Eating Disorder Maintaining Factors

Bridget Engel, Psy.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D. Feb 2, 2007

While there are a variety of factors that can trigger an eating disorder, additional factors often help to maintain disordered behavior once it begins. Indeed, once a disorder develops, the resulting changes can cause additional factors that maintain a debilitating pattern. The elements that initiate a disorder are not always the same things that keep it going.

Eating Disorder Mindsets

Dysfunctional thinking and negative mindsets can perpetuate eating disorders. While these thinking patterns may seem illogical and unreasonable to healthy individuals, those with eating disorders fully believe the entrapments of their mind.

Self-Punishment

Some clinicians and researchers have suggested that eating disordered individuals have difficulty coping with and managing strong emotions, such as anger. The anger they experience can be a result of bitterness toward their family, the world and themselves. These feelings are often turned inward, instead of being expressed in healthy, manageable ways. This inward anger often cultivates self-hatred. Anorexics punish themselves for their perceived failures and self-hatred by restricting their food intake. They atone for the ever-increasing pile of mistakes by punishing themselves through not nourishing their own bodies. For bulimics, however, their strategy for atonement is through purging. Their attempt to make up for binging and the resulting sense of shame is manifested through vomiting, exercising, laxatives and an otherwise abusive response to the body. Regardless of the means, self-hatred and punishment are generally unbridled, difficult to escape, and feed depression, anxiety, and secretiveness. Ultimately, these feelings keep eating disordered behaviors alive.

Sometimes, self-punishment is related to dangerous, destructive behaviors, variously called self-mutilation, para-suicidal gestures, or self-harm. These behaviors can occur in individuals who are depressed or anxious, lack alternative coping skills, or need attention and nurturing. Also, those who experience great loneliness, emptiness, and perceived deprivation often engage in self-destructive behaviors. All of these factors are common for people suffering from an eating disorder, putting them at greater risk for engaging in self-injurious acts. In addition to starving themselves or purging, people with eating disorders may purposely try to harm themselves by cutting or burning themselves, picking at wounds, pulling their hair, banging their head, trying to break their bones, or engaging in high-risk “extreme” behaviors.

Binge Eating As Comfort

If food is the enemy, it is also very much the temptation. Unlike anorexia, binge eating disorder does not revolve around deprivation from food for not being perfect, and instead uses food as a source of solace during times of distress. In high contrast to most other disordered eating behaviors, binge eating is experienced as highly pleasurable and comforting. Foods consumed during binges are generally high in fat, starch, and calories; low on nutrition and high on taste. Binge eating then is less a self-punishment and more a dysfunctional means of coping via an escape into a pleasurable reverie of food.

Many individuals with eating disorders search for an escape from their misery and are desperate to find peace. Before, during, and after binging, bulimics and binge eaters may become emotionally numb and withdrawn. They may also dissociate. Dissociation is a complex neuropsychological process that involves a disconnection from full awareness of self, time, external circumstances, and sometimes memory. The essential feature of dissociation is an involuntary separation from conscious reality which is created when the mind stops acknowledging some or all sensory information or memories. For bingers, dissociation may be experienced as a trance state, or something similar to a drug high.

The comfort derived from a binge is generally short-lived. After a binge, most eating disordered individuals feel guilty for having lost control and for the many calories they have consumed. Due to this shame, bulimic or anorexic bingers will move on to purge behaviors, which meet the need for self-punishment and atonement. There are a large group of binge eaters, however, who do not self-punish by purging. Often, such bingers feel depressed but resolve to do better next time.

Shame And Embarrassment

Behaviors associated with eating disorders that involve food restriction or purging often develop out of a sense of shame. Shame occurs when someone is painfully aware that they have failed to meet a social standard, and have let people down. Shame is an inherently social emotion, and one that reveals a deep dependency on social expectations and the status quo. Because individuals suffering with eating disorders cannot alter or reset the culturally established standards to which they hold themselves, their resulting moods and level of shame are dependent on their perceived ability to meet them.

Because there is shame attached to eating disorders, a sort of trap occurs when individuals realize that their disordered behavior is no longer manageable. For fear of being judged, and in an effort to preserve their self worth, they often avoid or reject assistance and help. When they are unable to help themselves, they feel ashamed to reveal their disordered behavior and embarrassed to admit that they are out of control. They believe that asking for help would be an admission of ultimate failure. This painful and shameful secret tends to perpetuate the problem and keep them enslaved in the disordered behavior.

Cognitive Biases

Psychologists know that dysfunctional thinking can contribute to the susceptibility toward and maintenance of eating disorders and depression. One example of maladaptive thinking is learned helplessness, discovered in foundational experiments by Martin Seligman at the University of Pennsylvania in the 1960’s. Learned helplessness is a psychological condition in which a person learns to believe that they are helpless even when their situation is avoidable or changeable. Individuals with eating disorders often believe that they have no control over the expectations imposed on them, the behaviors used to meet those standards, and the resulting pain and loneliness they endure. They believe that their situation is hopeless and anything they do is futile. As a result, they remain passive and stuck in an unpleasant and even harmful situation.

Another maladaptive pattern of thinking often found in eating disorder patients is body image distortion. Body image distortion occurs when people inaccurately perceive themselves as being different (generally heavier) than they actually are. Individuals with eating disorders continue to see themselves as fat and unattractive, even when the people around them worry about their weight loss and body size. Because they see themselves as significantly different than others, they do not trust the opinions or advice of those around them. Body image distortion occurs more frequently for women than for men. Teenagers may be particularly at risk for developing body image distortion during puberty, when rapid changes in body size and shape, as well as development of secondary sex characteristics make them vulnerable to feeling awkward and large.

Other Eating Disorder Maintaining Factors

Bridget Engel, Psy.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D. Feb 2, 2007

Peer pressure

Adolescents and young women experience a great amount of pressure from their peers to be thin and stay thin. One source of this peer pressure are “thinspiration” websites and discussion groups that have been created on the Internet by people who support and promote eating disorders. Thinspiration sites offer tips and tricks on how to lose weight, induce vomiting, what foods purge the easiest, and how to avoid detection, as well as inspiring photos, quotes and message boards. The anonymity of these websites provides support, friendship, and justification for disturbed thinking or behavior in private. Treatment professionals and other experts are concerned that these pro-ED (pro eating disorder) websites generate pervasive subcultures that potentially help spread dangerous and unhealthy eating behavior.

Other Maintaining Factors

Biological factors that cause eating disorders often continue to perpetuate them as well. As mentioned previously, researchers suspect that physiological mechanisms can help to maintain destructive behaviors. Malnutrition and unhealthy eating patterns change the level of neurotransmitters (chemicals that transmit nerve impulses) in the brain, including serotonin. Some anorexics have abnormally high levels of serotonin in parts of the brain involved in creating and maintaining anxiety and obsessiveness (repeated unwanted thoughts). For these individuals, not eating decreases levels of serotonin, which in turn decreases anxiety. Because these people now feel less anxious, their eating restriction behavior is reinforced.

In contrast, bulimics often show increased serotonin levels in the brain for short periods of time when they binge, which seems to decrease symptoms of depression that are caused by inadequate levels of neurotransmitters. Binging, therefore, temporarily decreases depressive symptoms. However, when serotonin overloads the brain after a large carbohydrate binge, the resulting increased anxiety, irritability, and agitation become precursors to purging behaviors.

Electrolytes (naturally occurring chemicals in the blood that conduct electricity) also play a key role in perpetuating disordered behaviors. Starvation of the body and improper vitamin and mineral intake causes abnormalities in electrolyte levels, resulting in confusion and unclear thinking. Researchers believe that unhealthy electrolyte levels and the resulting confusion maintain disordered behavior because individuals make poorly judged decisions about eating and their bodies.