Trading Shame for Joy: Eating Disorders, Treatment, and the Creator’s Perspective

As I reflect on my high school years, the majority of my memories are colored by the effects of a hidden eating disorder, as well as the associated shame and intense fear of gaining weight that often accompanies them. Although I once believed I had it “under control,” I quickly found that I had it backwards — I was under its control. As time went on, it became an ever-present, invisible barrier, affecting my plans to hang out with friends, performance in sports, outlook on life, and my very thoughts. I can recall the immense hopelessness I felt while in the depths of a restrictive eating disorder as if it were just yesterday. I knew that something had to give, but I didn’t know where to begin. I was overwhelmed with shame by the mere thought of confiding in someone about it, and I doubted that anyone or anything could pull me out of the darkness I found myself surrounded by. 

What is considered an eating disorder?

Eating disorders (EDs) are serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, body shapes, and weights. Eating disorders are distinct from disordered eating. Examples of disordered eating are skipping meals, restricting food intake, binge eating, excessive use of diuretics, laxatives, and weight loss medications, as well as the use of compensatory behaviors like purging or excessive exercising. Key differences between EDs and disordered eating often come down to severity and persistence, levels of psychological distress and functional impairment, and whether an individual’s symptoms meet the thresholds necessary for a diagnosable ED. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) recognizes seven EDs: pica, rumination disorder, avoidant/restrictive food intake disorder (ARFID), anorexia nervosa, bulimia nervosa, binge-eating disorder (BED), and other specified feeding or eating disorders (OSFED). The most common eating disorders are other specified feeding or eating disorders, followed by binge-eating disorder, bulimia, and anorexia. Eating disorders can appear in many ways and have varying severities depending on a wide range of social and personal risk factors such as family history, health history, and social pressures. 

Statistics:

• According to research, 30 million Americans will have an ED in their lifetime.

• Eating disorders have the second highest mortality rate of any psychiatric illness behind opiate addiction.

• Twenty-two percent of children and adolescents worldwide show disordered eating.

• The overall lifetime prevalence of EDs is estimated to be 8.60% among females and 4.07% among males.

• In a nationally representative US-based study, up to 23% of individuals with binge-eating disorder had attempted suicide, and virtually all (94%) reported lifetime mental health symptoms: 70% mood disorders, 68% substance use disorders, 59% anxiety disorders, 49% borderline personality disorder, and 32% posttraumatic stress disorder.

• Two to three percent of women 50 and older experience an ED.

• Fewer than 6% of people with EDs are medically diagnosed as “underweight.”

• Men account for 25% of ED diagnoses.

• 10,200 deaths each year are the direct result of an ED — that’s one death every 52 minutes.

  
  

Clinical Integration

Eating disorder treatment can be delivered in a variety of settings and approaches and is usually categorized into different levels of care. This continuum of care exists on a spectrum and is meant to slowly provide more autonomy for individuals as they progress on their recovery journey. Psychotherapy is shown to have the greatest impact on ED symptom reduction and other outcomes. At a glance, it’s generally aimed at correcting irrational preoccupations with weight and shape, managing challenging emotions and anxieties, and preventing relapse. Interventions include monitoring weight gain, prescribing an adequate diet, and connecting clients who fail to gain weight to a specialty inpatient or partial hospitalization program. Specialty programs that combine close behavioral monitoring and meal support with psychological therapies are typically very effective in achieving weight gain in patients unable to gain weight in outpatient settings. Most often, psychotherapy for EDs is provided as part of a multidisciplinary care approach in combination with medical and nutritional management and recovery-based supports, involving the person’s family, caretakers, and supports as much as possible. 

Eating disorder treatment options will vary based on an individual’s location, insurance coverage, readiness for change, the type of eating disorder, level of care needed, and other factors. Because ED treatment is very individualized, there is no “one size fits all” approach; certain treatment approaches may work for some, but not for others. Identified as the treatment of choice for bulimia and binge-eating disorder, cognitive behavioral therapy (CBT) is one of the most widely recognized ED treatments, with the best results achieved with the new “enhanced” version, expanding its approach to include anorexia and other specified feeding or eating disorders. Cognitive behavioral therapy and enhanced cognitive behavioral therapy (CBT-E) are relatively short-term, symptom-oriented therapies focused on the beliefs, values, and cognitive processes that maintain the ED behavior. They aim to modify distorted beliefs and attitudes about the meaning of weight, shape, and appearance, which are correlated to the development and maintenance of the ED. Other evidence-based psychotherapies for EDs include: Dialectical behavior therapy (DBT) and radically open DBT (R/O DBT), Family-Based Treatment (FBT) or the Maudsley Method, Acceptance and Commitment Therapy (ACT), and Interpersonal Psychotherapy (IPT). 

Dialectical behavior therapy is supported by empirical evidence for treatment of bing-eating disorder, bulimia, and anorexia, assuming that the most effective place to begin treatment is with changing behaviors. This treatment focuses on developing skills to replace maladaptive ED behaviors and skills focus on building mindfulness, becoming more effective in interpersonal relationships, emotion regulation, and distress tolerance. Radically open dialectical behavior therapy is a newer adaptation that addresses factors such as social anxiety, perfectionism, and emotional restriction; it may be particularly helpful for people with anorexia. Family-based treatment, also known as the Maudsley Method, is a home-based treatment approach that has been shown to be effective for adolescents with anorexia and bulimia. Family-based treatment doesn’t focus on the cause of the ED but instead places initial focus on refeeding and full weight restoration to promote recovery. All family members are considered an essential part of treatment, which consists of re-establishing healthy eating, restoring weight and interrupting compensatory behaviors, returning control of eating back to the adolescent, and focusing on remaining issues. 

In acceptance and commitment therapy, the goal is focusing on changing your actions rather than your thoughts and feelings. Clients are taught to identify core values and commit to creating goals that fulfill these values. This modality also encourages patients to detach themselves from emotions and learn that pain and anxiety are a normal part of life. The goal isn’t to feel good, but to live an authentic life. Through living a good life, people often find they do start to feel better and feel more confident about resisting the urge to engage in ED behaviors. Interpersonal psychotherapy is an evidence-based treatment for bulimia and binge-eating disorder that understands ED symptoms as occurring and being maintained within social and interpersonal relationships. This approach is associated with specific tasks and strategies linked to the resolution of a specified interpersonal problem area, and it helps clients improve relationships and communication and resolve interpersonal issues in the identified problem areas, which in turn results in a reduction of ED symptoms.

It’s important to note here that classifying a therapy as “evidence-based” doesn’t mean that it automatically works for everyone, just that it works for many people. When it comes to other specified feeding or eating behaviors and binge-eating disorder, the most successful modalities of treatment all focus on normalizing eating and weight control behaviors while managing uncomfortable thoughts and feelings. Eating disorders aren’t only psychological problems, they are also disorders of learning and habit. Shifting these habits can feel challenging, overwhelming even, however practice of healthy eating behavior under therapeutic guidance helps develop skills needed to manage anxieties regarding food, weight, and shape — all of which fade over time with the gradual achievement of mastery over recovery.

The Creator’s Perspective

Along with proper psychological and nutritional care, the power of faith in eating disorder recovery cannot be understated. For those experiencing excessive preoccupations with food, dissatisfaction with body shape or weight, disordered thinking, distorted body image, or those paralyzed with obsessive fear of weight gain, reflecting on biblical truth and God’s perspective of them can often be orienting and refreshing, as it provides clarity in what feels like darkness. Many people are unaware of the deep-rooted shame linked to EDs, often keeping individuals from confiding in a trusted friend or adult and seeking treatment. Several studies have shown that shame is an important predictor in ED pathology or symptoms, which means that overcoming it is a vital part of the healing process that can help improve ED outcomes and lower the relapse rate in the future. Because shame is extremely toxic and isolating, offering perspective and truth from God’s Word is vital. Individuals can utilize their Creator’s enduring perspective of them as armor in dismantling deep-seated shame. After all, there is no antidote to shame quite like being reminded of who we are in Christ.

God’s invitation for the Ashamed…

— Psalm 34:5 states, “Those who look to Him are radiant; their faces are never covered with shame."

— Hebrews 12:2 states, “fixing our eyes on Jesus, the pioneer and perfecter of faith. For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God.”

What living this out looks like…

“Fixing our eyes” on God and looking to Him is about maintaining a consistent focus on Him, His word, and His will, especially in times of difficulty or uncertainty. This involves more than a fleeting glance; it's a deliberate and habitual posture of the heart.  Here’s how that might look for individuals living with patterns of disordered eating or an ED:

• Instead of falling for the lies of an appearance-obsessed culture or engaging with self-loathing thoughts, reclaim your identity in Christ by taking a moment to refill your “truth jar.” You can do this by reading scripture about the Creator’s perspective of His people or by speaking truth over yourself with statements of faith. I invite you to try this out with the following:

  • I am a set-free child of God. 

  • I was not created to be measured by culture’s definition of beauty.

  • I am chosen by God and adopted as His child.

  • I am not the number on the scale.

  • I am not defined by my appearance.

• Instead of giving up and giving into disordered eating patterns or an ED, pause and pray. God’s word tells us to bring every concern to Him through prayer, and in return, He offers his peace which surpasses all earthly understanding (Philippians 4:6-7).

• If experiencing difficulty surrendering and having faith, reflect on past experiences where God has shown up and been faithful in your life. God’s word tells us that nothing is impossible for those with even a small amount of genuine faith (Matthew 17:20).

Scripture for the one struggling with their relationship with food:

Genesis 9:3 — “Everything that lives and moves about will be food for you. Just as I gave you the green plants, I now give you everything.”

Matthew 6:25 — “Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes?”

Romans 8:1-2 — “Therefore, there is now no condemnation for those who are in Christ Jesus, because through Christ Jesus the law of the Spirit who gives life has set you free from the law of sin and death.”

1 Corinthians 6:19-20 — “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your bodies.”

1 Corinthians 10:13-14 — “No temptation has overtaken you except what is common to mankind. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can endure it.”

Ephesians 1:5-6 — “he predestined us for adoption to sonship through Jesus Christ, in accordance with his pleasure and will— to the praise of his glorious grace, which he has freely given us in the One he loves.”

Ephesians 1:11-12 — “In him we were also chosen, having been predestined according to the plan of him who works out everything in conformity with the purpose of his will, in order that we, who were the first to put our hope in Christ, might be for the praise of his glory.”

A Final Word…

As for the young girl in the throes of an eating disorder, I received care and began rebuilding my relationship with food and my body, clinging to this truth: I was created in God’s image, His design is intricate and wonderful, and because I trust Him, I can trust my body during recovery. Along with psychotherapy and nutritional support, uprooting my worth from worldly beauty standards and fully believing who I am in Jesus Christ was key in my healing.

To the one suffering in silence, this same healing is available to you. To the one who is drowning in obsessive thoughts surrounding your body and/or food, there is hope. Take the first step by confiding in someone you trust and partnering with a counselor. As stated earlier, psychotherapy is shown to have the greatest impact on eating disorder symptom reduction and other outcomes. You don’t have to live in shame. Through fixing your eyes on the Creator, you will be able to reject the lies of diet culture, overcome distorted body image, and restore what you once likely felt was impossible. You are worth it.

Sarabeth's Interview with Birmingham Christian Family on Eating Disorders

References

Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74

Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.

Flament, M. F., Henderson, K., Buchholz, A., Obeid, N., Nguyen, H. N., Birmingham, M., & Goldfield, G. (2015). Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community. Journal of the American Academy of Child and Adolescent Psychiatry, 54(5), 403–411.e2. https://doi.org/10.1016/j.jaac.2015.01.020

Kelly, A.C., Carter, J.C., and Borairi, S. (2013). Are Improvements in Shame and Self-Compassion Early in Eating Disorders Treatment Associated with Better Patient Outcomes? International Journal of Eating Disorders.

Keski-Rahkonen A. (2021). Epidemiology of binge eating disorder: prevalence, course, comorbidity, and risk factors. Current opinion in psychiatry, 34(6), 525–531. https://doi.org/10.1097/YCO.0000000000000750

López-Gil, J. F., García-Hermoso, A., Smith, L., Firth, J., Trott, M., Mesas, A. E., Jiménez-López, E., Gutiérrez-Espinoza, H., Tárraga-López, P. J., & Victoria-Montesinos, D. (2023). Global Proportion of Disordered Eating in Children and Adolescents. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2022.5848

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