Written By: Ashley Moser, LMFT, CEDS
Clinical Education Specialist at The Renfrew Center
Eating disorders are about so much more than food and weight. In this post, we will explore the psychological impact of eating disorders to help prevent undertreatment and reduce the risk of relapse in the recovery process.
Due to misinformation and stereotypes about eating disorders, many continue to believe that eating disorders are only about food and weight. However, eating disorders are complex mental health conditions and often require treatment that is as complex as the disorder itself. Obsessive thoughts about food and weight can drive people to seek treatment that fails to address all the underlying aspects of an eating disorder. While food and weight are a part of the eating disorder treatment process, overlooking the psychological component can leave ‘holes’ in someone’s recovery.
What is the psychological impact of eating disorders and why is it so important in recovery? Here are some of the key psychological aspects that may accompany an eating disorder:
Anxiety
Anxiety may be a contributing factor in both the onset and maintenance of an eating disorder. While eating disorder behaviors like restricting, bingeing, and purging may temporarily alleviate anxiety, they can worsen anxiety symptoms in the long run. Heightened anxiety can occur in situations related to food, weight, body image, and social interactions, further reinforcing the cycle of disordered eating.
Depression
Like anxiety, eating disorder symptoms may temporarily soothe or distract from depressive symptoms, while also worsening depression as the eating disorder progresses. Symptoms of depression may include isolation, numbness, lack of interest or pleasure in usual activities, guilt and shame surrounding body image, food choices, as well as decreased self-esteem.
Suicidality
For many individuals, eating disorders often include suicidal thoughts and behaviors. Isolation, depression, hopelessness, and low self-esteem can all potentially increase the risk of suicide. Malnutrition is a common medical complication in eating disorders, impacting the brain’s ability to think clearly and regulate emotions and mood. Eating disorder symptoms can sometimes function as an attempt to cope with these distressing experiences or even serve as a form of self-punishment.
Co-occurring Mental Health Diagnoses
Eating disorders often co-occur with other mental health diagnoses. For example, obsessive compulsive disorder (OCD) can complicate eating disorder recovery by worsening obsessive thoughts and rigid rules around food, while attention-deficit/hyperactivity disorder (ADHD) may contribute to the impulsivity that frequently fuels symptoms such as bingeing and purging. Substance abuse may also occur as a form of coping with emotions, managing appetite, or manipulating weight. Post-traumatic stress disorder (PTSD) may also occur, as many with eating disorders have also experienced trauma.
Perfectionism/Control Issues
Eating disorders may involve unrealistic expectations and the desire to control others’ perceptions. Perfection is sought to avoid uncomfortable emotions associated with being human. Control in general can be a large function of eating disorders. Fear of weight gain or losing control can often be temporarily soothed by eating disorder behaviors. Ultimately, eating disorders provide a false and fleeting sense of control.
Body Image
Body image is just as much of a state of mind as it is a state of body. Eating disorders can involve a distortion of body size and shape as well as an over emphasis on the importance of body size in sense of self, worth and value. In eating disorder treatment, body image work often requires healing from deep emotional wounds related to self-worth, challenging harmful body ideals, and developing a strong sense of core values, rather than focusing on changing physical appearance.
READ MORE: What is Body Checking? Body Dysmorphia Signs
Eating Disorders are Emotional Disorders
What we know to be true about eating disorders is that they are about far more than food and weight. Eating disorders are emotional disorders and must be addressed as such to achieve long term and sustainable recovery, but what does that look like? How do you address the psychological aspects at the root of an eating disorder?
Eating Disorders and Emotions Overview
Eating disorder symptoms serve a function emotionally. Regardless of the specific behavior, eating disorder behaviors help to cope with uncomfortable emotions. This can manifest as avoiding uncomfortable emotions, distracting from them, numbing or dampening them, disconnecting, or even feeling a sense of relief. This immediate, yet temporary relief is incredibly reinforcing and fuels the eating disorder cycle even when logically we know it is not helpful.
This is why we continue to use eating disorder symptoms even when we do not want to! This also explains why just stopping the behavior is not enough to fully heal. When the behaviors stop, the emotions continue and often become more intense. With no way to manage, it is likely that another symptom will emerge to serve that function. The behavior has changed, but the desire to escape the distressing emotion has not.
It is important to note that the term ‘distressing emotions’ encompasses a wide variety of emotional experiences that may be present for someone struggling with an eating disorder. These include emotions associated with anxiety, depression, self-esteem issues, trauma, relationship issues etc. Failing to address any of these psychological factors increases the likelihood of symptom substitution and/or potential relapse.
Doing The Emotional Work
The ‘emotional work’ is a crucial and oftentimes difficult aspect of eating disorder treatment and recovery. While the emotional work may look different for each person, it is essential to address the unique emotional functions of the eating disorder. Here is a breakdown of what this process can look like.
Awareness
Eating disorder behaviors oftentimes function as a way to dampen, distract, or disconnect from an emotion. To begin addressing maintaining emotional factors, awareness is foundational. Instead of tuning out emotions, practicing mindfulness exercises and using emotional tracking tools can be helpful strategies to improve awareness of our emotional experiences. Try checking in with yourself throughout the day by asking yourself, “what am I thinking?”, “what am I feeling physically in my body?”, and “what urges surface when I’m feeling this emotion?”
Understand Your Patterns
Awareness of emotions in their context is important and knowing which triggers or antecedents precede your emotions is crucial. Do your lived experiences make your emotions feel more intense in the current moment? Are your emotional responses linked to trauma, childhood, or your relationships? When you feel uncomfortable emotions, what do you immediately do next? Do you shut down, lash out or ruminate? Approaching this work with curiosity rather than judgment can reduce shame, helping us build awareness of our emotional responses and experiment with more adaptive behaviors.
READ MORE: In Your Empowerment Era: 5 Ways to Choose Recovery
Build Emotional Tolerance
This is important! In addition to making steps towards eliminating eating disorder symptoms, improving tolerance of uncomfortable emotions is vital in the sustainability of progress and recovery. This means feeling your feelings without using distraction, avoidance or any other behaviors that dampen the emotion. As emotional tolerance increases, the need for eating disorder behaviors decreases. Learning how to accept, tolerate, and respond mindfully to uncomfortable emotions can help you finally break free from harmful eating disorder cycles.
Conclusion
Eating disorder recovery requires emotional and behavioral change to ensure sustainable long term recovery. In order to do this, seeking professional help with a team approach can be helpful so that all aspects of the treatment and recovery process are supported.
The Renfrew Center Can Help
The Renfrew Unified Treatment Model is an evidence-based treatment that targets maintaining emotional patterns at the root of an eating disorder and provides skills to improve emotional tolerance. This transdiagnostic approach is helpful in addressing the underlying emotional aspects of an eating disorder, as well as any co-occurring emotional disorders. Creative arts therapy and specialty services are also offered to address the emotional aspects of trauma, substance use, family work and relationships. By incorporating various therapeutic modalities, patients receive the tools and emotional support needed for lasting recovery.
Ready to start your recovery journey? Reach out to the expert team at Renfrew today and take the first step towards healing.
