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Order to Disorder

She wakes up and looks in the mirror, and her ribs are protruding from her torso, but all

she sees are extra pounds she could lose. This is when she decides to skip breakfast. Lunch

comes, she opens the lunch her mom made, and all she sees is the endless amount of calories,

fats, carbohydrates, and sugars. She picks out the apples and throws the rest away. She sits

through the rest of her classes with her stomach growling, but she suppresses the hunger

thinking, If I ignore it, it will go away, hoping no one will notice her grumbling stomach.

Unfortunately, a few do, but they are too afraid to say anything. She goes home and runs four

miles to burn the hundreds of calories that seem like thousands. At dinner time she pushes her

food around her plate, and to keep her parents clueless, eats a small amount of what has been

given. Just before bed she weighs herself seeing that she has lost a few pounds since the last

time. She was 100 pounds then, and now she is 98 pounds. This is the only thing that allows her

to fall asleep at night, but in the back of her mind she thinks, Its not enough, and the cycle

continues. The next thing she knows she is in the hospital fighting for her life because her

organs started to fail.

[Almost] 100,000 people are diagnosed with an eating disorder every year (Wade,

Keski-Rahkonen, & Hudson, Epidemiology of Eating Disorders). This statistic alone shows

that eating disorders are a large issue in our society, yet with a paltry $28 million in federal

funding, making it one of the most underfunded mental illnesses (National Institutes of Health,

Estimates of Funding for Various Research). Of the thousands of cases that are diagnosed

every year, there is no consensus as to what pre-conditions lead to the development of an eating

disorder. I wanted to know if there was one factor that was more prevalent than others, perhaps

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a chemical imbalance in the brain, or some other root cause? This prompted me to ask the

question: what are the psychological factors behind the development and recovery of an eating

disorder?

As defined by the National Institute of Mental Health, an eating disorder is a fatal

illness that causes severe disturbances to a persons eating behaviors. Obsessions with food,

body weight, and shape may also signal an eating disorder (National Institutes of Mental

Health, Eating Disorders). Alli Johnstone, a licensed marriage and family therapist, explains

the reasoning behind most eating disorders:

An eating disorder is never the problem, but it is a solution. Most people who

develop eating disorders do so because they feel out of control in their life, and

they believe that the only thing that they can control is eating, but poor body

image can also be a factor in development. Many people believe an eating

disorder is most comparable to Obsessive Compulsive Disorder (OCD); the

obsession is feeling out of control or lacking self-esteem and the compulsion is

the behaviors that go along with the eating disorder one has.

These people believe that controlling the way they eat, whether it is undereating,

overeating, or binging and purging, will be the solution to their problems. According to

Brownell et al, those who have eating disorders often have certain psychological factors that

should be a warning sign for others; anorexics tend to be perfectionists, and bulimics and binge

eaters tend to be impulsive (Brownell et al, Eating Disorders). A perfectionist wants

everything to be perfect, including their body, but they will never be satisfied. Their body will

never be perfect to them; they will always want what they cannot have. They will reach their

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goal and trick themselves into believing they need something else. As for bulimics and binge

eaters, their impulsiveness leads to them eating food in abundance and having difficulty

stopping. Bulimics realize they are unhappy with the binge, and purge to get rid of all the food

they have just eaten.

Eating disorders can also be developed as a way to cope with trauma. Sonenklar, the

author of Anorexia and Bulimia explains, the breakup of a family, the loss of a parent, or a

painful emotional rejection can lead to an eating disorder (Sonenklar 26). When something

traumatic happens to a person, it can lead to them feeling out of control or not good enough.

They develop these eating disorders, so they can start to feel in control again because for most

people, food is the only thing that they can control. In an interview with Maris Degener, a

freshman at University of California, Santa Cruz, she stated, I felt very out of control of my

life, and food was the only thing that allowed me to feel in control. There were a lot of changes

happening in my family and personal life that made me feel very lost and helpless, so I

channeled that energy into over-controlling my food and exercise Some people who have

experienced trauma use their eating disorder as a coping method. They believe their eating

disorder is the thing that will be there for them. It allows them to feel in control.

In addition to developing from control, some research indicates that people with

abnormal neurotransmitter levels have a predisposition to developing an eating disorder. Those

that have low serotonin levels are predisposed to disorders like binge-eating and bulimia.

Hormonal imbalance is likewise a predictor, high cortisol and low leptin levels have also been

observed in patients (Sonenklar 43-44). Serotonin can trigger an eating disorder from either

being too high or too low. When one eats too much from a binge, serotonin levels rise and may

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provide a brief respite from depression typically associated with low serotonin, but the respite is

all too brief and the cycle continues.

People suffering from an eating disorder are delusional; they think differently from

everyone around them, an internal monologue is telling them they arent good enough or that

they are worthless (Sonenklar 46). This internal voice fuels the illness and makes them believe

that it is good for them, regardless of the savage toll it takes on their body. They dont believe

that they are sick or that the eating disorder is actually harming them; and as with so many

mental illnesses, the patient needs to be ready to discuss the problem before they are prepared to

hear the concerns of others. Johnstone says, These people believe that their eating disorder is

their friend. For most people their eating disorder is a constant factor, possibly the only

constant in their life, and they believe that they know what is best for them.

Those with eating disorders suffer from many cognitive distortions throughout their

illness, for example, thought-shape-fusion, where the mere thought of a certain food, and its

association with weight gain, can compound the eating disorder, causing the patient to further

reduce the calories they are consuming. In a study of 42 women with an eating disorder and 42

without, the results showed that thought-shape-fusion was ...significantly associated with

eating disorders (Rachman and Shafran, "Cognitive distortions: Thoughtaction fusion").

People with eating disorders also suffer with other cognitive distortions such as all-or-nothing

thinking, over-generalization, mental filter, jumping to conclusions (Huston, Cognitive

Distortions for Eating Disorders). A patient may exhibit one or many of these cognitive

distortions making it extremely difficult for them to admit or address the disorder itself and its

underlying causes. All-or-nothing thinking makes it so the person believes things are the worst

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they can be or the best they can be. Over-generalization makes the afflicted view everything

negatively. Mental filtering in a person with an eating disorder is when one focuses on a single

aspect of a particular event, picking it apart until the resulting thought is overwhelmingly

negative. Eating disorders can cause their victims to jump to conclusions, the most common

being making assumptions about how others see them. Throughout an eating disorder a persons

mental status deteriorates as the illness progresses, and the persons mindset becomes a constant

stream of negative thoughts.

People suffering from an eating disorder are heavily impacted by other peoples words.

Although personal affirmations can often boost ones self-esteem, it can be dangerous to those

with an eating disorder because it involves self image. Hearing the words you look great or

you look healthy for anyone with an eating disorder may compound the illness because the

affirmation can be interpreted as approval of their activity as opposed to a simple compliment.

Due to the difficulty in identifying eating disorders it is near impossible for even close friends to

realize how their actions and words might encourage the destructive behavior. Harriet Brown,

mother of a recovering anorexic and author of Brave Girl Eating: A Familys Struggle With

Anorexia, states, And then the tech smiled at Kitty and exclaimed, youre so nice and slim!

How do you keep your figure? This wasnt the first comment shed gotten on her

slenderness, just the most inappropriate (Brown 28). Brown knew her daughter had anorexia

nervosa, and she knew that because her daughter heard these words from a medical

professional, it would only worsen her daughters condition, and it did. There are people that

know someone they are close to has an eating disorder, but Johnstone says that offering advice

may not help the person, but make things worse, and the best way to help someone with an

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eating disorder is to tell them that you are there for them when they are ready to talk. For these

people to have a successful recovery, something one should do is establish that they are a safe

space for them to talk to when they are ready to talk.

Recovery for an eating disorder is similar to that of an alcoholic, and unfortunately this

means the person sometimes cant start recovery until they have hit rock bottom, or they want to

recover. This realization of the need or want to recover usually happens because the person is

admitted to a hospital. Degener, when discussing her recovery process, states, I was

hospitalized for three weeks when my body started to shut down from the effects of my

disorder. I suffered extremely low blood pressure and an extremely low heart rate, putting me at

a high risk for heart attack, which caused me to be eligible for admittance into an eating

disorder-specialized hospital. For many people who are admitted to hospitals due to their

eating disorder they dont want to recover, but are forced to. Eating disorders, like alcoholism,

have a long recovery process, and patients never fully recover. When Degener talk about her

recovery she says, I consider myself to be in active recovery, and have been so for a year.

Recovery was, and remains to be, very difficult. It's a conscious choice I have to make every

day, although it does get easier with time. Everyday is a new day for those recovering. Every

day they wake up and have to make the decision to eat food that gives them enough calories, or

to not binge and purge. For example, its hard for an alcoholic to completely avoid alcohol; its

hard for those with an eating disorder to avoid trigger foods. For Harriet Brown, she watched

her daughter cry over certain foods like milkshake, and become doubled over sobbing

uncontrollably spewing words of hatred from gaining a single pound (Brown 111). Brown sat

there ecstatic that her daughter was gaining weight again, but she also knew how hard it was to

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get her to gain just a quarter pound. She watched her daughter take hours and hours to eat a

single meal and then had to sit with her for at least an hour so that she knew her daughter

wouldnt purge. The fact that the simple task of eating a meal takes hours for someone in

recovery shows how difficult the process really is. The worst part for people who are starting to

gain weight again is that they have to almost double the amount of calories they normally would

consume. Although these people can eat high calorie foods, those highly-caloric foods are also

trigger foods. Just because these people are now eating the right amount of food again, it

doesnt mean that their mindset has changed.

In order for the recovery to be successful Johnstone recommends family therapy,

thought replacement therapy, or cognitive behavioral therapy. Family therapy, often known as

the Maudsley family-based approach, is used to inform the family that it is not their fault as

parents tend to blame themselves. It is also used to help the family bring their child home and

aid in the recovery process. The goal of thought replacement therapy is when one tries to

replace their negative mindset with a positive one. Instead of saying, I look fat one says, I

love myself. This form of therapy is the hardest because the patients brain has adapted to

constantly thinking negatively about themselves and it is difficult to start thinking positively

again. Cognitive behavioral therapy is a short-term, goal-oriented psychotherapy treatment that

takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of

thinking or behavior that are behind peoples difficulties, thus changing the way they feel

(Martin, In-Depth: Cognitive Behavioral Therapy). Cognitive behavioral therapy is the most

productive form of therapy because it allows the patient to work slowly and in small increments

instead of making large strides in their recovery, which could lead to them getting anxiety,

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depression, and or relapsing. I have always imagined therapists office as dark, gloomy places

with the classic long gray couch and single chair, but as I walk into Alli Johnstones office my

preconceived notions are quickly changed. Although there is still the classic gray couch and

chairs, the paper room dividers let in the sunlight, but still keep my identity a secret allowing

me to feel at ease. The room gives off a comforting vibe making me feel instantly safe in this

new place. Once I sit down I realize all of the things that have probably happened in this room:

the tears, the struggles, the stories, and the secrets. I know that in this room people have talked

about their darkest moments, but also their happiest days. Yet, I still feel at ease.

Recovery is so difficult that Sonenklar states, most likely a patient will suffer at least

one relapse (Sonenklar 110). Although there are no medications that can be prescribed to cure

specifically eating disorders, they are often given antidepressants or antianxiety medication

(Sonenklar 101). The medication is given so that when they do start to eat normally again, they

can cope with the potential anxiety and depression that comes along with it. Johnstone also

recommended activities like exercise, church groups, or a hobby as something to help recovery

because if they learn to channel the control they used to put into food into something less

unsafe, they can still feel in control of something. Although these things will not provide instant

recovery, it is a step in the right direction for those suffering an eating disorder.

I was prompted to choose this topic because I have always been interested in

psychology, and I knew I wanted to do something related, but I chose eating disorders

specifically because I have known someone close to me that suffered from an eating disorder. I

watched this person become detached from all their friends, and shrink before my eyes. The

scary thing was I didnt know it was happening until after they were in active recovery, and I

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wanted to learn more about why this happened to a seemingly perfect girl with a seemingly

perfect life. Even though skipping a meal every once in awhile is not classified as an eating

disorder, it is something that can turn into an eating disorder. Before this research I thought I

knew quite a bit about eating disorders, but it turns out I knew very little. Although there is no

single cause for eating disorders they are mainly based on control issues, but the control issues

stem from other factors. I found out that there are many different categories of eating disorders

besides bulimia and anorexia; there is binge-eating disorder, atypical anorexia, purging disorder,

and avoidant/restrictive eating disorder. Many of those eating disorders stem from anorexia and

bulimia, but have a few different symptoms. I learned that I am very lucky to have grown up in

an environment where my parents never pressured me to look a certain way or tried to control

my life. I learned a lot about the timeline of eating disorders and that there is no specific starting

and ending point, but it is an ongoing disease that you never fully recover from. I learned that

the recovery process is not just for the person suffering, but for the entire family. The family has

to adjust their lives as well, in order to make sure the patient can recover successfully.

Researching this topic reinforced how important it is to remember how much words can impact

someone. Making assumptions about someone is dangerous and something that you think is

insignificant to say could set someone off, because after all, you never know what someone else

is going through.

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Works Cited
Books:

Brown, Harriet, and Daniel Le Grange. Brave Girl Eating: A Family's Struggle with Anorexia.
New York: Harper, 2011. Print.
Sonenklar, Carol. Anorexia and Bulimia. Minneapolis: Twenty-First Century, 2011. Print.
Electronic Sources:
Brownell, Kelly D., PhD, Kathy J. Hotelling, Phd, Michael R. Lowe, Phd, and Gina E. Rayfield,
Phd. "Eating Disorders." American Psychological Association. APA, Oct. 2011. Web. 05
Mar. 2017.

L.P.C., Natalie Hutson M.S. "Cognitive Distortions With Eating Disorders | Eating Disorder
Recovery & Treatment." Walker Wellness. Walker Wellness Clinic, 09 Feb. 2013. Web.
15 Mar. 2017.
Rachman, S., and Roz Shafran. "Cognitive distortions: Thoughtaction fusion." Clinical
Psychology & Psychotherapy 6.2 (1999): 80-85.
Martin, Ben, Psy.D. "In-Depth: Cognitive Behavioral Therapy." Psych Central. John M.
Grohol, Psy.D., 17 July 2016. Web. 17 Mar. 2017.
National Institutes of Health. (2011). Estimates of Funding for Various Research, Condition,
and Disease. Web. 21 Mar. 2017.
National Institute of Mental Health. "Eating Disorders." National Institutes of Health. U.S.
Department of Health and Human Services, Feb. 2016. Web. 21 Apr. 2017.
Wade, T. D., Keski-Rahkonen A., & Hudson J. (2011).Epidemiology of eating disorders. In M.
Tsuang and M. Tohen (Eds.), Textbook in Psychiatric Epidemiology (3rd ed.) (pp.
343-360). New York: Wiley. Web. 21 Mar. 2017.
Primary Sources:
Johnstone, Alli. Therapist. Concord, CA. Personal interview. 16 Mar. 2017.
Degener, Maris. Recovered Anorexic. E-mail. 11 Mar. 2017.

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