by Harvey Widroe, M.D.
American Reporter Correspondent
June 12, 2007
EAT OR DIE, Part III: WHY EATING DISORDERS PERSIST
ORINDA, Calif. -- Why do Debbie and thousands like her have eating disorders? Why do 50 young women for every young male suffer from anorexia or bulimia?
We have a few good ideas, and some not so good, but no one has come up with a solid answer. We wish eating disorders were like an infectious illness where, by identifying a specific microbe or virus, we could develop a new antibiotic or a disease-specific vaccine. Alas, the cause or causes of eating disorders are much more elusive.
One old hypothesis, largely discredited, was that vomiting represented an adolescent's rebellion against the influence of an over-bearing, controlling mother. The rejection of food prepared by the mother was presumed to be a slam at the mother herself. The secret stuffing and vomiting was viewed by mental health professionals as a bizarre activity of certain adolescent girls fighting perceived maternal suffocation and struggling for control of their own lives. In family therapy sessions, mothers were told to give their kids more space, but the problem was that the extra space strategy didn't work. The anorexic and bulimic behavior continued, with the sick kids in progressively more serious physical and psychological trouble.
We now believe the mothers got a bum rap. What mother wouldn't be frantic with a son or daughter whose health was deteriorating before her eyes? What loving parents could patiently do nothing as one's child faced death by starvation or cardiac arrest? Even the most kindly parents sometimes grow frustrated and angry over the daughter's persistence, seemingly crazy eating and incomprehensible eating behavior.
More likely, though not a complete explanation, is a lethal combination of cultural and psychological development factors. "Thin Is Beautiful" is a societal drumbeat. Look at any magazine, newspaper, tv or Internet advertisement. No plump bodies urge us and our impressionable daughters to be like them. No "Hefty is Beautiful" messages entice us to buy products to adorn the overweight body. We see only painfully thin models.
Adolescent girls, emerging from total parental nurture of childhood, transfer their allegiance and need for approval to peer group cliques. The group values, dimly and unwittingly fashioned by 13-year-olds, are shallow, clumsy, readily formed and reformed by the advertising world whose factions, vying for market share, easily manipulate teenage purchasing power. Searching for identity beyond childhood, teens mimic the cultural imagery they are constantly exposed to. Variations of "Thin Is Beautiful" become a group chant; and after enough repetitions this evolves into an individual mantra, and finally an internalized version of what was only a seductive tv message.
As adolescent boys developmentally shift from parental nurture to gang allegiance, the set of values pushed by our society's advertisers has nothing to do with "Thin Is Beautiful." Male adolescents most often value the macho images typically accepted by the guy groups in crude, simple, caricatured versions. Young males, though hardly exempt from adolescent problems, are usually spared the eating disorder that "Thin Is Beautiful" values foist on adolescent girls.
For most adolescent girls, becoming "thin" becomes a major preoccupation. Some give up quickly, and jealously watch their peers from the sidelines of dieting. They secretly aspire to achieve the "Thin Is Beautiful" goal, but, after a few failed tries, realize they aren't real contenders. Luckily, most are spared the dangerous pathways of anorexia or bulimia.
While not the only way to trials of stuffing and purging, "barf parties" may be a part of an adolescent girl's cultural exposure, the same as experimentation with alcohol, drugs, or sex. Such experiences are new and promise excitement in a world not controlled or influenced by parents. Most participants look back at the purge-party events of the previous day and aren't sufficiently enchanted to want to try it again.
Of those who experiment with stuffing and vomiting, some decide to try it again. Peer pressure to be part of a secret purge club may contribute to additional trials. Others try it again privately. For this most vulnerable subgroup the bulimic behavior seems to permit limitless eating without weight gain.
The self-induced vomiting can even be experienced as pleasurable. And the private, pleasurable regurgitation episodes become ritualized. The very thought of pleasurably stuffing and purging becomes a desire, and ultimately a compulsion. In controlling every aspect of her eating disorder, the bulimic has achieved a bizarre kind of independence.
Why some adolescent girls continue bulimic behavior is still an unanswered question. For the majority, "Thin is Beautiful" values are pursued in relatively healthier ways, but others get trapped into into anorexia and bulimia.
After a few more fainting episodes, each resulting in an ambulance ride to the hospital emergency room, Debbie started to acknowledge that something was wrong. The fainting episodes scared her, and her energy level had become significantly lower. Enough angry, frustrated doctors had gravely warned that her bulimic behavior was ruining her health and that if she didn't change her bad habits she might die.
She couldn't even blame her hormones and menstrual cycle any more. In her malnourished state, she'd stopped having periods months earlier. Then her dentist joined the chorus when he told her that her teethe were becoming stained, and that new cavities were appearing at an alarming rate.
By now, she knew that her vomiting and self-restricted food intake were factors in her feeling bad. Yet, at 93 pounds, she still thought she looked fat. Her secret goal was 81 pounds! She half-wished, half-reasoned that somehow she could reach her goal in a safer, more careful way, but was unclear what this might involve.
She couldn't rely on the advice of friends anymore. There were no more invitations to teenage vomiting parties. Her old friends, even those who used to stuff and vomit with her, were no longer a part of her life. She had lost interest in calling them or talking to them at school. With her low energy level, she didn't even think very much about seeing them anymore.
In turn, they seemed to lose interest in her, and some were afraid to be with her, as though her anorexia might be an infectious disease. Others, who were bulimic along with Debbie, felt guilty that they had helped start her down a precarious path. A few more astute former friends recognized that Debbie's health was so fragile that she could drop dead at any moment.
Losing girlfriends wasn't all of it. Debbie had once been interested in boys, and dated a handful of times. Now this interest faded away.
School became another disaster. Not only had her grades fallen; she couldn't do her school work at all. and received Incompletes for all her classes that semester.
It became harder for Debbie to resist some of the demands of her mother and doctors. She just didn't have the energy anymore for head to head confrontations. Part of her wanted to believe that nothing was wrong with her, but finally she gave in to the idea of treatment. That's the final installment, next week.
Harvey Widroe, a longtime practicing psychiatrist, is the author of the recently published, "The Smart Dieter's Cheating Guide: Eat and Watch Pounds Melt Away," with Ron Kenner (Outskirts Press)