By: Randy K. Hardman, PhD And Michael E. Berrett, PhD
Women who suffer from eating disorders battle intense emotions and inner conflicts that negatively impact their recovery. For many of these women, deep spiritual struggles are a major impediment to their ability to recover from an eating disorder.
The purpose of this article is to acknowledge the importance of including a spiritual perspective in treatment of and recovery from eating disorders. We recognize that this spiritual perspective can be an important part of recovery for many of the women who have suffered many years from the effects of a damaging eating disorder. We recognize that an eating disorder has led many of these spiritually oriented women away from personal, spiritual connections, religious communities, and loving relationships that are so vital in their ability to recover from the disorder. We believe that as patients express and clarify their spiritual beliefs and then begin to activate those beliefs in a more congruent fashion, they will receive benefit in their healing process. We simply want to encourage these women to take advantage of this spiritual source of healing and empowerment that can help them in their journey of recovery.
Women suffering from long-term eating disorders feel terribly alone, inadequate, unworthy, undeserving, and hopeless. Many sufferers, at previous times in their lives, have felt a connection to God and a degree of personal spirituality. Some have participated in religious observations, but through the course of their eating disorder have, almost universally, lost those connections. They feel unworthy of love and acceptance of others, and in an act of self-rejection they believe that they are undeserving of God’s love and acceptance as well.
“The eating disorder consumed every aspect of my life. My life was centered entirely around food and weight. I felt unworthy and undeserving of having a relationship with God. I hated myself and did not think it was possible for anybody, including God, to love me. I did not feel that I was good enough to merit a relationship with God.” (20-year-old woman.)
When incorporating a spiritual perspective into the recovery from eating disorders there is no need to be disrespectful of anyone’s spiritual or religious beliefs and behaviors. Therapists can be respectful of each person’s perspective and simply encourage them, within the context of what they believe, to once again open the door to spiritual influence in their recovery.
Significant Spiritual issues
Some of the significant spiritual issues that women with eating disorders encounter are:
1) negative image of God,
2) feelings of spiritual unworthiness and shame,
3) fear of abandonment by God,
4) an intense difficulty of surrendering and having faith, and
5) dishonesty and deception.
Negative Image of God
When discussing their negative images of God, eating disorder patients tend to describe God much as they describe their parents. If they perceive their parents as distant or unavailable, they often feel that distance is true of God as well. If they perceive their parents as rejecting, critical, controlling, angry, devaluing, shaming, etc., they also often project these characteristics onto God. As the eating disorder progresses, this negative image of God plays a significant role in their disconnection from spiritually -based relationships. “Around the time my eating disorder started, I began to lose a connection with God, and as I got sicker, I became totally disconnected to God, even doubting his existence. My eating disorder made me want to pull away from and go against my family and parents’ belief, causing me to pull away from God even more than I would have because my parents were so strong in their spirituality. There were some days I would have gone to church but had binged the night before and was too fat to go.” (18-year-old woman.)
Feelings of Unworthiness and Shame
A second spiritual issue that impacts eating disorder recovery is a deep feeling of spiritual unworthiness and shame. Many of these women believe that God and everyone else views them as unworthy, unacceptable, and flawed. They often try to compensate for these feelings of spiritual unworthiness through perfectionism and a relentless pursuit of impossibly high standards. Their failure to meet these perfect expectations only confirms their belief that they are unworthy of spiritual connections or spiritual experiences. They decide that they have disappointed God and that are unworthy of his kindness and love. They may feel undeserving of forgiveness or acceptance from anyone, including God. “Throughout my eating disorder, my spirituality decreased dramatically because of actions and behaviors I did to support my eating disorder. The more wrong choices and inappropriate my behaviors got, the more I felt undeserving and unworthy of God’s love.” (23-year-old woman.)
Fear of Abandonment by God
A third issue that arises among women with eating disorders is a fear of abandonment by God. The desire to receive approval from other people is a significant emotional issue and they fear that if they displease or disappoint, then loved ones will abandon them. That fear and belief is also projected onto their beliefs about God. A number of these women have been sexually abused as children and they believe that God abandoned them during the abuse. In such cases it becomes difficult for them to trust again and believe that God will support and help them in their times of need. The feelings of abandonment that originate for many of these women in childhood can become their reason for avoiding spiritual relationships completely and can be deterrent to re-establishing spiritual connections that can aid them in their recovery. “My eating disorder destroyed my relationship with God. It blocked me from him and I lost all faith and trust in God. I became very angry with him because I felt like he had abandoned me. Eventually, I just stopped thinking about him. My eating disorder became my God and my body became the Devil. Now, I feel a lot of guilt and shame in denying Him.” (25-year-old woman.)
Intense Difficulty in Surrendering and Having Faith
A fourth spiritual issue that impacts eating disorder recovery is the difficulty in surrendering, trusting, and acting in faith. Many eating disorder patients become experts at controlling or numbing their emotions, and, consequently are often unable to experience sensitive spiritual feelings. They attempt to avoid experiencing emotions and the associated primary emotional pain that contributed to their eating disorder. Thus, to “let go” and begin to exercise faith and trust in God becomes a frightening challenge to these women. They may feel so afraid of losing control, or whatever sense of control their eating disorder brings them, that they struggle with giving up their control to a “higher power”.
“Becoming so obsessed with my body decreased my faith in everything I believed. I wanted and knew that I could only go through this pain with the help of God, but my life revolved around me. There wasn’t enough room in my heart for both my eating disorder and Heavenly Father. I had to choose. I chose wrong and ended up in an eating disorder clinic.” (19-year-old woman.)
Dishonesty and Deception
A fifth spiritual issue in recovery is dishonesty and deception. Common coping strategies among eating disorder patients include “covering up,” secrecy, and blatant deception and lying. Many feel a great deal of shame and remorse about their deception and lying, compounded by feelings of guilt from too many failed promises to give up their eating disorder. Many have lied over and over again to people who love them, in order to protect their eating disorder. All of this leads to the incorporation of “false pursuits” within the eating disorder that become substitutes for the spiritual connections in their personal lives.
Ten Common False Pursuits of Eating Disorders
This section of the article will address ten false pursuits of an eating disorder, their spiritual consequences, and some pathways that can help these women begin to change course and once again reopen a more healing and helpful spiritual perspective in their lives and in their recovery. These ten falsehoods are what women with eating disorders pursue in place of, and often at the expense of, emotional and spiritual nourishment in their lives. Women who suffer may pursue one or more of the following:
1) An eating disorder can give a false sense of control. Many of the women who suffer from eating disorders experience a tremendous fear of losing control or “not being in control.” The pursuit of control at all costs eventually becomes the very narrow crusade of their eating disorder. They try to avoid any feelings associated with being out of control and also the literal experience of not being in full control of their environment. Many of these women have suffered painful experiences in childhood which they could not control or stop. They have the illusion that by denying themselves food or getting rid of their food they are in control of their circumstance and can avoid the very things that they are so very afraid of, such as pain, disapproval, criticism, abandonment, etc.
One way this falsehood impacts their spiritual lives is that they will not let go of fear or mistrust enough to believe that someone outside of themselves can care for them, can accept them, or can even love them. They do not believe that another being, whether a person or God, will see more in them than what they see in themselves. As a result, they keep people at a distance, refuse to allow vulnerability in themselves, and subsequently do not allow emotional intimacy or closeness in relationships. The openness and honesty necessary to create meaningful and responsive relationships does not occur. They substitute this false sense of control for meaningful and loving relationships. Experiencing vulnerability and trust in a safe relationship is the beginning step to change this pattern.
2) Eating disorders are a false form of communication about pain and suffering. People with eating disorders recognize at some level that their eating disorder is a means of communicating, albeit indirect, their pain, suffering, and feelings of unacceptability. This form of communication is a false pursuit or false means of conveying the pain and misery of their lives in an attempt to solicit help from others. Because most people do not respond to this indirect communication in the way that is needed, it is not usually met with supportive, kind, reassuring, or comforting responses. People with eating disorders are usually told that they are selfish and seeking attention, or that they just need to eat. The way that this false communication about their pain impacts their spiritual life is that they are often not willing to be direct and honest with God either. Instead of expressing the pain they are feeling in their prayers or other communication with God, they talk about how fat they feel. Instead of sharing how lonely, inadequate, or empty they feel, they tell God and others what a bad person they are or how undeserving they are of love and acceptance. Part of spiritual healing comes out of directness and honesty in their relationship with themselves, with other people, and with God. Pain and internal suffering can be expressed and shared, eventually without shame, to those who will show empathy and validate their emotional experience.
3) An eating disorder can give a false sense of being the exception or exceptional. The pursuit and feeling of being the exception can be a tremendous barrier to recovery from eating disorders. Those who hold this belief feel that somehow they are exempt from, or the exception to, love, kindness, forgiveness, or support, and that somehow empathy, compassion, mercy, and grace apply to other people but not to themselves. They feel like there is something inherently wrong in them, and their shame-based thinking tells themselves that “other people deserve kindness and love but I don’t. I deserve contempt, hatred, and rejection.” In a sense, these women become exceptional at their refusal to allow any kind of acceptance, kindness or support to be beneficial to them. In a paradoxical sense, this pursuit of being the exception, or exceptional, is a false pursuit of being special.
This kind of “specialness” distorts their view of how they are unique from other people and can lead them to feel that they have no potential for recovery. Ironically, individuals in this situation will typically do anything they can to help another woman recover from her eating disorder–believing the ability they lack still exists, but only in others. This false sense of being the exception can be a major roadblock to maintaining a spiritual life or a relationship with God. These women have usually stopped praying because they feel like they are unforgivable, unacceptable, or undeserving of a relationship with God. They feel too unworthy to ever be forgiven. And yet, it is this extreme notion-that the rules are different for them, that keeps them from actively pursuing the kind of relationship with God that would help them in their recovery. It is sad that it is their own false pursuit of being the exception that reinforces their sense of aloneness and emptiness. Healing can start when they are willing to be no better or no worse than any other person and to share their similarities with others. Healing can start when there are no special rules or requirements for them that are different from other people.
4) An eating disorder can be a false crusade for evidence and proof against self. In time, a woman with an eating disorder uses the very eating disorder itself as her evidence that she is bad, unacceptable, and deserving of punishment. Some believe that if God and other people are not going to punish them, then they should do it for themselves. Sufferers will use all their time and energy to prove to God and others this terrible truth that they feel about themselves and will add new degrading and demeaning experiences and events to their list as proof for their deserved rejection, unkind treatment, and pain. The spiritual consequence is that much of this pain comes from the self-inflicted experiences of this false crusade. The message seems to be that “even God could not like me.” These women become so busy proving themselves right that there is not time to be wrong about their false beliefs. Whenever they feel happy, hopeful, or peaceful they will chase those positive feelings away by mentally beating themselves up with their long list of personal negatives. The truth is that the illness or “disorder” is not who they are. It is not their identity. As these women begin to separate who they are from what they do they can begin to give up this false crusade against themselves.
5) An eating disorder can be a false pursuit of perfection. This perfection is a rigid pursuit of something specific that is unreasonable or unrealistic for anyone to obtain or maintain. Women with eating disorders have deceived themselves into thinking that if they obtain perfection in their bodies, in self-control over their bodies, or in body image, that somehow this perfection will make up for their other perceived inadequacies and failures. Many times we have heard women with eating disorders talk about how they need to be perfect “for everyone else,” but this is really a false perfection because even when they receive acceptance or approval, the best they can ever do is “break even” in their own minds. Consequently, any criticism or disapproval creates intense feelings of failure and imperfection that feed the eating disorder cycle making it more intense and rigid.
In a sense, seeking perfection becomes a substitute for love, because for most of these women, they have externalized perfection assuming that if they can perform well or do something very well it will translate into external validation (love) from other people. The pursuit of perfection impedes them spiritually. They neglect spirituality and higher love in pursuit of a kind of a physical and literal justification for their existence. “If I obtain this perfection, I have a right to be here.”
One of the things that happens in the religious community to women with eating disorders is that they can become very discouraged, feeling they can’t live up to certain religious precepts and principles in a perfect enough fashion. Instead of trusting that self-improvement is an ongoing and unfolding process, they become perfectionistic and adopt an “all or nothing” approach, leaving God out of their self-improvement pursuits. In order to change the course of this perfectionistic pursuit, these women need to learn that it is okay to make mistakes, and that through their mistakes and subsequent corrections, they will make the improvement in themselves that will, over time, make a significant difference in their lives. It is also important that they come to understand that their specific pursuit of being the best in the eating disorder realm is why they often end up feeling unsatisfied and unhappy. Letting spiritual influences help them make corrections, learn from their experiences, and help them in their efforts to do things better, becomes a positive journey instead of a negative one.
6) An eating disorder can be a false form of comfort and safety. For many, eating disorders relieve anxiety and help them avoid painful emotions. This false sense of safety and comfort is a temporary absence of pain rather than a true form of comfort. Many women with eating disorders, especially bulimia, often describe their pursuit of bingeing and purging as an attempt to find comfort and relief from the anxiety and tension that they are feeling. It becomes a very unsatisfying and fleeting form of comfort in which, almost before they are done with one binge and purge episode, it is necessary to begin another. Certainly, this false sense of comfort, relief, and safety that the eating disorder brings implies that the eating disorder is the source and author of their comfort instead of God.
The spiritual consequence in looking for immediate gratification and immediate release from whatever they are experiencing is that it distracts them from seeking a greater and more profound type of comfort. They miss the soothing, lasting effects of knowing that there is someone more powerful than themselves who desires to support and comfort them, provide answers to their questioning, and bring healing to their pain and emotional quandary. True safety and comfort for these women comes from loving and accepting relationships and from knowing that they are not alone in facing the ups and downs of life.
7) An eating disorder can give a false identity and perception of self. Invariably, women with severe eating disorders talk about how the eating disorder has become their identity. They lose their sense of self and become frightened at the thought of giving up the eating disorder asking, “Who will I be without it? This is me. This is my life.” Many of these women have an underlying feeling of emptiness and void, and facing those feelings is a very threatening prospect without the false identity of their eating disorder. Anyone who spends all their mind, body, and soul in the energy of an eating disorder soon has no room for anything else.
We often say that it is hard to have an eating disorder and a life at the same time. Clients have to pick one or the other. When an eating disorder is their life, it also becomes their sense of who they are. Certainly, this impedes their ability to make spiritual connections because an eating disorder is something one does and not who one is. By treating the eating disorder as who they are, then what they believe is, “God could never accept me as an eating disorder,” because implicitly they know the extreme costs and consequences of living their life this way. They return to the spiritual hopelessness of, “If there is nothing else to me, how can God help me find the rest of me? How can God help me feel good about who I am if this is all there is? Is this all I’m good for?”
Many women say, “This is the one thing I can do better than anyone else. This is the one thing that I can do well.” Consequently, doing the eating disorder well becomes a false form of acceptance, replacing true acceptance from themselves and acceptance from God and other people who recognize and value their unique human qualities. Part of a spiritual reawakening is the discovery that who they are is more than what they do. What anyone does, including those with an eating disorder, can never express fully the unique and distinct person or the distinct personal qualities and characteristics of the individual. Believing that God or others can accept all of you with your strengths, weaknesses, pluses, and minuses, and do so unconditionally with love and kindness, is a spiritual experience that can help in the recovery process.
8) An eating disorder can be false compensation for the past. Sometimes, an eating disorder is an attempt to compensate or make up for past childhood abuse or trauma, family problems, and sometimes past personal mistakes. And so, in a fashion, the eating disorder becomes false pursuit for penance. It becomes a way to justify one’s existence by trying to atone for past mistakes, pain, or negative experiences. This false attempt to make up for the past becomes a driving force for many women with eating disorders. Its message is “the suffering that I experience from denying myself through the eating disorder will emotionally justify past errors, failures, and suffering.”
One of the ways that this pursuit greatly impedes spiritual and religious activity is that it puts the burden on the person suffering to do what only a higher influence can do to bring healing, forgiveness, and relief from past trauma, abuse, or past errors. In essence, they are punishing themselves in an attempt to somehow resolve the guilt and the pain of the past.
Consequently, they overlook God as a source of the comfort, inspiration, and guidance that they need. They also don’t trust counsel, encouragement, or comforting words of pastors, ministers, family, or friends because somehow, they alone must make up for what has happened instead of allowing God to help them resolve the pain of these events. These beliefs become an ongoing crusade of self-punishment that never leads to resolution, peace, or comfort, but can actually become the opposite–a way to communicate to themselves that no matter how much they suffer, they will always be unacceptable and unworthy. Letting go of the past is a spiritual process in which they can give away to God what they cannot correct from the past and ask for help to do things differently in the present and future.
9) An eating disorder can be a false attempt to avoid personal responsibility for life. Without question, an eating disorder can become a tremendous explanation and justification for the absence of an abundant life. It becomes a sufferer’s reason for everything that is missing. In that sense, it becomes an indirect and false attempt at ownership or responsibility for life choices. In essence, what women harboring this false notion are saying is, “My choice to have an eating disorder preempts all the other choices for which I am accountable and responsible.” Blaming life’s troubles, relationship problems, feelings of inadequacy, and their inability to function in life on their eating disorder implicitly dismisses them for being accountable for their life, as if it is beyond their direct control.
The roadblock to recovery with this pattern is that without accountability and responsibility for the choices and consequences they have created, there is no way for them to be empowered to choose otherwise. They cannot change something or let go of something until they first take ownership for it. It is impossible to turn their lives over to God if first they have not taken ownership for their lives and if they have not been honest and open with themselves about their mistakes, poor choices, and weaknesses. Responsibility is very different from blame, judgment, or fault. It is an acceptance of the fact that much of the eating disorder behavior, pursuits, and coping strategies are learned and a willingness to admit that, “I learned it, I have choices about it, and it is mine to change.”
Once proper ownership is taken, then one can ask for help from spiritual influences and others for making new choices. These women can have difficulty approaching God honestly and straightforwardly because they feel a victim of their eating disorder rather than a collaborator and enabler of the eating disorder. We encourage them to choose to be kind and patient with themselves as they assume personal responsibility and learn from their choices along this recovery. It is essential for them to face their lives directly, without blame so they can begin to make better choices and see options beyond their eating disorder.
10) An eating disorder can be a false pursuit of approval. Many women with eating disorders have substituted approval for true acceptance and as a substitute for love. They often think approval is validation that they are acceptable. The eating disorder and all it brings with it, including societal approval for attractive body image, thinness, or external beauty becomes their object of worship. Approval becomes a false form of worship in which they let go of everything else that has meaning or matters in life. Approval from others becomes their purpose in life. We have heard many women with eating disorders talk about how they lost weight initially and how positive, affirming, and congratulatory people were toward them, in contrast to how bad they felt about themselves on the inside. These temporary expressions of approval from other people become the false pursuit of their lives as they obsess about and actively pursue approval.
The problem, of course, in a spiritual context, is that approval from others is not sufficient to bring change and healing. It does not last. Approval is not deep enough; it is short lived. The free gift of acceptance and a deep sense of acceptance that can be felt from other people and from a relationship with God is a much more powerful motivator and incentive for anyone to work with themselves, find solutions, and make corrections. Approval becomes a very externalized, narrow, and short-sighted solution for pain. Seeking the approval of other people rather than the more healing acceptance that comes from God leaves these women feeling empty and starved.
Godly approval does not carry the damaging conditions or expectations that are so often found in human relationships. Godly approval can bring peace, comfort, and hope rather than worry, anxiety, and pressure to please other people. Acceptance and love are worth working for in relationships in which people develop real, honest, and congruent connections with God and with other people. Love is a change agent. Approval is not. Love has greater influence in changing lives than approval. Sometimes women with eating disorders use approval as love, when in fact, it usually makes them feel very unlovable. Often, this pursuit of approval gets in the way of giving love to other people. Approval is about trying to get love, where acceptance is about giving and receiving love. Giving love, service to others, and thinking about someone other than themselves can open the door to a spiritual recovery and a fulfilling life journey.
There are numerous spiritual interventions that can be used to help in a woman’s recovery from an eating disorder. A few mentioned here are:
- teaching spiritual concepts
- encouraging the reading of religious and spiritual articles and literature
- encouraging prayer
- encouraging spiritual imagery and meditation
- encouraging forgiveness
- encouraging people to seek spiritual direction from their own religious leaders
- encouraging self-correction and self-kindness in their recovery
- encouraging people to be involved in their own religious community, etc.
Certainly, what interventions are encouraged and emphasized are dependent upon the individual and what they are willing to do within a spiritual framework. The client always leads in her own spiritual journey and recovery. She does most of the work outside of therapy with occasional conversations within the therapy setting to encourage and support this component of recovery.
One of the things that we encourage in the beginning stages of recovery is to start praying again, and in those prayers to be honest, direct, and to tell the truth about their feelings, whether positive or negative, distorted or accurate, and to begin to reopen the communication with other people, with themselves, and with God.
“Once I came to the realization that the only way I was going to recover was through God, a huge weight was lifted off my shoulders. I was humbled in His presence. I pray every time I feel anxious, depressed, or not myself. I ask him to help me to work things out and to listen to what is going on around me. As soon as I put my recovery in God’s hands, things started to fall into place.” (19-year-old woman.)
We are cautious not to tell people how to pray. We do encourage those who believe in God to address that relationship in the context of prayer and to begin to talk honestly and openly about internal experiences, struggles, and emotional conflicts, and, in time, to begin to ask God for help in sorting out and resolving these struggles. We encourage them to listen for answers to their prayers and to use the understandings or insights that may come to them.
“My relationship with God has helped me so much in my recovery. Just knowing there is someone you can always turn to and trust always gave me somewhat of a relief after I prayed–kind of a peaceful feeling. It helped me see there is so much more to life.” (20-year-old woman.)
We have seen that the women who are able to use prayer in the stages of recovery begin to recognize an influence beyond themselves and feel evidence that God is helping them as they include Him in their eating disorder recovery.
“Being able to feel like someone else is in control can help make me feel better and feel like a weight is lifted off my shoulders when I tell God my concerns.” (23-year-old woman.)
A woman who is in the severe stages of an eating disorder feels powerless to change her course or correct it on her own. But when she begins to feel help beyond her own to change her course and to begin to do things she could not do on her own in her recovery, it strengthens her hope and resolve to continue to develop and enjoy that personal relationship with God.
“My spirituality and my relationship with God have given me hope and strength. Whenever I’m too weak, out of control, or just lonely, I close my eyes and imagine God and His angels with me. My faith is unstable right now, but even that helps me. ‘If ye have faith as small as a mustard seed, nothing will be impossible for you.'” (23-year-old woman.)
This spiritual perspective of help in recovery is not without its challenges. It is important to remember that oftentimes spiritual recovery is an unseen, subtle, and quiet experience. It is also important to remember that the intense worship of the eating disorder is a hard one to give up because it is so deeply based in fear and self-contempt. The barriers to spiritual reconnection are often the very things that aided in the beginnings and maintenance of the eating disorder.
“I believe that God answered my prayers and my family’s prayers for making a way for me to get better. He helped me feel loved and not alone in my most difficult days away from home. He gives me answers and instructions that help me, makes me hopeful in the scriptures, and I know that He is there to support me and help me recover.” (18-year-old woman.)
We encourage women with eating disorders to regain spiritual connections by participating in structured assignments and activities where questions are asked and where they reflect and respond in writing. We encourage readings that they can select, including books, scriptures, writings, and affirmations. We encourage personal and private meditation and self-reflections. We encourage prayerful hearts or spiritual pauses in the course of their day. Support can also be given to reconnect with their religious communities, activities, and structures that many of these women have given up.
“I believe spirituality is a pivotal aspect of recovery. I don’t think it is possible to get through this without having faith in God or a higher power. When I am in my eating disorder, I feel alone and tend to isolate myself from the world. I feel lonely and disconnected. It is easy to give up on life if you don’t have a belief that there is something greater than yourself to live for.” (19-year-old woman.)
In treatment, encouragement is given to reexamine or challenge the beliefs that impacted them negatively in their earlier lives spiritually or religiously. We encourage them to reexamine old beliefs and decisions and to make new decisions, changes, and develop new direction for themselves within a spiritual and religious context.
“It is only through the grace of God that I was able to pull through my eating disorder. Because of His unconditional love and the Atonement, I am able to be whole once again. Never in my life have I felt so much peace and comfort. I rely in Him in all I do. Praying for strength daily, I am able to win this battle.” (28-year-old woman.)
A new hope for recovery is kindled when suffering women begin to turn away from the false pursuits of the eating disorder and embrace again their own spirituality. Therapists can be an important support in this process.