Eating disorders come to serve a purpose for those who suffer from them : after all, one of the first things we're taught in psychology is that behaviour exists because it gets reinforced. Therefore, once we understand what we derive from our eating disorders—how restriction, bingeing, compulsive exercise or even self-criticism meets a need—it can make so much more sense, both to us and those around us.
THE 'SWAG' STEREOTYPE
Another barrier to understanding eating disorders are the myths and stereotypes. Despite the fact that eating disorders can strike people of any age, race, income, gender or body type, the eating disorder sufferer is still predominantly seen as the SWAG: a skinny, white (usually young) affluent girl.
This stereotype is detrimental for many reasons: those that fit into this, are dismissed as spoilt young girls 'choosing' the behaviours to chase some insta -worthy fantasy flat stomach. Those that defy this SWAG stereotype, (those of a 'normal' and higher weight range, from ethnic and racial minorities, from socially disadvantaged backgrounds and boys and men)- their illness easily gets missed, written off or overlooked, sometimes for years. Screening, diagnosis, referrals to treatment, or simply being taken seriously are all less likely because they don’t match the expected profile of someone with an eating disorder. While anyone of any body type and from any demographic can suffer from an eating disorder, what ties together everyone who suffers is mindset. Understanding the mindset of eating disorders can improve empathy, and most importantly, recognition and treatment for everyone.
WHAT IS A MINDSET?
When we talk about mindsets, we are talking about a set of assumptions, attitudes and the way we typically think about things.
In eating disorders there are a number of factors that underpin the thoughts and assumptions and so 'drive' the ED and help lock it into place.
Here are 4 factors that drive the mindset of eating disorders:
1. CONTROL
Life can easily feel overwhelming, with constant change and challenges being the only real certainty in life, and the past 18 months or so have been particularly destabilizing for most people.
Controlling your eating can be a way to create a sense of control during periods of transition and uncertainty, such as going to university, or family conflict, loss or relationship breakdowns. Internal change such as puberty or ageing can provoke the same responses.
Controlling food isn't necessarily (or even very often) a conscious choice, but the sense of discipline, focus and agency gained, the dopamine release when we 'succeed' at restriction, can powerfully reinforce the behaviours.
So those of us with eating disorders can gain some sense of certainty and solidity with every mouthful or restriction and every choice we make over our intake.
There is a small sub-group of individuals with anorexia who don't share the usual core psychopathology of over concern about weight and body shape. Here instead the core component of anorexia is ALL about control.
This is one of the (many) reasons eating disorders are so hard to treat. We don't 'resist' treatment because we're difficult, or because we're happy or satisfied with the eating disorder in any way. The potential loss of the only thing we (consciously or unconsciously) feel we have control over, is a genuinely frightening possibility.
Once triggered, the eating disorder, with it's obsessional focus around weight , shape and eating can serve the purpose of helping us to avoid and numb intense unpleasant thoughts and feelings.
2. AVOIDING NEGATIVE FEELINGS
A study out of the university of Torino p (2002) examined personality traits in people struggling anorexia and bulimia. The personality profiles that emerged are characterized by low Novelty Seeking, high Harm Avoidance, high Persistence, and low Self-Directedness in anorexia, and by high Novelty Seeking, high Harm Avoidance, and low Self-Directedness in bulimia.
So although traits differed in this study, you'll notice one thing united them: a trait called harm avoidance, which is characterized by shyness, a fear of uncertainty, self-doubt, worry, pessimism, and neuroticism.
Excessive worry has been shown in itself to be a form of avoidance: it’s a distraction that keeps us on a shallow, verbal, and cognitive level. It’s something that can occupy our minds keeping us distracted us from facing deep painful fears of being unloved, incapable, or a failure.
Obsessive thoughts about food, calories, weight, measurements, or steps can serve the same function: they can be a distraction from deeper fears of being bad, worthless, or powerless.
Although it has ruffled feathers in the profession, some researchers think eating disorders should be classified as an anxiety disorder and may, indeed, be a form of OCD.
The obsessive intrusive thoughts about guilt, shame, inadequacy, or failure are neutralized with compulsions around selecting foods, eating, restricting, or exercising. Studies indicate that two-thirds of people suffering with an eating disorder also suffer from anxiety, while one study in the American journal of psychiatry found that 41% of individuals with anorexia or bulimia could also be formally diagnosed with OCD.
The obsessions around food, weight, or shape can certainly help us to avoid bigger, deeper uncomfortable thoughts and fears.
3. PERFECTIONISM
Many people with eating disorders are high achievers in fact I personally have never met or worked with anyone with an eating disorder who wasn't . They’re hardworking, hold incredibly standards, and are diligent and thorough. But aiming so high frequently can cross the line into relentless pushing and harsh self-criticism when , inevitably, these unrealistic standards inevitably aren’t met.
Restriction, restraint, purging, compulsive exercise can be areas in which you can excel when you've 'failed' to live up to your punishing self-expectation.
A very common concern among those with eating disorders is feeling not good enough—not capable, not competent, not worthy, not loveable, not acceptable, just 'less than'. Many perfectionists believe they can remedy these perceived fatal flaws only if they can meet particular goals. This is called conditional goal setting, and in the case of eating disorders it may make happiness (or mere adequacy) contingent upon weight, caloric intake, or the elusive feeling that they had a 'good' day or that day when we don’t 'feel fat'.
Of course, perfectionism isn’t driven by trying to be perfect; it’s driven by feeling inadequate, attempting to avoid criticism or judgement or being 'found out'. It's driven by a feeling of not being good enough.
Achieving through anorexia, bulimia, binge eating, orthorexia, or a combination (EDs do exist on a spectrum, remember) can create a crucial sense of compensation.
4. SHORT-TERM SATISFACTION
A study in the Journal of Psychological Medicine looked at thousands of people with eating disorders and found that 27% of them also had a history of self-injury. Among individuals with bulimia, 33% had a history of self-injury. So why the link?
One compelling hypothesis is that both eating disorder behaviours and self-injury act as a form of emotion regulation. For example, have you ever had an 'ugly cry' and then felt calmer?
It’s the same principle: a big physical release, whether from crying, self-injury, extreme restriction, bingeing to the point of pain, or exercising to the point of exhaustion can create a temporary feeling of calm or , due to the release of brain chemicals, even short-term euphoria.
This temporary feeling of clarity and increased energy may have addictive qualities. A study in the journal PNAS (Proceedings of the National Academy of Sciences of USA) found that anorexia and ecstasy activate some of the same brain receptors. With AN, the drug is deprivation itself.
In the short term, eating disorder behaviours 'work' to regulate emotion—restriction, purging, bingeing, and compulsive exercise are each, in their own way, forms of coping. They can create a sense of control, achievement, compensation, or distraction from core fears of worthlessness, helplessness, or defectiveness. Clearly, though, They’re not healthy or sustainable forms of coping for the long term.
Ultimately, we need to trade these methods of coping for healthier ones, like increasing our self-esteem, practicing self-compassion, challenging the harsh voice in our head, or understanding the automatic negative self-criticism is an inculcated thought rather than a fact. But until we all get to that point, building empathy and understanding of what drives eating disorders and helps keep us stuck is a great place to start.