Understanding “The Monster Within”: Eating Disorders, Part 1

Marie NotchevaMay 4, 2015

A Word from Your BCC Team: You’re reading Part 1 of a two-part BCC Grace & Truth blog miniseries on eating disorders by 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 by renewing 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.

Gospel Grace for the Eating-Disordered Woman, Part 2

Marie NotchevaMay 5, 2015

A Word from Your BCC Team:You’re reading Part 2 of a two-part BCCGrace & Truthblog miniseries oneating disordersby 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 1here.

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 with1 Corinthians 6:11where 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).

Facing Temptation

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 17:4is 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.