This article originally appeared on The Biblical Counseling Coalition’s website.
© Marie Notcheva
A Word from Your BCC Team: You’re reading Part 2 of a two-part BCC Grace & Truth blog miniseries on eating disorders by Marie Notcheva. In the first part of this series, we considered the faulty thinking and “idolatry” behind eating disorders. In the second, we will consider some gospel-centered differences in how to counsel anorexic and bulimic women. You can read Part 1 here.
Accepted by Grace
In her book, Good News for Weary Women, Elyse Fitzpatrick draws an interesting parallel between extra-biblical advice Christian women receive on how to be “godly” and the Galatians whom Paul was chiding for adding rules onto faith in Christ. Fitzpatrick correctly points out that trying to live up to our own standards in an attempt to make ourselves “acceptable” to God will lead to guilt, failure, and self-condemnation.
Some of the examples of guilt-inducing, unwritten “rules” for Christian women include the pressure to homeschool, teach Sunday school, and feed the family organic, home-cooked meals regularly. All of these are good practices but are neither biblical commands nor do they gain us “points” with the Lord. The point Fitzpatrick is making is that when we (women) add additional burdens to our “self-improvement” lists, we are putting ourselves back under the “bondage of the Law,” attempting to make ourselves look “okay in our own eyes” and denying our need for grace.
For an anorexic or bulimic woman, the bondage to her self-imposed rules and rituals is exponentially worse. “Allowed” foods become progressively fewer, mandatory exercise regimes become longer and more arduous, and calorie intake drops to starvation levels.
For a bulimic, eating “too much” (even by one bite) causes her to justify an all-out binge: “I’ve already blown it now…I may as well go all in.” This all-or-nothing thinking leaves no room for grace; the woman feels dirty, weak and guilty when she “fails.” Former anorexic, Michelle Myers, wrote of being struck by a friend’s words when she was most stuck in her sin: “God loves you just as much whether or not you work out.” Being no less “worthy” by skipping a workout or eating carbs is a difficult concept for an eating disordered counselee to grasp and is a very concrete example of where she needs to apply the gospel in her daily life.
Differences in Counseling Anorexic and Bulimic Clients
When discussing the young woman’s “rules” and what she feels may be gained by keeping them, you may encounter many different responses according to how deeply entrenched her eating-disordered behavior is. Also, be aware that anorexics generally are more difficult counseling cases than bulimics for a number of reasons:
- They are often (but not always) more medically fragile; doing the hard work of biblical change may require more energy than they have.
- The level of self-deception is greater in anorexia.
- Fear of food and the idolatry of thinness has become all-consuming. Anorexics often begin counseling with little hope of being transformed.
If you are counseling a young woman who has been clinically diagnosed with anorexia nervosa (meaning she is at least 20% below her ideal body weight), I would strongly suggest you require she be monitored at least weekly by a physician and have labs drawn regularly. Electrolyte imbalances are common among both anorexics and bulimics, but the risk of cardiac or renal failure is greater in severe anorexia.
Secondly, be prepared for pushback from the anorexic counselee when trying to get her to see her behavior as “sin.” This is one of the biggest differences I have noticed in counseling young women with eating disorders: a bulimic counselee already knows her behavior is wrong and self-destructive, and she is typically ashamed of her “loss of control.” An anorexic, by contrast, often feels empowered by restricting. She believes her rigid behavior is the epitome of “healthy,” justifies it as “self-discipline,” and feels revulsion for being a normal weight (which in her eyes is “fat”). When she looks in the mirror, no matter how emaciated she may be, she sees an obese person looking back at her. A bulimic may have an idolatrous view of weight (wanting to be thin so badly she is willing to sin in order to obtain it), but typically her weight is close to normal and self-image is not quite so skewed.
The anorexic takes great pride in her “law-keeping”—it has become her identity. The desire to be thin at all costs takes over—to the point where her fear of food has become irrational. The progressive nature of anorexia nervosa leaves the counselee literally afraid to swallow food.
Besides helping her counter these fears biblically, I require anorexic counselees to see a nutritionist (assuming they are outpatient) and strongly encourage it for bulimics. Meeting with a dietician helps the anorexic gain confidence in consuming what her body needs nutritionally, while countering the lies she has internalized with you, the biblical counselor.
As a rule, I do not ask either anorexic or bulimic counselees to keep food diaries—although a dietician may require it. Writing down everything she eats focuses undue attention on the food itself, rather than on uncovering her heart motivations and renewing her mind.
Giving Hope and Teaching Her to Treasure Christ
However your counselee’s eating disordered behavior manifests, giving hope in the first session is crucial. She likely will have internalized a lot of myths about eating disorders from “pop psychology,” such as “You’re never fully recovered; always in recovery.” Contrast this with 1 Corinthians 6:11 where Paul admonished former gluttons, drunkards, homosexuals, and others “addicted” to their sin that they have been “washed…sanctified…and justified in the name of the Lord Jesus.” Help her to see that she is using food in a way that God did not intend it and that she is harming the body He gave her to serve and honor Him.
A similarity between anorexia and bulimia is that in both disorders the behavior is serving as a “false savior”—they make the sufferer feel better (temporarily) so stopping is hard. When comfort and thinness are her top priorities, her mind is not “set on things above” (as we saw in Part 1), and her heart is drawn to herself (Matthew 6:21). To be transformed, she must learn to renew her mind with God’s Word and turn her heart to Christ (Romans 12:1-3; 2 Corinthians 3:18). As in all life-dominating sin, the believer must learn to see Jesus Christ as more beautiful and desirable than her “idol.” Your task is to help her discern what His immediate will is for her life (a transformed mind, health, restoring food to its proper, life-sustaining place) and to trust God and those He has given her to help her (Proverbs 3:6).
Overcoming an eating disorder is not easy, even for a Christian who sincerely desires to follow Christ. Women may often be fearful of revealing their “secret” to anyone when they first come to you, ashamed of their behavior, and desperately wanting to stop but terrified that God’s Word will not be “enough,” and they will not be able to turn from their eating disorder.
Be prepared to re-visit the gospel (the Person and work of Jesus Christ on their behalf) many times and to demonstrate, scripturally, grace for each failure (Luke 17:4 is a powerful verse for addictive sin, as is Romans 7). Teach her to turn to Christ for help and comfort in times of struggle (Hebrews 4:14-16; 1 Peter 5:6-7; Matthew 11:28-30). Each time she is able to turn to God in her moment of weakness and resist the temptation to restrict or purge, she will gain confidence and come to see herself as waging a spiritual victory.
Healing in Body, Mind, and Spirit
Once the counselee has begun to eat regular, healthy meals and develop new patterns of thinking, the urge to restrict or purge tends to subside within a couple of months. The anorexic has now faced her greatest fear—gaining weight—and sees an improvement in health. The weight gain will usually plateau relatively soon, but insist that she stick to her “maintenance” meal plan as part of her homework assignment. See chapter 13 (“Practical Considerations”) of my book, Redeemed from the Pit: Biblical Repentance and Restoration from the bondage of Eating Disorders.
A bulimic finds her intense cravings subsiding as her mind is restored, partly because she is retaining the nutrition her body desperately sought. Her energy and concentration dramatically improves, almost as soon as she stops purging, as her blood sugar is no longer spiking wildly every few hours. Emotionally, anorexics and bulimics tend to be on a much more even keel once their eating normalizes, and do not find themselves fixating nearly so often on food.
It is tremendously encouraging, both for the woman overcoming an eating disorder and for the counselor, to see the transformation take place as she learns to fix her eyes on Christ and permanently leave her bondage at the foot of the cross.
Join the Conversation
When addressing struggles with eating disorders, either in your own life or in your counselees, how can you apply the gospel of Christ’s grace?