I am really angry. My parents are accusing me of having an eating disorder, which I do not have. Now they say I can’t go away to college unless I gain 20 pounds! Twenty pounds! I think I will lose my mind if I cannot get away from their incessant nagging.

I have researched anorexia on the web. People who have it look emaciated and simultaneously believe they are fat. I am neither skeletal nor fat! I am slim, like the rest of my friends, nothing more, nothing less. What they may not understand is that I am constantly hungry, which is my response to stress, just like other people get headaches or stomach pains. If I were to eat whatever I wanted to eat, or whenever my parents were “at me” about eating, I would look like a blimp.

I thought maybe if I wrote to you, you would post something to show my parents that they are wrong. Frankly, they are the messed up ones, wanting their own daughter to look unattractive, especially to boys. As usual, they are trying to control me. It is infuriating. Can you please settle this?

Dr. J replies:

I can certainly hear how angry you are at your parents.
It would be helpful to try to separate out several issues that seem intertwined at present.

Eating problems are extremely prevalent in this culture, especially in young women, although some men have them as well. You may not meet the most stringent technical definition of anorexia, so you are correct about refuting that diagnosis. However, eating disorders exist on a spectrum, ranging from intrusive preoccupations with food and dieting, to serious, even life-threatening caloric restriction. Body image disturbances accompany anorexia as well. Other eating disorders, again on a spectrum of disturbance, involve binge eating, eccentric eating behaviors and bulimia ( cycles of binging and vomiting).

Even though you may not meet all the criteria for anorexia, at least not at present, you still fall someplace along the spectrum of eating disordered behavior. Some of the feelings and issues you describe are commonly part of the picture. I am struck by your feeling of horror at the thought of gaining weight, and I suspect that you are reacting to the injunction to gain weight, as much as to the number of pounds your parents suggest. I gather that as this moment you are experiencing your family as intrusive and manipulative, so food has become a way in which each side struggles for power and control.

I have no way of determining whether you are slim in a normal way, or slim in a distorted way, as you do not mention your height and weight. However, it is not my place to establish that, but if you distrust your parent’s assessment, perhaps another caring adult would have an opinion on this. Your family doctor or the school guidance department might be helpful consultants. Be aware that distortions in body image are present in most disordered eating syndromes, and but also occur without disordered eating in other syndromes. For example, men who are losing hair may feel they are already bald, or attractive people may feel ugly.

While you are clearly astute in assessing that your anxiety triggers hunger, you may also be hungry because you are restricting your food intake unnecessarily. I wonder about other aspects of your life style, ranging from skipping meals, or eating in unhealthy ways, to compulsive exercise or sleep deprivation.

Successful weight regulation is complex and involves eating adequate protein as well as eating in patterns that do not inadvertantly trigger the body into “starvation mode”, thus reducing the amount of calories that can be consumed without weight gain. All calories are not created equal in the sense that different foods eaten at different points in the day may be more or less likely to be “burned off” as opposed to “stored” as fat. There are as yet poorly understood genetic predispositions to weight gain. Finally, hormones as well as certain medications can also effect metabolism.

You and your parents are in a power struggle, a power struggle you can always win if you ignore the cost of your victory. If you view eating as a surrender to them, then of course you will resist eating. It is helpful that you know yourself well enough to know that hunger is your response to anxiety, but it is unclear what conflicts are producing that anxiety. People are anxious for both conscious and unconscious reasons. It sounds like your fear of losing control of your appetite, which may be a magical way of controlling something
else, such as your anger, may be leading you to compensate by maintaining too tight a control. I would wonder if you could figure out some some capacity for moderation without rigidity. Occasional “indulgences” might even reduce your chronic hunger. Sometimes simply reminding yourself that your body is trying to alert you, via hunger, to some other source of concern can make a difference. It is a subtle but important shift to value your body as kind of radar giving you helpful information, as opposed to an enemy you must defeat.

I am a night binger. I eat normally but then towards bedtime I am ravenous. I don’t keep sweets in the house. Yet, around midnight, I go downstairs to the local deli and buy junk food. Bread, ice cream, stuff like that. Then I throw up afterwards. Disgusting. For a while I thought it was a clever way to not get fat. I reasoned, “Ballet dancers do it” so it can’t be so bad. But after my sister got engaged, it did get bad. That was a year ago. So I now know I have a problem. However, it’s extremely embarrassing. I don’t want anyone to know. How can I help myself?

Dr. J replies:

You’ve already taken an important step by acknowledging that you do have a problem and that you do need help.

An eating disorder means precisely that… a disordered relationship to food, whether or not your weight is technically normal for your height and body frame. While bulimia is embarrassing for you, it is also a significant symptom. Your motivation for throwing up exists in a “psychological” blind spot, which is another way of saying it is “unconscious.” Without outside help, you probably cannot change this behavior.

Binge eating frequently leads to throwing up. The cycle of being empty and then full, or full and then empty is your body’s way of dealing with intense forbidden feelings. Binge eating not just fills your stomach. It is a desperate effort to fill a sense of inner emptiness and address emotional hungers you may not be aware of. It is followed by the act of purging — a way to symbolically eject unwelcome or even unbearable feelings.

The uses and misuses of food as a way to deal with psychological pain often go back to childhood. But a “triggering event,” such as your sister’s engagement, provides some clues as to what feeling states and issues are involved.

Ask yourself, “what are some of the things that might account for your sense of being empty?” Early childhood traumas sometimes interfere with the consolidation of a sense of self. Or the self you are aware of does not feel vital and present. Perhaps you are depressed?

And ask, “what feelings might you symbolically be evicting?” I wonder if the engagement means to you that your sister will have a full bed while you have an empty one. So perhaps there is some envy of her situation or a resurfacing of competitive feelings? Or you may fear she will have no room in her life for you, that you are being replaced? Your empty
feelings surface at bedtime, linking it with feelings about loneliness, sexuality, and conflictual feelings about relationships.

Clearly, these are all speculations, but I hope you will consider psychotherapy. Medication alone, or nutritional counseling alone is rarely sufficient. In the safety of a professional relationship, you will come to explore these different possibilities. That understanding may allow you to stop binging and purging.