Eating Disorders: Two Sides Of The Same Coin

By: James P. Krehbiel

Eating disorders are a troublesome problem, usually with an onset during adolescence. Although typically associated with teenage girls, there has been a steady increase in the number of boys affected by this disorder. Whether the individual is anorexic or bulimic, the common thread is a fascination and fear with the notion of gaining or losing weight.

Those who are anorexic or bulimic tend to have common behavioral characteristics related to their disorder. Although each case is unique, eating disordered children often suffer from obsessive-compulsive behavior, issues of power and control, perfectionistic tendencies, depression and anxiety, and thwarted rage and anger.

A multidisciplinary approach consisting of outpatient or inpatient therapy, medication management, family counseling, nutritional assistance, and regular monitoring by the child's physician is imperative. Cognitive-behavioral therapy, coupled with family systems treatment and psychiatric intervention appear to work most effectively in assisting youngsters in managing the disorder.

Children who are anorexic have a fear of gaining weight. The anorexic will crave food, by will refuse to eat or retain it because of an intense fear of weight gain. The behavior of an anorexic may be characterized by a pattern of social withdrawal, rigorous exercise, and ritualistic eating patterns. Body misperception is a core feature of the anorexic. As they look out of the lenses of their disorder, being excessively underweight appears normal. Teenage anorexics will look in the mirror at 90 pounds and tell you that they look fat.

Those who are bulimic use various mechanisms to control their weight. The most frequent pattern is the ritualistic binging and purging cycle along with the use of various diuretics and laxatives. Adolescents may fluctuate between the presenting symptoms of bulimia and later manifest the patterns of anorexia. Both eating disorders are extremely dangerous and can be life threatening. The effect on the child's health cannot be underestimated.

Eating disorders are fueled by existing media portrayals of "thin is in." The disorder can also be exacerbated by certain types of rigorous activity such as jogging and dance. I believe there are ballet companies that actually ignore the issue of eating disorders in the process of training their dance students. Eating disorders can also be intensified by parents or peers who draw attention to the adolescent's weight. Parents or friends who make disparaging comments about weight gain or loss can help trigger or sustain the eating disorder pattern.

Adolescents tend to be resistant to receiving treatment, refusing attempts at therapeutic intervention. Counselors can overcome this obstacle by developing a collaborative, discovery-oriented relationship. I might say, "Let's work at this together. One of the cardinal features of your disorder is your inability to appropriately evaluate your own weight. If you canvassed five of your friends, what do you think they would say about the nature of your weight?"

I believe that unexpressed anger is at the core of most eating disorders. A child may be saying, "I'll show you! If you won't love me for who I am and what I think and feel, I'll take it out my body and hurt you by doing so." Often, I tell people that vomiting is a metaphor for "spilling their guts" over pent-up anger and rage.

Parents are usually overwhelmed when they fully recognize that their teenager has an eating disorder. Sometimes parents stay in denial about the nature and severity of their child's problem and consequently take no corrective action. Here are some recommendations for parents of eating disordered teenagers:

It is imperative that parents understand that an eating disorder involves adolescent power and control. Resist the urge to micromanage the disorder while acknowledging its existence. Minimize household tension and resistance by reserving positive and negative consequences for behaviors outside the domain of the disorder. Try not to get discouraged. Treatment takes time and commitment. There are many supportive programs and mental health providers who can assist you.

James P. Krehbiel is a licensed professional counselor and nationally certified cognitive-behavioral therapist in private practice in Scottsdale. He can be reached at (480) 664-6665 or via email at

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