical form. For example, the person who is constantly has a sore throat may be expressing a difficulty with communicating. This may happen because the physical form may be more manageable than the emotional form of the experience (i.e. having to confront or talk with someone about how you feel). Some people can only somatize because they cannot present their emotional life in any other way other. A client who is constantly ill, or who manifests with many injuries may be somatizing.
Psychology looks at somatization as a mind-body split. Medical science often emphasizes the body to the exclusion of the mind and diseases such as Cancer, AIDS, etc are seen only as a physical problem. More emphasis is now being given to the impact of the mind on the physical manifestation. The mind and the body are not separate entities. You are your mind, you are your body. If you think about the body, you would not be able to see if you did not have eyes. You would not be able to drink water if you did not have a mouth and a hand to pick up a glass. Basically without our bodies we cannot actualise who we are. This concept is particularly important for eating disorders which are all about distortions of body image and body experience.
How do individuals with eating disorders gain emotional control? Even though one may be looking at the physical behaviour, such as excessive food, excessive exercise or bulimia, etc, the question is what is the person trying to control? It may be emotions or feelings of discomfort or distress. The person with anorexia nervosa controls emotions by either not eating or by eating and then purging her food. The same applies for bulimia and binge-eating disorder. Purging is not, however, just because the person wants to get rid of food! Purging is a way of trying to get control of something inside, something emotional for example, such as a feeling of self-loathing. Some individuals may also control emotions through excessive exercise and compulsive behaviour patterns such as being obsessively rigid about routines, clothes, tidy cupboards, etc. The dynamic for this person is that there is a perceived feeling of control over something that s/he can actually see or feel, (e.g. how the body looks or the amount of exercise) because the person just cannot control or understand what is going on emotionally.
The person with bulimia will eat and then control the effects of over-eating by purging, fasting or over-exercising. Compensation is ongoing. Compulsive behaviour is also part of the constant attempt to regain emotional balance, or equilibrium. This may consist of behaviour such as hand washing, excessive exercise and/or tidiness to name but a few. Being tidy and organised only becomes a disorder when it is so extreme that it interferes with one’s life. We all like to exercise, we all like to eat but it is how much we eat and what we do with it, how much exercise we do and how compulsive we are, that indicates the severity of a problem. As an example, the severely compulsive person will be so busy tidying cupboards that social engagements and/or interactions with others will be forgotten.
The way that the person who is obese controls emotions is to eat. Eating in response to life has almost become like a knee-jerk reaction. When there’s a problem, eating is the only learnt solution and other options have not been learnt and are difficult to consider. For someone who eats to cope with life I frequently hear they have eaten before they even realise what they have eaten and they usually only taste the first mouthful!
The main point is that the issue for an individual with an eating disorder and/or disordered eating is never about food! The emphasis is on the concept of symptoms versus causes.
The symptoms being the things that everybody sees, the low or high weight, the over exercise, the purging – that is the symptom which results from extreme behaviour. For individuals of normal weight who purge the internal struggle is equally painful as seeming normality in appearance may cover up the extent of the person’s feelings. The money market for eating disorders and/or disordered eating is always at the level of these symptoms. Very few programmes have the manpower or the skill to deal with the deeper causes.
People need to learn about optimum exercise and eating. None of these problems and/or behaviours, however, will change without an individual having an understanding of the underlying issues - the psychological causes.
If you are working as a professional with specialist groups such as eating disorders and/or disordered eating, you will need to deal with them in a specialised way and may need the assistance of specialists. You need to know enough about the problem to enable you to identify who needs special care and how to refer to the appropriate professionals. Knowing your limitations does not minimise or undermine your role! On the contrary, you will feel more confident and be more effective!