By: Dr. Kip Rasmussen, PhD

The World of Those With Eating Disorders 
The first thing to understand about eating disorders is that they are extremely difficult to grasp and treat. But if there is a shortcut to this understanding, it is to remember this definition: Eating disorders are a desperate and ultimately self-destructive attempt to “cope” with intense feelings of inadequacy and worthlessness. This sense of worthlessness can come from a variety of sources. In this article, I will focus primarily on one of these sources: social pressures.

An acquaintance of mine recalled having had a crush on a school classmate for roughly two years. One day as she was walking down the hall at school, this boy walked by and said an incredibly insulting expression to her about her weight. This expression, though hurtful, was of the type heard commonly in ordinary daily life. Nearly all of us have heard comments similar to this on TV, popular films or in social circles – probably within the last week. The only unusual aspect of this incident is that both the boy and the girl involved in this incident were in second grade. As a result of this incident, my acquaintance vowed she would never again leave herself vulnerable to these expressions of contempt based on her weight. Over the years, she developed a severe eating disorder, one which has plagued her now for almost a decade.

It’s never been an easy world in which to grow up. It’s harder now than ever before. My experience with clients, youth of my acquaintance, and my own children has startled me at the severity of their challenge. Growing up is hard for both boys and girls, but I believe girls today face difficulties which would truly amaze their parents.

One of the most eye-opening books of recent years was Mary Pipher’s Reviving Ophelia, a book which galvanized the nation in its harrowing portrayal of the arduous path to adulthood experienced by many young women. Many readers, including this reader, were startled by the level of depression, peer infighting, sexual coercion/assault, and general trauma many of these young women had been through in their young lives. In fact, initially, I thought Pipher was relating the unusual experiences of a self-selected population, and that the majority of the population of young women were different than those she described. But upon inquiry among adult female acquaintances about trauma such as those Pipher recounted, I was dismayed to discover that the women who had escaped trauma were the exception, not the rule. I found very few women who had not experienced alarming levels of harrowing incidents while in their childhood.

My experience with clients suffering from eating disorders has only confirmed Pipher’s experience. In the last decade, we, those parents who have been given watch over development of children, have been made more starkly aware than ever before that children and youth cannot be expected to raise themselves without an increased level of watchful concern from us for their healthy growth.

• Social Pressures on Young Women
As far as the development of eating disorders is concerned, perhaps the most common experience for those women who are suffering is to have been judged regarding their appearance. The damage occurs for those women who experience both extremes of the judgment scale.

It is well known that girls criticize each other regarding virtually every element of their appearance, from clothing, to make-up and hair, to issues of weight and shape. It is rare to find a young woman with a serious eating disorder who has not been singled out for criticism regarding her appearance, (most often involving weight), even from other girls.

But this emphasis on appearance by girls pales in comparison to their being judged by young men. Boys, beginning from their years of puberty, engage in constant communication regarding the appearance of girls. While boys seldom intend for their comparisons and comments to hurt girls, the result is nonetheless often devastating. It only takes one or two incidents of hearing boys evaluate girls on issues of appearance for them to assume that the only way girls can get attention from boys is to look “hot”. One client found that when she lost weight, her phone began ringing off the hook. It was difficult to convince this wonderful individual, who had previously suffered so much loneliness, that this attraction to her physical appearance was extremely unlikely to make her truly happy in the long run.

While relatively few individuals of any gender reach adulthood without at least some rejection in romantic matters, many girls have faced much more than their share of it. Being rejected as objects of attraction by boys, often due to their weight, they are acutely aware of that relatively small percentage of girls who receive inordinate amounts of attention from boys, oftentimes based solely on their physical appearance. These girls, valued for their beauty alone, are often perceived to receive more offers for dates and invitations for parties than other girls, and because they are receiving more attention, they seem to be having more fun, and consequently leading better lives. It is not hard to believe that those who hold this view of their situation in life will lean toward taking extreme measures to lose the weight they see as preventing them from being accepted. I have worked with many young girls who would literally rather die than feel more rejection and worthlessness in their social encounters.

But the other end of the attraction continuum is fraught with the potential for even worse trauma. As, mentioned, many girls are under tremendous pressure from young men to engage in sexual contact they don’t want. These pressures range from the strategic use of alcohol to the old phrase, “If you love me…..” And many of these boys follow through on this threat to reject girls who won’t engage in sexual relations with them, leaving lost, confused girls in their wake. Sadly, girls often fail to consider that young men who want girls for this reason are shallow and do not yet possess insight into the fact that relationships based solely on physical attraction will never be truly fulfilling to either party. This fact is often lost on girls, who frequently fail to realize that this is not the kind of attention they really want from boys. What they invariably crave is for someone to really care about them as a whole person, not just for their physical appearance. This becomes a terrible dilemma for girls who don’t want to be rejected for being overweight, but don’t want to be sought after and used for their physical appearance either.

Even worse, many girls are victims to what amounts to various forms of sexual assault, falling prey to being groped and other forced physical contact. This can happen at parties, dance clubs, on dates and even in the halls at school. Many girls feel so violated that they go to the opposite extreme. In an effort to become unattractive to boys, they lose weight to the point of emaciation.

The Emotional “Benefits” of Eating Disorders
Faced with the tremendous pressures of growing up, girls will often turn to eating disorders for what they truly see as “relief”. Those with severe eating disorders are often asked why they do such terrible things to themselves. The answer is that it gives them an emotional and often physical “fix”, to something which can be as addictive as any drug. Girls often respond to trauma in “internalized” ways: self-loathing (a very descriptive word for depression), addiction to achievement, cutting on their skin, and eating disorders. Girls often turn to these “coping” mechanisms in order to sedate themselves from their feelings of trauma, self-hatred, insecurity and vulnerability. They want to “numb” themselves. Those suffering from severe emotional trauma feel a constant need to “not feel” since the feelings they have are overwhelmingly negative. And eating disorders provide a respite for these painful feelings at least at first.

Eating disorders also give them a form of quick weight loss, which often is very highly rewarded by those in their environment: “Wow, look at all the weight you’ve lost. You look great!” The eating disorder can also serve as a “friend” they can “rely” on, a form of control in the face of what they perceive to be an uncontrollable environment. In addition, when eating disorders worsen, and those who suffer start to look ill, the attention and sympathy they receive for being sick can become intensely addictive, since they often believe that they will not receive this attention in any other way.

How Parents Can Help if Their Daughter Already Has an Eating Disorder
Eating disorders lead to serious consequences for the physical and emotional health of those who suffe,r and parents naturally want to know how they can help. Here are some ideas of what you, as a parent, can do if you suspect your daughter has an eating disorder.

• No matter how frustrated you are, don’t approach her with anger.
You will most likely feel intense frustration, but you should show this frustration only with great caution. Approaching her with anger will almost inevitably push her even further away from what is reasonable and rational in her life. If she feels harshly judged, she will retreat even further into a shell of depression and further pursuit of eating-disordered behaviors. As mentioned, eating disorders involve intense feelings of worthlessness. What she needs more than anything is reassurance that you love her in spite of your fear and frustration.

• Give her the opportunity to accept your love.
Those with eating disorders often isolate themselves from the affection they crave from others. They do this for a variety of reasons, but usually because they don’t feel they deserve it. They will often push parents away, even when they secretly (and desperately) crave the affection parents can give. Let her know you love her and are willing to give her the physical affection she craves but will almost never ask for.

• Let her express herself.
Listen to her without trying to control the outcome of the conversation. Many of those with serious eating disorders have felt silenced by various sources of authority in their lives. But because of the universal need for self-expression, those with eating disorders resort to restricting or bingeing/purging as a very indirect and self-destructive way to express the pent-up feelings of worthlessness which are often, quite literally, killing them. Eating disorders have been called “the good girl’s rebellion” because rather than scream and yell at what is bothering or hurting them, they will turn to self-harm (including cutting and eating disorders) to “tell” those who can read the code that they disagree or are hurting.

• All parents make mistakes.
All parents make mistakes, even dedicated, caring parents. It is not a sign of weakness to admit that you inadvertently erred at times in the way you raised your kids. Be willing to take a look at the weaknesses in your own family and parenting. If you have made mistakes, admit it. Let your daughter know that you love her, that you never wanted to do or say anything to hurt her or impede her development and that you’re sorry for what you might have done that may have hurt her. Write these feelings in a Letter of Regret and give it to her without justifying your actions, without blaming her for anything she might have done (having her admit her part in the problem will come later). This letter will take some courage, but I have never encountered a therapeutic intervention as healing as sincere letters of regret sent from parents to their daughters.

• Get help from specialists.
The overwhelming complexity of the issues involved in treating eating disorders can make even experienced therapists look like rookies. Therapists unfamiliar with these issues can provide general levels of emotional support, but rather quickly run out of helpful ideas because of the lack of understanding of the relevant issues. Your daughter will also most likely need to visit a dietitian, one who can correct the numerous incorrect ideas regarding nutrition and physiology which girls with eating disorders hold. We also recommend that this dietitian understand an approach known as intuitive eating. We should also mention that this dietitian must never recommend an approach involving any kind of dieting or weight loss.

• Don’t be the food police.
Don’t give in to the urge to monitor her food intake unless she is physiologically collapsing. In this case, let qualified medical personnel engage their expertise. Eating disorders can be fatal, but let physicians help determine the course of treatment if she is suffering from this illness with severe symptoms. Explain to her how you see things in life, but remember that this is an uphill battle and she is unlikely to be convinced by logic if she is engaging deeply in her eating disorder.

• Allow imperfection.
Help her understand that it is not only OK to be imperfect but that it’s inevitable. Let her know that you will love her if she makes mistakes, and when it happens, prove it by showing her your regard and love for her.

How Parents Can Help to Prevent Eating Disorders
It seems critical when discussing issues of this severity to include a discussion about prevention. Here are some things to remember for parents who want to avoid the development of eating disorders in their children. Many of these will be similar to how parents should interact with their daughters who have serious eating disorders but there will be some critical differences:

• Love them.
Remember that love is an action. You may feel the intense emotions of love and protection parents have for their kids, but this is not enough. You have to show her in ways that she interprets as “love” for her to understand how you feel about her. Obviously, parents who give of their love freely serve to protect their children from a host of problems throughout their lives. This is particularly important in relation to young men. In fact, the more parents (particularly fathers) show appropriate physical affection to their daughters, the less likely they will be to desperately seek attention/contact/approval from boys later in their teens.

• Talk to them-Listen to them.
Establish a channel of communication so that when they need to talk to you about important matters, they will, by force of habit, come to you.

• Know their interests – Be a part of their lives.
If your interest is genuine, most kids won’t see your involvement as nosiness. Stay current on who their friends are, what they spend their time doing, what they want to do with their lives, and what their goals and objectives are in the present and the future. Make them aware of what you see as their talents and abilities. Become familiar enough with their lives that you will notice when they are not doing well emotionally. Again, you have to know how to decode them.

• Let them know that they are good enough.
Let them know that they are good enough even if they are not perfect; that perfection is not a pre-requisite for your love, approval, and acceptance.

• Allow them to speak their minds.
Allow them to disagree with you as long as they do it respectfully.

• Don’t value them for their appearance.
If they believe you value them for their beauty, they often become preoccupied with it, to the neglect of deeper, more enduring traits that have far greater capacity to help them succeed. Tell them you love them for reasons more important than outward beauty. Praise them for their personality and intelligence, their sense of humor, their integrity, reliability, talents, desires, spiritual strength, etc.

• Take notice of and emphasize their positive attributes and traits.
Spend more time recognizing and acknowledging their strengths, efforts, and successes. If they have weaknesses, help them work on them in a positive, encouraging manner.

• Teach them to respond effectively to pressures of physical affection they may not want.
As mentioned, girls with eating disorders often feel voiceless and powerless to change their lives or their situation. They can often submit to traumatic sexual experience because they feel they may deserve punishment, or haven’t learned to assert themselves over the course of their lives. Teach them to be able to set boundaries with people they encounter in their lives. Help them to develop direct and assertive communication patterns, to protect themselves in times of risk or threat.

Conclusion

The social influences that can contribute to the development of an eating disorder are intense, and, unfortunately, too evident in the world that surrounds these girls and young women. The awareness and influence of a loving parent is essential in combating and preventing these negative social influences or in helping to challenge and correct the flawed beliefs and experiences of a child suffering already with an eating disorder. Please remember to never give up on her. Remember also that recovery from eating disorders is a long and emotionally brutal journey. You will need your own support system through the ups and downs of recovery. You won’t fully understand many of the issues involved in the illness for many years-even if you were to study them intensively. The key is you don’t need to know everything. All you need to do is give her love and approval for the positive you see in her, while gently helping her to understand a more reasonable way of looking at the world than her errors in thinking and the mirages she truly believes in, which only lead her to even deeper levels of long-term emotional pain. Recovery is possible and women can heal from the hurts, rejections, untrue beliefs and the wounds of child or adolescent social pressures.