Emotional Health

Eating Disorders, Then and Now

Meanwhile, the daughters never relinquish their need for self-object support—self-sustaining relationships that help provide emotional equilibrium. Babies and young children naturally rely on the mother for this support, but these girls were not encouraged or prepared to internalize the mother’s functions and learn how to soothe themselves and maintain a stable sense of self. 

Thus they experience profound difficulties when they make attempts to separate. ED’s almost always develop in response to some kind of separation—going away to camp, boarding school, or college. They are often a common response to a breakup of a friendship or romantic relationship as well. 

The ED girl, deprived of the “stability” provided by the self-sustaining relationship, feels out of control, lost. She begins to worry about her weight, trying to control her whole life by reducing it to this one number as the ultimate test of her worth. The anorexic woman often experiences a grim kind of satisfaction from feelings of being able to master her appetite. This kind of person, striving for perfection, does not want to be “found wanting” literally or figuratively. 

Bulimia, a syndrome which usually involves binge eating followed by purging food by vomiting or other means, including the use of laxatives is similarly an attempt to cope with problems central to the sense of self and the regulation of emotions. Though bulimia may start as an attempt to purge calories after a binge, it is the purging itself that becomes addictive after a while. The cycle of bingeing and purging becomes a way of coping with negative feelings, and some victims do this multiple times a day, posing serious risks to their health.

Essentially the baby boomers are the first generation to go through midlife since the onset of this epidemic, and the news is not good. Once thought of as  “young women’s” afflictions, eating disorders are more and more common in older women as well. Of these, there are women who have been suffering from a disorder since their youth, while others don’t begin their disordered eating behavior until later in life, when they may develop a preoccupation with preserving a youthful, fit appearance.

The former group includes women who have never essentially been free of an eating disorder and have more or less “adapted” to lifetime habits ranging from unhealthy to debilitating to deadly. There are many women in midlife who have managed to pass for years and years with restrictive eating and/or a serious eating disorder “in the closet.” Other women, who might not fit the official diagnoses for anorexia or bulimia nervosa, suffer from idiosyncratic issues (“eating disorders not otherwise specified” officially), that might include interminable yo-yo dieting, abuse of pharmaceuticals, excessive exercising or adherence to very rigid diets, purportedly for health reasons (orthorexia).

In my clinical experience, eating disorders tend to be chronic, and even patients who may be years beyond them can relapse in times of extreme stress. For example, I have had several patients who were anorexic as teenagers, presumably fully recovered, who relapsed when their marriages broke up. The experience of being abandoned by a husband rekindled the feelings of stress, loss of control, and separation anxiety that often are the precipitants of eating disorders in the first place. 

Other “recovered” patients have managed to maintain their health but have done so partly by redirecting their focus on eating and thinness in more positive directions by becoming personal trainers, chefs, or even eating disorder counselors. In fact, I think it is helpful to look at these issues along the alcoholism “model”: one is recovering or recovered, never cured. The danger of relapse is very real, and some women literally go to their graves never having made peace with food.

Awareness of this epidemic has grown and they are now recognized as a grave threat to health. They remain more prevalent in women than men, and schools and medical professionals are now alert to the dangers of disordered eating and excessive dieting. Social pressure on women to strive for an ideal, while being challenged by the Body Positive movement and others, remains very strong. In some ways, things have only gotten worse in the age of computers and social media, as the culture of comparison and competition has exploded. 

The age range of people suffering from eating disorders has expanded, from the very young to the very old, in successive generations with no end in sight. Each of us needs to examine our own relationship to food, not only for our own health, but also as role models for other women. Eating is one of life’s most healthy pleasures, when approached in a balanced, positive manner, but unfortunately, for many of us, it has become tainted by shame, fear, and anxiety.


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