What Makes Anorexia a ‘Harder Case’ Than Bulimia?

What Makes Anorexia a ‘Harder Case’ Than Bulimia?

(From Biblical Counseling for Women blog)

Marie Notcheva, Author of Redeemed from the Pit:  Biblical Repentance and Restoration from the Bondage of Eating Disorders, shares with us today about Anorexia Nervosa and Bulimia. 

The two main eating disorders, anorexia nervosa, and bulimia are both relatively common in the Western world, with bulimia being 5-10 times more common than anorexia (especially among college-aged women). Broadly speaking, however, anorexic clients are much more difficult counseling cases than bulimics. Why is that? Why does ‘being transformed’ and renewed in her thinking seem to be that much more elusive for the starver than for the purger?

This was not a subject I got into in my own book, Redeemed from the Pit.”  I did not focus very much on the differences between the two disorders, but rather dealt primarily with the root sins contributing to both behaviors. Moreover, most Redeemed_Hi-Res_CoverSample-02a.jpg
anorexics end up becoming bulimic at some point. It is much more difficult to continue to starve than it is to give in to the urge to eat, and then purge as an “escape hatch.” However, there are women who maintain anorexia long-term without ever giving in to bulimia. I have known women to go well over a decade as anorexics, while their body tissues slowly disintegrate, still pursuing that elusive thinness. This scenario is much rarer than the more common one: A low-to-average-weight woman who binges and purges in secret, or an overweight lady who habitually overeats and cannot seem to moderate her eating habits.

The Depth of Deception

What is it about anorexia that makes it harder to counsel? Here is my theory (and it is just that – my somewhat-educated opinion): the level of self-delusion in anorexia is deeper.

A bulimic knows that what she is doing is wrong. She feels shame constantly, even when she has been purging for so long her conscience is desensitized. Even before she seeks counseling, inwardly she knows it is sinful to gorge and vomit up food. She knows the risks of laxative abuse, and is filled with disgust and self-loathing. She wants to stop the binge/purge cycle, but on the other hand is conflicted: The frenzied act of eating/purging retains some sort of reward to her that she is reluctant to give up, yet she is deathly afraid of gaining weight. As with her anorexic sister, the bulimic has made weight her idol. Nevertheless, she rarely has any delusions that bingeing and purging is anything less than sinfully self-destructive.

The anorexic Christian, on the other hand, is less likely to really see her self-starvation as wrong. Anorexia seems the more “noble, stoic” of the two eating disorders — after all, it takes enormous willpower to consistently refuse food. The anorexic is typically very proud of overcoming her baser human instinct – the need to eat for survival – and sees herself as of stronger, more self-controlled stock than other women. She has never eaten food only to “get rid of it,” so ‘what’s the problem?’ she may reason.

Distorted Body Image

Add to this the grossly distorted body image more common to anorexics, and you would have a hard time convincing them that they need to gain weight. I remember when I was anorexic in 11th grade, looking in the mirror (at 5’5″ and 90 lbs.) and seeing a normal-weight girl. Interestingly, in photographs of myself I saw how emaciated I was; but anorexics do not see themselves realistically in “real time.” For this reason, I highly recommend meeting with a nutritionist as well as a biblical counselor during the re-feeding process. A nutritionist provides an objective, science-based eating plan according to biological, nutritional needs. In my experience, this was helpful in giving me the confidence to eat nutritionally-balanced, if small, meals and to gain weight without freaking out.

Asceticism is Worshiped in Our Culture

A third reason anorexics may present tougher counseling cases than bulimics is the connection between asceticism and “religion.” I use ” ” around the term, religion to distinguish this way of thinking from true, biblical Christianity. The ascetics were an ancient group that believed in subjugating the body (believing all matter to be evil, like the Gnostics) in an attempt to reach a higher level of ‘spirituality.’ This way of thinking was also rampant in Medieval Catholicism (read about ‘holy anorexia’ and the contemplative practices of nuns of the time period) where flagellants and penitents would beat, starve, and sleep-deprive their bodies mercilessly as “penance.”

The notion of “penance” is antithetical to the Gospel, which teaches repentance. Repentance is godly sorrow over sin; trusting in Christ’s finished work on the Cross as atonement, and dependence on Him to turn away from the sin. Penance, on the other hand, is self-inflicted punishment or man’s attempt to “make it up to God” by performing some act. This is the height of pride (thinking that we can add something to our redemption, on top of Christ’s sacrifice). It is also a gross perversion of the true motivation for the spiritual disciplines (including fasting).

A Christian anorexic could easily justify her habit as “holy” by calling it a “fasted lifestyle.” The secular media certainly reinforces this mindset, by glorifying women who successfully lose weight through willpower, the secular term for self-control. Self-control is certainly a fruit of the Spirit, and fasting is something Christians are expected to do in seasons of intense prayer, but the anorexic mindset perverts them both. Although she is called, as a believer, to “put on the new self,” she is, in fact, giving reign to vanity and self-absorption. Paul writes:

“Therefore if you have been raised up with Christ, keep seeking the things above, where Christ is, seated at the right hand of God. Set your mind on the things above, not on the things that are on earth. For you have died and your life is hidden with Christ in God.”  ~ Colossians 3:1-3

The anorexic’s mind is most definitely not set on “the things above,” nor is she walking in the Spirit. Her mind is set on the carnal desire for unnatural thinness and adulation. She ruminates about food day and night. Her lifestyle and habits “sow to the flesh” (Galatians 6:8). However, it is much more difficult for her to see her true spiritual condition through the eyes of faith than it is for a bulimic, whose purging habit is more obviously sinful (gluttony, waste, destruction of the temple – 1 Corinthians 6:19). Anorexia is just as grievous a sin against the body as bulimia is, but for these reasons, I believe it can be harder to convince an anorexic that this is indeed the case.

What are your thoughts on this? I am especially interested in feedback from women who have counseled clients struggling with anorexia. Do they see this as a life-dominating sin, or something that makes them “purer” (even if only in their own eyes)? Do they consider jeopardizing their health by self-starvation to be as wrong as overeating, or do they see it as “virtuous” (even if only secretly)?

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One thought on “What Makes Anorexia a ‘Harder Case’ Than Bulimia?

  1. There is a lot of truth here. To simplify, where bulimia was a cycle of punishment for eating food (and then for getting rid of it), being able to say no felt like an accomplishment. There is also a type of physical high that accompanies it (which is partially delirium from a starving brain, partially a mental high-five). Of course, it soon turned into prison of overwhelming fear and panic. Other spiritual roots and emotional factors have always always involved, of course. It has definitely been harder to walk away from than bulimia for a few reasons, at least for me. This is something I’d be happy to converse more about from personal experience. I was blessed to have been introduced to a wonderful biblical counselor when I had very little choice but to deal with this, among other things. I am now in the midst of the training course, myself.

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