Translator: Galina Mitricheva Reviewer: Denise RQ
Most of us like food and enjoy eating as a very pleasurable experience.
But sometimes, this relationship with the food
becomes an anxiety-provoking one.
I would like to go deeper.
And I will start from my personal memories.
It happened in 1994,
my very first day working as a psychologist.
I, as a novice specialist, was sent to talk with a thin, curly, redhead girl.
She was very difficult to relate to, and she bearly spoke,
and she was angry, and I was angry at her.
And all team was annoyed with her as she was sick with anorexia.
After few months,
she was sent out of the hospital without any noticeable change.
And you know, I still remember her name,
and I remember my own helplessness while working with her.
And the question in my head, "Why it was so hard to treat her?"
Now, I have much more experience.
Through over 25 years of my career as a psychologist, psychotherapist
I have found an answer.
A very provocative answer.
The answer is that eating disorders are hard to treat
because actually they are not only about eating.
But if they are not about eating what they are about then?
In essence, it is difficult to treat
because it's not just a simple human behavior, eating,
it's [something else and it's hidden].
But before we go to these complex things
I would like first to just simply describe you quickly
what do we mean by the title eating disorders.
So it's an umbrella term for usually three mental illnesses.
First is anorexia.
Anorexia is characterized by a very low weight
and a huge fear of putting on weight.
It's the most severe eating disorder type
and with long-standing consequences,
and the highest mortality rate of any mental illnesses.
Next is bulimia.
Bulimia is characterized by a binging and purging behavior:
it's cycles of binging, guilty feelings,
and unhealthy compensatory behavior afterwards.
This unhealthy behavior could be laxative use, extreme sporting,
could be dieting, and it's there for one reason - the one goal -
just take the control, emotional and body control back.
The last one is the binge eating disorder.
Actually it's a very modern disease,
officially recognized as a mental illness only recently, namely 2013.
And it could be diagnosed in a person who in a very short period of time
swallows huge amount of food without being physically hungry
and who does it alone.
So after the swallowing of this amount of food,
the person feels disgusted with oneself.
I want to stress here that the binge eating disorder
is not the same as chaotic eating
or sometimes like when after holidays we all overeat
especially after Easter or Christmas, you know that.
But it's a repetitive pattern,
it's twice a week or three times a week.
So it's a very severe mental illness.
And because the person has no compensatory behavior,
it usually goes together with obesity, too.
And almost half of the patients who have
binge eating disorders are male.
So what is behind eating disorders?
As I have mentioned, you could notice that it has psychological and physical issues.
And they are tightly interconnected.
But despite a long history
of medical history on eating disorders and especially anorexia,
- it goes back to the end of the 17th century -
and zillion research on eating disorders and other types,
we still don't know how the psychology and biology is interconnected.
So I would turn to the psychology part first.
Eating disorder is very much about emotions.
And especially shame.
Shame and other emotions
could be controlled by starving, or eating, overeating food.
Because of this unbearable state, the person overeats
and this overeating could increase even an emotional turmoil afterwards.
Second, to have a mental illness means to have a stigma.
Especially in Lithuania.
And to have a stigma means, in eating disorders, to be a loser,
to be worse than your family members, than your friend, than a loved person,
and nobody wants to go to treatment
because nobody wants to be officially recognized as a failure.
It's so hard to treat eating disorders.
And this stigmatization holds the person from treatment,
and this stigmatization is even more difficult to bear by the male patients.
Because of this stigmatized image of the eating disorders as a female disease,
and you know this.
For many, many years,
the origins of eating disorders were thought to only be psychological ones.
And this lead to simplification of the understanding,
and this understanding lead to some ineffective treatment
that was to arrive.
But I want to stress here:
we have lots of myths about the psychological issues,
and one of them is that parents or the family are responsible
for children developing eating disorder symptoms,
or the social media and cultural attitudes are to be blamed for it.
I followed this particular misconception at the beginning of my career, too.
But not now.
However, there is more that just psychology,
and I would like to talk about it.
Sure, psychological and social attitudes have an influence
on the way we look at ourselves,
the way we judge others, their appearance.
But I want to stress that they don't cause eating disorder directly.
And there is a hidden biological mechanism to blame.
And as I have said,
biology and psychology become interconnected,
and all these factors could be divided into three main groups;
and I will explain this in detail.
The first group is so called the "predisposing factors".
These factors make us vulnerable to eating disorders,
and the evidence suggests now
that our body weight, our body shape
is determined by genes.
In some regions of our brain
we have signals,
we have neurochemicals
which send messages about hunger, about our appetite balance,
signals in our brain and other sides respond to it.
But what is interesting is that for eating disorders
patients seem that they can't recognize the signals
or moreover, patients with anorexia
are able to even ignore these signals,
and this is why they could starve longer,
and not recognize that they are hungry, and suffer all these consequences,
that's why it's more difficult to treat them also.
Genetics contributes to some psychological personality features
even before we start to develop the eating disorder.
Especially with anorexia.
In childhood, anorexic people had
this tendency to [inaudible]
high aggressiveness, obsessiveness, perfectionism,
and these trends tend to stay even after recovery.
So all I have mentioned here is about
these predisposing hidden factors,
and they are silent, we don't know what we have in our brain, in our genes.
Now we know that for eating disorders there is nothing specific:
our inheritability follows the same not-specific pattern;
many genetic factors are responsible for it,
like for depression, for schizophrenia.
It's why we have no specific medicines to treat eating disorders.
But all these biological factors are hidden, are secret,
until they are released
by a second group of factors; the triggering factors.
These triggering factors could be very simple.
it's all psychological or social factors.
It could be like a critique of your body shape,
or someone who said you are too fat,
or it could be an enormous stress of a job or could be stress at school,
particularly when ending school.
It could be dissatisfaction with oneself, and it could be losing a beloved one.
It could be psychological trauma - very much -
and it could be sexual abuse, for example.
And the social pressure to remain thin.
So it's about psychological factors which release like a bullet
these hidden biological mechanisms,
and they all push toward either binging either starving
and all the biological mechanisms that lay underneath.
So the last group - I said there are three groups of factors -
the last group is so called "maintaining factors",
and they are like anchors for eating disorders.
They make specifically harder to make the disorder go away
because of the physiological consequences of starving,
that become a vicious circle, and it's difficult to change habits.
And these factors could be psychological or social too.
One of the main psychological factors, you know, it's the compliments
a person gets from his environment when he loses weight,
"Oh, you look great!"
And the person goes, "OK, I reached a goal, I want to continue."
And that goes further and further and slowly, slowly it develops,
and the disease is maintained.
The message I want to leave you with is that eating disorders are hard to treat
because slowly, slowly, slowly these patterns
overtake the person's thoughts, actions, lifestyle,
and become the only way to define themselves.
It's the only way to feel the value of life.
Slowly, it becomes an identity.
And it's not a disease anymore, it's a new identity.
And getting better with treatment for such kind of person
means to lose one's identity.
And the patient asks, "If I will be treated who I will be then?"
It's very scary to go to the treatment. It's very scary.
You know, keeping this in mind and the illusions
the psychological security that the eating disorders provide,
I would like just to use the metaphor of the woolen sweater:
it keeps you warm but it starts to itch, and you want to take it off.
Bur it's cold, and you want to put the sweater on again.
But it keeps on itching and it's bad enough that you take it off again.
Or you need an alternative, and if you have no alternative,
you put this itching sweater on you again.
Yes, actually it takes a long ti,me to recover from eating disorders
and my practice shows that it took four,
five, seven, even twelve years
to recover from eating disorders completely.
And just to finish my talk:
what we do really seek by having eating disorders?
Consciously, we seek to improve our experience, our physical self,
but unconsciously, we do seek love, admiration,
we want to feel better than others.
Sometimes, eating disorder helps to deal
with aggression or sexual identity issues.
And it's why it's about our unstable emotional self.
Therefore, the opposite for eating disorders is not a normal eating
- you could guess already -
the opposite is self-acceptance and a high self-esteem.
High self-esteem will not let all these hidden mechanisms start working.
And it's why I ask you
make a difference and care about your emotional self
and direct toward more valuable goals in your life.
Thank you.
(Applause)