What pulls the trigger?

Gun shaped man hand

Eating disorders can often wax and wane throughout a person’s life course. Most clinicians and theorists attribute this vacillation to ‘stress’ but they fail to specify the types of stress that actually trigger the disease. In the world of someone with an eating disorder, not all stress is created equal. I once asked a group of women with eating disorder if their car getting a flat tire would trigger symptoms of eating pathology to worsen. The response was a resounding ‘no’. However, earlier in the group many mentioned that ‘stress’ worsened their urges to purge and restrict. I reflected back to them that getting a flat tire is very stressful, as would be enduring a hurricane, having one’s cat die, having one’s wallet stolen, etc., yet none of these events could be imagined by the group as triggering their eating pathologies. However, when I mentioned the type of stress such as mom and dad getting in an argument and the client getting pulled into the middle, your mother telling you she is very embarrassed by you because you didn’t make the cheer squad, or being told by your husband that you are not a good mother, these ‘stressors’ were endorsed as being very triggering of eating disorder. I feel this is important, because the type of stressor that triggers symptoms speaks highly to the social and psychological origins of those symptoms. I am frustrated that most people believe that skinny models and dieting ads are ‘triggering’. Granted, a lot of people with eating pathology would endorse that these issues are triggering, but I believe this is due to a superficial understanding of what really causes eating disorders. Skinny models and dieting ads may make urges to restrict and body image concerns more salient for a short time, but it is the self-system and feedback about roles and place in the family that actually changes one’s self-worth, triggers feelings of failure, which triggers urges to self-punish and self-neglect. Most individuals are exposed to images of emaciated models and actresses, and may even experience a desire to be thinner, but eating disorders are NOT a desire to be thinner. Eating disorders are patterns of self-deprivation and self-punishment that result from a crisis of self and a severe imbalance of energy in the social system. I believe targeting the media as a cause for eating disorders is the same as believing cold weather causes the flu. Yes cold weather can worsen a flu if an individual is carrying the virus, but it is the virus itself that causes the illness of the flu, not cold weather. Yes there is an association, but I think in the field of eating disorders, we have mistaken correlation with causation.

2 thoughts on “What pulls the trigger?”

  1. You post here is so true. I was anorexic for 25 years and finally put the majority of the dreaded disease behind me. But if it were due to waif like models, would not a larger percentage of men and women suffer? Thank you for opening up this conversation. We need to find a formula that will work. Keep up the good work.

    Donna Friedman Member of the Board of Directors for the Academy of Eating Disorders.

    1. Thanks for reading Donna! That was the first real head-scratcher in this field–if we are all exposed to the thin ideal, and many healthy people might even say they want to look like one of those super-thin Victoria’s secret models, but never themselves develop an eating disorder, then what is the real triggering variable here? It seemed to me that so many of the clients I worked with actually did NOT endorse wanting to lose more weight or look like the fashion models, but nevertheless were simply unable to give themselves permission to eat. In my personal experience, I had Anorexia during my teen years, it mostly went away during my 20’s and then came roaring back when I was 31, right at a time that I couldn’t care LESS about what I looked like. It was when my second son was born. Half the days I wore no makeup, walked around with the standard “mommy unstyled hairstyle’ and was generally sporting some kind of snot trail on my clothing in multiple places. So WHY in the heck develop AN at that time??? That was the question that sparked my curiosity, and the work I do now is centered around what I discovered…Thanks so much for the discussion and sorry about the late reply!

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