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Solutions Christian Counseling - Kim West PhD, M.Div.

                       Part 1 - Eating Disorders                Part 2 - Anorexia and Bulimia

Upon diagnosis, it must be determined if long-term treatment and/or hospitalization are required. Hospitalization would be warranted if there is excessive and rapid weight loss, metabolic disturbances, depression or risk of suicide.

Treatment should include an internist, nutritionist and therapist.

"The challenge of treating eating disorders is made more difficult by the metabolic changes associated with them. Just to maintain a stable weight, individuals with anorexia may actually have to consume more calories than someone of similar weight and age without an eating disorder. In contrast, some normal weight people with bulimia may gain excess weight if they consume the number of calories required to maintain normal weight in others of similar size and age." 10

Biochemical connections between depression, obsessive-compulsive disorder, and eating disorders have been found. Those with eating disorders may respond favorably to medication for depression or OCD. Also, medications for depression have been shown to be beneficial in some cases.

Regaining weight must be a very slow process. There is an impairment of digestion in starvation and the body needs time to rebuild the enzymes of the liver and pancreas. Rapidly ingesting food after starvation may result in bloating, nausea, vomiting, and even congestive heart failure due to the strain on the weakened heart from the large metabolic rebound.

Group therapy is more effective with bulimics than anorexics. This is because the bulimic is aware that s/he has a problem.

"In a recent study of bulimia, researches found that both intensive group therapy and antidepressant medications, combined or alone, benefited patients. In another study of bulimia, the combined use of cognitive-behavioral therapy and antidepressant medications was most beneficial."

In treatment, the patient rather than the illness is often seen as the "problem."

The patient is blamed and guilt becomes the treatment of choice. This approach actually exacerbates the problem.

The perfectionism of the patient is a major factor in the feelings of being "bad" and deserving of punishment. Counselor's need to consider their own thoughts, feelings and actions with their clients. The client needs more than food to regain health, they need acceptance, hope, concern, respect, care, and love. Christ calls us to love our neighbor as ourselves in Matthew 19:19. This type of love, love that considers the well-being and needs of another equally important as our own, models for the client their importance and value.

What is needed during recovery

Eating disorders are a result of complex behaviors made up of many reasons. Counseling needs to be individualized.

Conditional love, criticism, black and white thinking, perfectionism, low self-esteem, all can play a part in founding the disease in the patient to varying degrees. Those with eating disorders have underlying false beliefs. These false beliefs need to be exposed, argued against, and replaced with truth. While doing this the counselor can show themselves to be real people with real struggles that have real solutions.

"As most clients with eating disorders are bright and active, they are usually quite well-read and will soon detect gaps of knowledge in a counselor. If the gaps are too large and glaring, therapy will end as trust and respect are lost...Counselors, as well as parents, sometimes pretend they know all the answers to all the questions so that their respective clients and children will respect them for their great knowledge. This unhealthy approach is an example of a false belief that will certainly erode respect and have devastating consequences for the client."11

Clients need a relationship with their counselors that is based on trust and that is based in truth.

They also need understanding. A sense of empathy will help ease the feelings of loneliness in their disease. We mustn't assume we know how the client feels but allow thoughts and feelings to be expressed in an atmosphere of acceptance and trust. This acceptance and trust will facilitate an environment in which the client can accept and assimilate truth.

An atmosphere in which the illness can be openly discussed is critical to recovery.

The eating disorder has been a behavior that the client has tried to keep secret. They fear that lack of understanding will lead to rejection and punishment. They fear that who they are will be rejected and this is all they have.

The counselor and client will cooperate in the healing process when their is an emotional bonding that cause the feelings of isolation in the patient to be lessened. Knowing and accepting each other will lead to being able to discuss thoughts and feelings. The task is to tell the truth in love as Christ did.

"Self-esteem problems may arise from seeing oneself in the mirror of distorted relationships. It suggests that resolution requires someone caring enough to notice the struggle, and offer the love, acceptance, and encouragement needed to risk removing the defenses so that the person can begin to see herself as she really is. We all need somebody who loves us enough to tell us the truth."12 Counselors have the opportunity to be accurate mirrors.

Resistance to Recovery

"The largest obstacle to treating anorexia is that those who suffer from the disorder do not want to be treated." 13

Therefore, people with eating disorders may not receive medical treatment and therapy until they are dangerously thin and malnourished. People with bulimia are often at their normal weight and able to hide their illness. Eating disorders in males may be overlooked as they are rare.

Those with eating disorders feel that they must be punished for their "sins."

The counselor and the patient are both "sinners saved by grace." In Romans 3:23-24, we see that God justifies and makes righteous freely and by His grace through redemption in Christ. Therefore, our pride and boasting (our striving for perfection) are worthless. God did not send Jesus to condemn us but that we might find salvation in Him (John 3:17). The solution for error is not punishment but forgiveness.

Resistance to recovery can best be interpreted as fear of change rather than rebellion.

Clients may need to be helped to see that they have permission to change and then protected during the process of change. Knowing the principles of cause and effect that are specifically related to the illness, and presenting them in a caring manner place the power struggle between the individual and the unchanging reality of the consequences of the disorder. The person with eating disorder cannot gain health, joy and acceptance when starving to death. What we reap we sow (Gal. 6:7-9).

A refocusing of the family's energy will be necessary to reduce the power struggle at home.

The family can be released from the responsibility of the eating behavior and be asked to be responsible only for the unhealthy self-esteem, perfectionism, and depression in their child. The patient is not the problem; the illness is the problem.

If the child had cancer, the family would support and encourage the child and allow the physician to deal with the illness. The physician and family work together to fight cancer, it is the same with the counselor and family working together to fight this illness.

Those with eating disorders are afraid to grow up fearing that they will handle the increased responsibilities as poorly as they have their health.

Counselors need to assist the client in making clear, attainable goals and then teach how to obtain them. As she sets more realistic goals, and sees small successes, she can feel that entering into adulthood in freedom and as a responsible individual may actually be possible.

Signs of Recovery

Signs of recovery include: acceptance of self and others; love of self and others; appropriate self-worth in their sexual identity; joy; open honesty; independence; and collaboration.

"When these thoughts, feelings, and behaviors are present to a reasonable degree and when they have become a very part of the individual's personality, one can be reasonably sure that the eating disorder has been resolved." 14

~ In Christ, Dr. Kim West

Recovery from Eating Disorders

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