Anorexia, bulimia and compulsive over-eating are three aspects of the same condition: the use of food (or it absence) for mood-alteration. For counsellors already familiar with treating alcoholism or drug addiction, there should therefore be no difficulty in transplanting their skills to this area of clinical work.
The addictive substances in an eating disorder are the refined carbohydrates (sugar and white flour). These substances, because of their refinement, cause cravings, in the same way that cocaine becomes progressively more powerful with increasing refinement from coca to bazuco paste and then on to crystalline cocaine and crack.
People suffering from anorexia are terrified that once they start to eat they will binge uncontrollably. People suffering from bulimia are compulsive overeaters who have discovered that they can vomit or purge and thereby get rid of the calories that they previously consumed. They maintain their body weight at the expense of the destruction of the enamel in their teeth (by the regurgitated acid from the stomach) and the electrical conductivity of their heart muscles (caused by potassium depletion through vomiting). Thus, all eating disorders should really be considered as one.
I am very familiar with the various sub-divisions that doctors make in the classification – and hence in the treatment – of eating disorders. I was a practising doctor for many years and I have treated on an inpatient basis over 1500 patients who suffered from eating disorders. I have an eating disorder myself. My weight used to vary 50 pounds up and down each year or two but it has been stable for the last 30 years since I became fully abstinent from all mood-altering substances and worked the Twelve Step programme of Overeaters Anonymous on a continuing basis. I understand addiction in general, and eating disorders in particular, from the inside.
‘Body dysmorphia’ is the term given to the perception deficit whereby sufferers from eating disorders do not judge their own weight and shape accurately. People with anorexia see themselves as being fatter than they are and people who are overweight see themselves as being thinner. As essential part of treatment is to help to correct this. Correspondingly, sufferers have to develop an understanding of what a normal portion size looks like (by looking at the portions of other people who do not have eating disorders). Taking three regular meals each day, with nothing in between, counters the process of continuous binges interspersed by episodes of starvation.
As with all other addictions, the problem is probably genetically inherited – which is why treatment (working the Twelve Step programme) has to be continued, one day at a time, for life.
Emotional traumas, in childhood or later life, complicate the problem but they are not its prime cause. They can be dealt with appropriately through counselling, preferably (because of effectiveness and speedy resolution) by Eye Movement De-sensitization and Re-processing (EMDR) or Neuro Linguistic Programming (NLP).
One way or another, eating disorders are quite easy to understand – even if, especially in anorexia, they are sometimes fiendishly difficult to treat.