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Question
Posted by: curious | 2010/09/20

just wondering...

I know this must sound like a really daft question, but can you explain why people develop eating disorders and why is it so difficult to treat? I am sure most people are fully aware of the damage they are causing to their health? Is it only to do with emotional problems? Thank you for taking the time to respond to this question.

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Our expert says:
Expert ImageEating Disorders Expert

Hello “Curious” Your question is certainly not daft, but it is one that can only be adequately answered in volumes of texts and numerous conferences. And even this isn’t adequate, we keep exploring. Yes, the answer to your question remains open to ongoing debate, and in practice requires the implementation of new and exciting, cutting-edge therapeutic techniques. I am going to be very brief in my response to your question, rather than attempt to be comprehensive, as this forum cannot provide a too detailed outline of causes and treatment. In my treatment philosophy, I see eating disorders serving a similar purpose that addiction like alcoholism and drug abuse play. I like to define all addiction as the use of either substance of behaviour that serves the purpose of temporarily blunting uncomfortable emotional reality. And here, eating disorders fits very comfortably into the defining arena of addiction. Although there is increasing evidence of a genetic link in the development of eating disorders (as is the case with most psychiatric disorders), eating disorders appear, certainly in my experience, to emerge from environmental influences where there has been trauma of one form or another. Very often the family has its own dysfunctional dynamics, be it that various family relationships (usually the ones between parents and the eating disorder sufferer) are enmeshed or over-involved; or under-involved, neglectful, or absent. Quite often you find addiction running in the family, which might be that genetic link, but it might reflect as environmental trauma, where the eating disorder sufferer is witness to abusive behaviour as a result of alcohol or drug abuse. Eating disorders in the family is also a frequent occurance. Research has shown (and this is reflected in my practice) that as much as half of eating disorder sufferers have a history of sexual abuse. This traumatic abuse evolves into an eating disorder, where the sufferer will deny their sexuality by either becoming emaciated (in anorexia), hide in a big body (by binge-eating and becoming obese), or by replaying the abuse in a metaphoric way through their bulimic behaviour by bingeing and purging. Goodness, I really could elaborate here, but space is limited. As for treatment, the key it to first interrupt the disordered eating though various psychotherapeutic techniques. The most popular and most favoured therapeutic modality used worldwide is cognitive-bahavioural therapy (CBT), which in a nutshell challenges dysfunctional thoughts and feelings and helps the sufferer replace such dysfunctional ways of operating with new healthy scripts for conducting life. Eating disorder treatment also almost always required multidisciplinary team involvement, where a dietician, psychiatrist and biokineticist all have an important role to play in instilling healthy and often corrective lifestyle habits. Once a healthy daily lifestyle has been implemented and is maintained, therapy needs to explore the underlying issues that account for the eating disorder, and here psychodynamic therapy is helpful. Again, there is much that I could elaborate on, but my space to respond to each question is limited. If you email me, I can recommend you some good books to read, but I would rather not favour the promotion of specific books on the open forum. A final word: You ask whether sufferers are aware of the damage that they are doing to themselves. At a conscious level most sufferers are aware of the physical damage they are inflicting on themselves, but their personal emotional traumas almost always overshadow the concern for the physical damage they are doing. Only when they begin their recovery do they begin to realize the price they are paying for their self-neglect. I hope my relatively brief overview has wet your appetite for more knowledge? Regards, Graham

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Our users say:
Posted by: Eating Disorders and Obesity Expert | 2010/09/25

Hello “Curious” Your question is certainly not daft, but it is one that can only be adequately answered in volumes of texts and numerous conferences. And even this isn’t adequate, we keep exploring. Yes, the answer to your question remains open to ongoing debate, and in practice requires the implementation of new and exciting, cutting-edge therapeutic techniques. I am going to be very brief in my response to your question, rather than attempt to be comprehensive, as this forum cannot provide a too detailed outline of causes and treatment. In my treatment philosophy, I see eating disorders serving a similar purpose that addiction like alcoholism and drug abuse play. I like to define all addiction as the use of either substance of behaviour that serves the purpose of temporarily blunting uncomfortable emotional reality. And here, eating disorders fits very comfortably into the defining arena of addiction. Although there is increasing evidence of a genetic link in the development of eating disorders (as is the case with most psychiatric disorders), eating disorders appear, certainly in my experience, to emerge from environmental influences where there has been trauma of one form or another. Very often the family has its own dysfunctional dynamics, be it that various family relationships (usually the ones between parents and the eating disorder sufferer) are enmeshed or over-involved; or under-involved, neglectful, or absent. Quite often you find addiction running in the family, which might be that genetic link, but it might reflect as environmental trauma, where the eating disorder sufferer is witness to abusive behaviour as a result of alcohol or drug abuse. Eating disorders in the family is also a frequent occurance. Research has shown (and this is reflected in my practice) that as much as half of eating disorder sufferers have a history of sexual abuse. This traumatic abuse evolves into an eating disorder, where the sufferer will deny their sexuality by either becoming emaciated (in anorexia), hide in a big body (by binge-eating and becoming obese), or by replaying the abuse in a metaphoric way through their bulimic behaviour by bingeing and purging. Goodness, I really could elaborate here, but space is limited. As for treatment, the key it to first interrupt the disordered eating though various psychotherapeutic techniques. The most popular and most favoured therapeutic modality used worldwide is cognitive-bahavioural therapy (CBT), which in a nutshell challenges dysfunctional thoughts and feelings and helps the sufferer replace such dysfunctional ways of operating with new healthy scripts for conducting life. Eating disorder treatment also almost always required multidisciplinary team involvement, where a dietician, psychiatrist and biokineticist all have an important role to play in instilling healthy and often corrective lifestyle habits. Once a healthy daily lifestyle has been implemented and is maintained, therapy needs to explore the underlying issues that account for the eating disorder, and here psychodynamic therapy is helpful. Again, there is much that I could elaborate on, but my space to respond to each question is limited. If you email me, I can recommend you some good books to read, but I would rather not favour the promotion of specific books on the open forum. A final word: You ask whether sufferers are aware of the damage that they are doing to themselves. At a conscious level most sufferers are aware of the physical damage they are inflicting on themselves, but their personal emotional traumas almost always overshadow the concern for the physical damage they are doing. Only when they begin their recovery do they begin to realize the price they are paying for their self-neglect. I hope my relatively brief overview has wet your appetite for more knowledge? Regards, Graham

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