The Mindset of Eating Disorders
Eating disorders can be a mystery to outsiders. It’s difficult to empathize with throwing up, starving, or bingeing until it hurts. But there’s a reason for every eating disorder. The Savvy Psychologist reveals 4 psychological drivers behind anorexia, bulimia, orthorexia, and other forms of disordered eating.
Looking in from the outside, it can be difficult to understand an eating disorder. Why would anyone want to throw up, starve themselves, binge until they hurt, or feel tortured by food?
But eating disorders serve a purpose for those who suffer from them. After all, Psychology 101 teaches us that behavior exists because it gets reinforced. Therefore, once we understand what individuals derive from their eating disorders—how bingeing, purging, or restricting meets a need—it makes way more sense.
Another barrier to understanding eating disorders is stereotyping. Despite the fact that eating disorders can strike people of any gender, race, income, or body type, the cliché is that of a SWAG: a skinny, white, affluent girl.
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This stereotype hurts everyone. Those that fit the SWAG pigeonhole are often dismissed. Their disease is written off as a lifestyle choice for rich girls fixated on their thigh gap.
On the flip side, for those who defy the SWAG stereotype—men, racial minorities, those from socioeconomically disadvantaged backgrounds, and higher-weight individuals—their disease also gets written off and can fly under the radar for years. Screening, referrals to treatment, or simply being taken seriously are all less likely because they don’t match the expected profile of someone with an eating disorder.
While humans of any demographic can suffer from an eating disorder, what ties together those who suffer is mindset. Understanding the mindset of eating disorders can improve empathy, and most importantly, recognition and treatment for everyone. Therefore, this week, here are 4 factors that drive the mindset of eating disorders:
Factor #1: Needing Control
Let’s start with the big one. Eating disorders are a way to exert control when life feels turbulent and chaotic. In a world where the only constant is change, controlling one’s eating can be a way to feel power and agency as you watch your parents get divorced, your own relationship breaks apart, you show up at a new school or job, or your longtime social circle shifts under your feet.
An eating disorder can also be a way to deal with internal change, like the physical roller coaster of puberty, post-pregnancy, or aging. It can also be an attempt to deal with a roiling mass of negative feelings like loneliness, difference, or inadequacy.
Therefore, as change swirls externally or internally, folks with eating disorders gain certainty and reliability with every mouthful, every calorie, and every bite.
Interestingly, in western cultures, a minority of individuals with anorexia—around 1 in 5—report not caring about body weight or shape, prompting some researchers to think that the core component of anorexia isn’t weight at all, but control.
This is part of the reason eating disorders are hard to treat. Those who suffer may resist treatment not because they’re happy or satisfied—they’re not. But imagine if the one thing you felt you had control over was taken from you. You’d likely resist, too.
Any way you slice it, the obsessions around food, weight, or shape function as a way to avoid bigger, deeper fears none of us would relish facing.
Factor #2: Avoiding Negative Feelings
A study out of the University of Torino in Italy examined personality traits in anorexia and bulimia. Many of the traits differed, but one thing united them: a trait called harm avoidance, which is a tendency to worry excessively about potential danger, failure, or, as the name implies, harm. It’s a heady mix of fear, doubt, and pessimism.
Excessive worry has been shown to be a form of avoidance: it’s a distraction that keeps us on a shallow, verbal, and cognitive level. It’s something to do that keeps us from facing our deepest fears of being unloved, incapable, or a failure.
Therefore, obsessive thoughts about food, calories, weight, measurements, or sets and reps can serve the same function: it’s a distraction from deeper fears of being bad, worthless, or helpless.
To take things further, some researchers think eating disorders are actually a form of OCD. The obsessive intrusive thoughts about guilt, shame, inadequacy, or failure are neutralized with compulsions around selecting foods, eating, restricting, or purging. One study in the American Journal of Psychiatry found that 41% of individuals with anorexia or bulimia could also be formally diagnosed with OCD.
Any way you slice it, the obsessions around food, weight, or shape function as a way to avoid bigger, deeper fears none of us would relish facing.
Factor #3: Perfectionistic Striving
Many people with eating disorders are high achievers. They’re hardworking, hold high standards, and are diligent and thorough. But aiming high can cross the line into relentless pushing and harsh self-criticism when unreachable standards inevitably aren’t met.
Other individuals with eating disorders can’t point to a history of achievement. But dieting, restricting, purging, exercising, or weight loss can be an area in which they excel. Hitting their exact caloric budget, purging every bite, or powering through on the elliptical until the readout says exactly 2,000 calories is a way to be excellent at something.
The newest way to be perfectionistic around eating is orthorexia, a little-known but burgeoning eating disorder which is essentially clean eating on steroids. Foods that aren’t pure, clean, or healthy enough—in other words, perfect—get cut out or rigidly controlled.
All in all, a common refrain among those with eating disorders is feeling not good enough—not capable, not competent, not worthy, not lovable. What’s more, many perfectionists believe they can remedy these perceived fatal flaws only if particular goals are met. This is called conditional goal setting, and in the case of eating disorders it may make happiness (or mere adequacy) contingent upon weight, caloric intake, or the elusive feeling that they had a “good” day or don’t “feel fat.”
Despite the name, perfectionism isn’t about being perfect; it’s about never being good enough, so striving through anorexia, bulimia, binge eating, orthorexia, or a combination thereof creates a much-needed sense of compensation.
A common refrain among those with eating disorders is feeling not good enough—not capable, not competent, not worthy, not lovable.
Factor #4: Short Term Fulfillment
A study in the journal Psychological Medicine looked at thousands of people with eating disorders and found that 27% of them also had a history of self-injury. Among individuals with bulimia, 33% had a history of self-injury.
Why is there such overlap? One hypothesis is that both eating disorder behaviors and self-injury act as a form of emotion regulation.
For example, have you ever had an ugly cry and then felt calmer? Or vomited when you were ill and then felt sweet relief? It’s the same principle: a big physical release, whether from crying, cutting, vomiting, bingeing to the point of pain, or exercising to the point of exhaustion can usher in a feeling of calm or even short-term euphoria.
In addition, with anorexia, many individuals with the disorder report a feeling of clarity and increased energy when they’re starving and it’s hypothesized that the feeling has addictive qualities. For example, a study in the journal PNAS found that anorexia and ecstasy activate some of the same brain receptors, except in the case of anorexia, the drug is deprivation itself.
In the short term, eating disorder behaviors “work” to regulate emotion—vomiting, bingeing, and fasting are each, in their own way, forms of coping. They instill a sense of control, achievement, compensation, or distraction from core fears of worthlessness, helplessness, or defectiveness. The rub? They’re not sustainable or healthy forms of coping for the long term.
Ultimately, the goal is to trade unhealthy methods of coping for healthier ones, like practicing self-compassion, challenging the harsh voice in our head, or labeling self-criticism as mere thoughts rather than gospel truth. But until we all get to that point, building empathy and understanding of what drives eating disorders is a great place to start.
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About the Author
Dr. Ellen Hendriksen was the host of the Savvy Psychologist podcast from 2014 to 2019. She is a clinical psychologist at Boston University’s Center for Anxiety and Related Disorders (CARD). She earned her Ph.D. at UCLA and completed her training at Harvard Medical School. Her scientifically-based, zero-judgment approach is regularly featured in Psychology Today, Scientific American, The Huffington Post, and many other media outlets. Her debut book, HOW TO BE YOURSELF: Quiet Your Inner Critic and Rise Above Social Anxiety, was published in March 2018.
