Eating Disorder Behaviors Are Adaptive Functions

continued

Some theorists, including this author, view this process as if, to a greater or lesser degree in each individual, a separate adaptive self is developed. The adaptive self operates from these old sequestered feelings and needs. The eating disorder symptoms are the behavioral component of this separate, split-off self, or what I have come to call the "eating disorder self." This split-off, eating disorder self has a special set of needs, behaviors, feelings, and perceptions all dissociated from the individual's total self-experience. The eating disorder self functions to express, mitigate, or in some way meet underlying unmet needs and make up for the developmental deficits.

The problem is that the eating disorder behaviors are only a temporary Band-Aid and the person needs to keep going back for more; that is, she needs to continue the behaviors to meet the need. Dependency on these "external agents" is developed to fill the unmet needs; thus, an addictive cycle is set up, not an addiction to food but an addiction to whatever function the eating disorder behavior is serving. There is no self-growth, and the underlying deficit in the self remains. To get beyond this, the adaptive function of an individual's eating and weight-related behaviors must be discovered and replaced with healthier alternatives. The following is a list of adaptive functions that eating disorder behaviors commonly serve.

ADAPTIVE FUNCTIONS OF EATING DISORDERS

• Comfort, soothing, nurturance

• Numbing, sedation, distraction

• Attention, cry for help

• Discharge tension, anger, rebellion

• Predictability, structure, identity

• Self-punishment or punishment of "the body"

• Cleanse or purify self

• Create small or large body for protection/safety

• Avoidance of intimacy

• Symptoms prove "I am bad" instead of blaming others (example, abusers)

Treatment involves helping individuals get in touch with their unconscious, unresolved needs and providing or helping to provide in the present what the individual was missing in the past. One cannot do this without dealing directly with the eating disorder behaviors themselves, as they are the manifestation of and the windows into the unconscious unmet needs. For example, when a bulimic patient reveals that she binged and purged after a visit with her mother, it would be a mistake for the therapist, in discussing this incident, to focus solely on the relationship between mother and daughter.

The therapist needs to explore the meaning of the bingeing and purging. How did the patient feel before the binge? How did she feel before the purge? How did she feel during and after each? When did she know she was going to binge? When did she know she was going to purge? What might have happened if she didn't binge? What might have happened if she didn't purge? Probing these feelings will provide rich information concerning the function the behaviors served.

When working with an anorexic who has been sexually abused, the therapist should explore in detail the food-restricting behaviors to uncover what the rejection of food means to the patient or what the acceptance of food would mean. How much is too much food? When does a food become fattening? How does it feel when you take food into your body? How does it feel to reject it? What would happen if you were forced to eat? Is there a part of you that would like to be able to eat and another part that won't allow it? What do they say to each other?

Exploring how acceptance or rejection of food may be symbolic of controlling what goes in and out of the body is an important component of doing the necessary therapeutic work. Since sexual abuse is frequently encountered when dealing with eating disordered individuals, the whole area of sexual abuse and eating disorders warrants further discussion.

SEXUAL ABUSE

A controversy has long been brewing about the relationship between sexual abuse and eating disorders. Various researchers have presented evidence supporting or refuting the idea that sexual abuse is prevalent in those with eating disorders and can be considered a causal factor. Looking at the current information, one wonders if early male researchers overlooked, misinterpreted, or downplayed the figures.

In David Garner and Paul Garfinkel's major work on treating eating disorders published in 1985, there were no references to abuse of any nature. H. G. Pope, Jr. and J. I. Hudson (1992) concluded that evidence did not support the hypothesis that childhood sexual abuse is a risk factor for bulimia nervosa. However, on close examination, Susan Wooley (1994) called their data into question, referring to as highly selective. The problem with Pope and Hudson, and many others who early on refuted the relationship between sexual abuse and eating disorders, is that their conclusions were based on a cause-and-effect link.

Looking only for a simple cause-and-effect relationship is like searching with blinders on. Many factors and variables interacting with one another play a role. For an individual who was sexually abused as a child, the nature and severity of the abuse, the functioning of the child prior to the abuse, and how the abuse was responded to will all factor in as to whether this individual will develop an eating disorder or other means of coping. Although other influences need to be present, it is absurd to say that just because the sexual abuse is not the only factor, it is not a factor at all.

As female clinicians and researchers increased on the scene, serious questions began to be raised regarding the gender-related nature of eating disorders and what possible relationship this might have with abuse and violence against women in general. As the studies increased in number and the investigators were increasingly female, the evidence grew to support the association between eating problems and early sexual trauma or abuse.

As reported in the book Sexual Abuse and Eating Disorders, edited by Mark Schwartz and Lee Cohen (1996), systematic inquiry into the occurrence of sexual trauma in eating disorder patients has resulted in alarming prevalence figures:

Oppenheimer et al. (1985) reported sexual abuse during childhood and/or adolescence in 70 percent of 78 eating disorder patients. Kearney-Cooke (1988) found 58 percent with a history of sexual trauma of 75 bulimic patients. Root and Fallon (1988) reported that in a group of 172 eating disorder patients, 65 percent had been physically abused, 23 percent raped, 28 percent sexually abused in childhood, and 23 percent maltreated in actual relationships. Hall et al. (1989) found 40 percent sexually abused women in a group of 158 eating disorder patients.

Wonderlich, Brewerton, and their colleagues (1997) did a comprehensive study (referred to in chapter 1) that showed childhood sexual abuse was a risk factor for bulimia nervosa. I encourage interested readers to look up this study for details.

Although researchers have used varying definitions of sexual abuse and methodologies in their studies, the above figures show that sexual trauma or abuse in childhood is a risk factor for developing eating disorders. Furthermore, clinicians across the country have experienced countless women who describe and interpret their eating disorder as connected to early sexual abuse.

Anorexics have described starving and weight loss as a way of trying to avoid sexuality and thus evade or escape sexual drive or feelings or potential perpetrators. Bulimics have described their symptoms as a way of purging the perpetrator, raging at the violator or oneself, and getting rid of the filth or dirtiness inside of them. Binge eaters have suggested that overeating numbs their feelings, distracts them from other bodily sensations, and results in weight gain that "armors" them and keeps them unattractive to potential sexual partners or perpetrators.

It is not important to know the exact prevalence of sexual trauma or abuse in the eating disorder population. When working with an eating disordered individual, it is important to inquire about and explore any abuse history and to discover its meaning and significance along with other factors contributing to the development of disordered eating or exercise behaviors.

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With more women in the field of eating disorder research and treatment, the understanding of the origins of eating disorders is shifting. A feminist perspective considers sexual abuse and trauma of women as a social rather than an individual factor that is responsible for our current epidemic of disordered eating of all kinds. The subject calls for continued inquiry and closer scrutiny.

Considering the cultural and psychological contributions to the development of an eating disorder, one question remains: Why don't all people from the same cultural environment, with similar backgrounds, psychological problems, and even abuse histories develop eating disorders? One further answer lies in genetic or biochemical individuality.

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