This is the first of a 2-Part article I wrote on counseling eating disordered women biblically. It first appeared on the Biblical Counseling Coalition’s website. You can read the Albanian version here, which ran on the Koalicioni i Këshillimit Biblik Shqiptar.
© Marie Notcheva
In the first part of this series, we will consider 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.
Societal Dynamics and a Biblical Diagnosis
In the early 1980’s, the terms “anorexia nervosa” and “bulimia” became household words in the United States. Soon, behavioral and clinical psychologists rushed to find a “cure” for this new phenomenon—starvation and purging amidst affluence. Cynthia Rowland’s book The Monster Within: Overcoming Bulimia (1985) was one of the first testimonies of its kind published. The 1983 death of pop singer Karen Carpenter was one factor in the surge of media attention given to eating disorders. Another, likely, was the rise in popularity of female athletes in sports like gymnastics and figure skating who came forward with their struggles. Whatever the reason, self-starvation and binge-purge behavior are not recently-developed behaviors; nor are they limited to wealthy Western nations.
It is helpful for any biblical counselor who works with young women to understand the mindset behind eating disorders. Although your counselee may not have been clinically diagnosed with anorexia, bulimia, or binge-eating disorder, many young women will open up in the privacy of the counseling room about their insecurities regarding weight, appearance, and erratic eating/exercise habits. It will be helpful to be able to spot unbiblical thinking and counter it with grace and truth before she develops a full-blown eating disorder.
Note that body image issues and insecurities about appearance are not limited to female counselees—young men also struggle; thus the same principles apply to them. However, given the greater emphasis on weight maintenance and the prevalence of eating disorders among women, I refer to the counselee with feminine pronouns.
What Are Anorexia and Bulimia?
The medical definition of anorexia nervosa is:
“An eating disorder characterized by refusal to maintain a normal minimal body weight, fear of gaining weight or becoming obese, disturbance of body image, undue reliance of body weight or shape for self-evaluation, and amenorrhea” (loss of menstrual periods).
Bulimia nervosa is defined as:
“Episodic binge eating usually followed by behavior designed to negate the caloric intake of the ingested food, most commonly purging behaviors such as self-induced vomiting and laxative abuse but sometimes other methods such as excessive exercise or fasting.”
For a more complete explanation of the clinical criteria for anorexia and bulimia, as well as resultant medical complications, please see chapters 2 and 13 of my book, Redeemed from the Pit: Biblical Repentance and Restoration from the Bondage of Eating Disorders.
In short, anorexia is distorted body image leading to self-starvation (often combined with compulsive exercise—aka anorexia athletica); bulimia is a binge-purge cycle leading to “food addiction” and loss of control. Both behaviors are all-consuming, life-threatening, and while they have many components, at their core they are spiritual in nature—as is all of life.
There are many similarities between the two disorders, and often the behaviors overlap. In the first part of this series, we will consider the faulty thinking and “idolatry” behind both disorders; in the second, we will consider some differences in how to counsel anorexic and bulimic women.
“I’d Rather Be Run Over by a Truck”
In his recent book, Eating Disorders: Hope for Hungering Souls, Dr. Mark Shaw quotes professor Glenn Gaesser as saying, “Over 50% of females surveyed between the ages of 18-25 would prefer to be run over by a truck than be fat, and 75% would rather be mean or stupid.” This one statement speaks volumes about how young women’s priorities have been conditioned. If we consult the Bible, even in Old Testament times we can see the value placed on physical beauty—even from Patriarchal times (think of Leah vs. Rachel, Esther, Daniel, Absalom and others who were noted for their appearance). We also see a God with a completely different set of priorities—and His definition of beauty in verses such as: 1 Samuel 16:7, Isaiah 53:2-3,Proverbs 31:30, and 1 Peter 3:3.
Spending time unpacking the counselee’s position in Christ (1 John is an excellent homework assignment), begins the counselee’s journey toward grasping the truth that she is no longer a slave to sin. The implication? There is no life issue your counselee struggles with that she cannot overcome in Christ; there is no sin that your counselee battles that she cannot repent of. If God has called her to “put off” what belongs to the flesh and “put on” holiness, then, empowered by the Holy Spirit, she is capable of doing so.
This realization is usually the turning point for counselees with life-dominating sins (“addictions”) including anorexia and bulimia. Often, they have believed for so long that they are under the “control” of the behavior that being able to “choose” freedom—based on their position in Christ—is a very liberating concept. She can learn to “put off” the unhealthy behaviors byrenewing her mind.
Where Is Her Mindset?
One of the first places I take young women struggling with either anorexia or bulimia is Colossians 3:1-3:
“Since, then, you have been raised with Christ, set your hearts on things above, where Christ is, seated at the right hand of God. Set your minds on things above, not on earthly things. For you died, and your life is now hidden with Christ in God.”
What are your counselee’s daily priorities? Where does her mind go? Is her focus on things of eternal value? Is she resting in Christ’s finished work on the Cross and the Father’s personal love for her? What is causing her anxiety? At this point, using the “Discovering Problem Patterns” worksheet as a weekly homework log is helpful in uncovering specific “triggers” that lead her to restrict or fall into a binge-purge episode.
For example, a bulimic woman may feel attacked by her husband’s criticism, conclude that she does not “deserve” food in her stomach and then purge in self-punishment and to numb her hurt feelings. Of course, this will lead to increased depression and feelings of failure and will probably set her up for the next binge. A woman finding victory over and repenting from anorexia may feel frightened by a colleague’s compliment on her recent weight gain—panic—and begin restricting again. The media is a constant source of secular definitions of beauty, and the temptation to vanity is as real to a woman repenting from an eating disorder as “peer pressure” is to a teenager.
Now…Let’s Transform that Mind!
As the counselee becomes increasingly able to recognize these triggers as unbiblical (and even irrational) thinking, she is learning what it means to “take every thought captive to make it obedient to Christ” (2 Corinthians 10:5). She can be challenged to identify specific thought patterns such as: “No one loves me. I may as well go ahead and binge” or “The number on the scale determines my value.”
Then she can begin to counter them with the biblical truth: “God loves me, and I am created in His image. He has promised never to leave me nor forsake me” (Genesis 1:27, Hebrews 13:5). “My value comes from my position in Christ, and He calls me ‘friend.’ My purpose is to live for Him” (John 15:14).
The “put on/put off” chapter of the Bible, Ephesians 4, becomes a daily exercise for a woman being transformed in her thinking from an eating disorder. Vanity and fear of man (insecurity, desire for approval, being seen as “the thinnest”) are two heart motives behind anorexia and bulimia. Over the course of counseling, these and other manifestations of pride need to be gently countered with a high view of God and an accurate view of herself (a dearly beloved daughter in need of a Savior). God is often viewed as angry or distant by women struggling with addictions. Hebrews 4:14 is helpful to illustrate that Christ does understand her weakness and sin and is willing to strengthen her.
The Role of Grace
Moralism, at its core, is human nature’s attempt to make ourselves “right” in our own eyes. We do this by steps, rules, and how-to lists—often making our own “rules” on what it means to be good, successful, or attractive. Of course, this sets us up for failure as we will inevitably break one (or possibly all) of our self-imposed rules. Perfectionism—trying to attain works-righteousness by our own standard—flies in the face of the gospel.
“If being ‘thin’ is good, ‘thinner’ is better,” the inner taskmaster screams. “Spartan” eating habits and exercise regimes can take on a life of their own.
The Rest of the Story of Victory in Christ
Eating-disordered women are notoriously perfectionistic by nature. What “works of the law” do they create for themselves, and how do we counsel them? We will examine perfectionism and how to speak grace to anorexic and bulimic believers in Part 2.