Understanding The Functions of an Eating Disorder
As a specialist eating disorder clinician, I am often frustrated by the many misconceptions and misunderstandings associated with eating disorders. Not just the misconceptions about who gets an eating disorder (it's not only white, teenage girls!), but also the lack of understanding over why people might develop an eating disorder (it’s not just because they spend too much time on social media!). Much is said about the various genetic, environmental, temperamental and societal triggers that might contribute to the development of an eating disorder - each of which of course play a part, but far less is said about the functions (or role) that eating disorders can hold for those struggling.
Eating disorders are notoriously challenging to treat, and one of the main reasons for that is that they are ‘ego-syntonic’ - that is, aspects of the eating disorder are valued and desired by the individual. This differs from almost all other mental health conditions which are not generally valued by the sufferer. Understanding why an eating disorder may be wanted or valued, involves understanding the role that it plays, and the function that different symptoms may hold. Of course each person's experience is unique, but in this blog I hope to shed some light on some of the common functions associated with eating disorder behaviours.
Before exploring the functions of eating disorder behaviours, it is also crucial to point out that while these behaviours may serve a function initially, they generally do not keep serving that function over the longer term, in fact they usually make things much worse in the long term, as people become unable to meet their needs in healthy and effective ways.
What functions can eating disorder symptoms hold for the individual?
Achievement
For some eating disorder sufferers, some of the eating disorder symptoms - rigid control over food, denying themselves certain foods, or control of weight can feel like an ‘achievement’. This may be particularly important for those with low self esteem who struggle to feel they are ‘achieving’ in other areas of their life.
Affiliation
A subset of people with eating disorders will feel that they will better ‘fit in’ to their family or peer groups if they diet, or maintain a lower weight. When people believe that their social groups value low weight, or place a lot of importance on low weight, they may try to 'achieve' a reduction in weight in order to feel that they may be better liked or valued by others. Of course this sets them up for either a restrictive or a binge - purge eating disorder if taken to an extreme.
Avoidance of adulthood
For some, the idea of facing 'adulthood' and all that comes along with adulthood - intimate relationships, responsibility, a reduction in structure, the possibility of parenthood etc, can feel overwhelming. Maintaining a smaller 'childlike' body, and the suppression of hormones may feel like an advantage to someone who holds an intense fear of reaching adulthood.
Avoidance of emotions
Both weight suppression, and objective bingeing can serve to ‘block’ or ‘numb’ emotions. Because of this, difficult, unwanted or distressing emotions can be avoided rather than felt (and dealt with). Bingeing often serves as a form of temporary 'dissociation' from emotions - the binge becomes all encompassing, shutting out all awareness of a person's surroundings, difficulties and emotions. This 'time out' is often what drives people to binge.
Avoidance of gender / sexuality
At very low weights, not only does hormone production slow or stop, but the body looks emaciated, less 'adult'. This may be one way in which people feel safer, less sexualised, or limit their own sexual urges or interest. This can feel beneficial if trauma or abuse has occurred before the onset of the eating disorder.
Care
The presence of an eating disorder, particularly a visible one such as anorexia, may help people to feel cared for by close others, or by professionals. The concern evoked by an eating disorder may often be the only way in which people know they are cared about, or cared for, or may be the only way in which people feel able to ask for care.
Control
For some, the lack of control they have over certain aspects of life can feel intolerable - they fear losing control (which of course means many different things to different people). Rigidly controlling food, counting calories, controlling weight may be one way in which people maintain a sense of control and reduce the overwhelming sense of fear of losing control.
Communication
For some, the change in their physical appearance, or the visible presence of some eating disorder symptoms- restriction, bingeing, purging, may be a way of communicating to others that they aren’t ok, that they need help, that they are feeling bad - people often talk about trying to match their external appearance to their inward feelings - ‘If I look awful then maybe people will realise how terrible I feel on the inside'.
Distraction
For some, struggling to tolerate certain emotional states, or struggling to cope with what is happening either in their mind or in their environment, the obsessional preoccupation with food, weight, calories, planning binges, buying binge food etc, may serve as a welcome distraction. Thinking about food and weight tends to take up a huge amount of time for someone with an eating disorder, and often serves to ‘occupy’ thinking time that may otherwise be spent engaging with unwanted thoughts or feelings.
Experiential avoidance
For many, the experience of being a low weight, or the act of bingeing on food, means they feel disconnected from their body - as though they aren’t living in their body, aren’t living in their own life. It is this disconnection, or bodily dissociation that may be valued by the sufferer.
Emotional regulation
Bingeing, purging and control of food all serve as emotion regulation strategies - they feel as though they help people cope with, or tolerate difficult emotions, they provide a 'solution' to difficulties, a coping strategy that people can engage with when they aren’t sure how else to respond to emotions that may be feeling difficult, or overwhelming. Just as drugs, alcohol, self harm, obsessive rituals serve to dissipate emotions - symptoms of an eating disorder can serve exactly the same function.
Identity
The presence of an eating disorder in one's life can be all encompassing. When someone has had an eating disorder for some time, it can feel that they achieve a purpose or identity through the presence of the eating disorder. People may be scared of or uncertain who they would be without their eating disorder and may value the identity that the eating disorder provides them with.
Keeping a family together
Particularly true for young people, they may feel as though the presence of their eating disorder is the only thing that keeps their parents together or keeps their parents caring together about them. It may provide a focus within a family that may otherwise be struggling.
Keeping a relationship
Just as for a young person who feels their eating disorder keeps their family together, in adults it may feel that the presence of an eating disorder keeps a partner close, that without the eating disorder perhaps the partner would stop caring, would feel free to find a new relationship, may not feel sexually attracted to them anymore, or may feel unable to cope with the distress that may be present if the eating disorder were not.
Punishment
Just as eating disorders can provide a source of pleasure, satisfaction or enjoyment, they can also serve as a punishment. The act of starving oneself close to death, of bingeing on thousands of calories to the point of physical pain, of self inducing vomiting - these are not easy things to do to oneself. They are physically and emotionally painful, and for those that for whatever reason feel that they deserve to be punished - these symptoms of an eating disorder serve as this punishment.
Release of Emotions
Purging in particular can serve as a strategy to release (or purge oneself) of emotions. When other ways of healthily reducing the intensity of emotions don't feel possible, or tolerable, self inducing vomiting can serve as a way of feeling as though you are removing emotions from the body.
Social avoidance
Particularly true of severe eating disorders, for some people for whom social experiences, or close relationships and friendships are more anxiety provoking - the presence of an eating disorder can serve as an 'excuse' not to need to socialise with others. Similarly it can serve to keep people out of other settings that may feel overwhelming such as school or employment.
As clinicians, understanding these functions not only helps us develop empathy and insight into the complexities of eating disorders, but helps us understand how to tailor treatment effectively to each individual. While these behaviours may initially serve a purpose, they often exacerbate problems in the long term, preventing individuals from meeting their needs in healthy ways. As clinicians, it is essential to address the underlying functions and support individuals in finding healthier strategies to cope with their emotions and life challenges.