In the broadest sense, the term eating disorders refers to a group of conditions defined by abnormal eating habits that involves either insufficient or excessive food intake to the detriment of an individual’s physical, mental, and spiritual health.
At my practice counseling in San Jose, I work with the most common types of eating disorders (anorexia nervosa and bulimia nervosa). These are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the International Classification of Diseases (ICD-10).
With regard to anorexia nervosa, one of the key diagnostic criteria is insufficient weight, which the anorectic achieves through dieting and excessive fasting. Bulimia nervosa is an illness in which a person binges on food and then uses various methods—such as vomiting, laxatives, and fasting—to prevent weight gain.
To be diagnosed with an eating disorder, an individual must meet the criteria listed in the DSM-IV or the ICD-10. Disordered eating, on the other hand, is a term that describes the spectrum of abnormal and harmful eating behaviors that are used in a misguided attempt to either lose weight or maintain an abnormally low or unhealthy body weight.
The obesity epidemic in the United States has had numerous implications, including the perception that Americans have difficulty controlling their food intake. Bernhard Muller, a German author, said, “Today in the Western world it is definitely easier for people to die from overeating than from starvation.”
Our relationship with food is a complex neurobiological, behavioral, and cultural phenomenon. When this dynamic backfires and we depend on feasting or fasting in an unhealthy way, the stage is set for an eating disorder. The following sections provide some preliminary information on the background and diagnostic criteria of the aforementioned types of eating disorders and their relationship to fasting.
Almost all eating disorder sufferers participate in the practice of fasting, using it to manage their weight and to gain a greater sense of control. The anorectic tends to have the most extreme fasting practices, whereas the bulimic usually fasts for shorter periods. The fasting that occurs among binge eaters and food addicts is typically sporadic, with some individuals fasting more often than others.
The most commonly used treatment for eating disorders is psychotherapy, coupled with special attention to medical and nutritional needs. For a psychotherapist who treats someone with an eating disorder, having a thorough understanding of the practice of fasting should be a required standard of care.
Without this knowledge, it becomes more difficult to decipher the patient’s motivations and defense mechanisms that pertain to fasting. Regarding anorectics who have abused fasting to the brink of death, examining their bond with fasting in psychotherapy—much in the same way an alcoholic does with alcohol—could play an important role in recovery.
For patients who have not abused the practice of fasting, as is often the case with food addicts and compulsive overeaters, therapeutic fasting may represent a beneficial method in which to reframe an unhealthy relationship with food.
These may seem like a radical contention, but revolutionary ideas may be exactly what is needed to win the battle against eating disorders, a group of psychiatric disorders with the highest mortality rate at 5.6% and whose research is grossly underfunded. Individuals who have eating disorders have the highest risk of premature death (from both natural and unnatural causes) compared to other psychiatric disorders.
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