A client in an eating disorder group I worked with recently disclosed her feelings that living with eating-disordered thinking makes you feel like you are in a jail. She described how there is a constant battle going on, and it is exhausting.

Research has shown that one aspect of the eating disorder experience is the presence of an inner voice that strongly influences thinking and behavior, and prevents individuals from taking necessary steps towards recovery. People with eating disorders may also hear negative, judgmental voices from family, friends, community members, and even at times from health care providers. They receive ambiguous messages regarding their illness, which often warn against weight loss and nutritional deprivation, while encouraging the unachievable goal of a perfect body image and the ability to control intake of food and weight.

Like most psychological disorders, eating disorders are a result of an intricate combination of biopsychosocial influences.   This term means that there are genetic, biological, environmental, and social aspects that determine why some people struggle with eating disorders and others do not.  Cultural factors supporting dieting behaviors appear to trigger complex biological responses, which in genetically vulnerable individuals cannot be appropriately regulated. Personality traits, obsessive-compulsive tendencies, and environmental factors such as family dysfunction, trauma, overwhelming emotions, and low self-esteem often serve as triggers for disordered eating. Psychological factors such as controlling food intake as a coping mechanism for regulation of emotional distress, and cultural norms that uphold thinness as an ideal for beauty and body image allow for the establishment, maintenance, and resilience of these illnesses.

A lack of understanding of the many causative factors of eating disorders has led to common misunderstandings that they are a lifestyle choice made by individuals striving to meet sociocultural norms of beauty, resulting in a judgmental, shaming attitude towards them. This often leads to stigmatization and considerable negative consequences to patients suffering from them, including low self-esteem, social isolation, and hesitancy to seek treatment. It is truly like being in prison. There is, however, an opportunity for family, friends, community members, and healthcare providers to speak in a different, more positive voice to those who suffer from eating disorders. This includes advocating for prevention efforts such as promoting healthy body image, assisting in early detection of eating disorder symptoms, and encouraging appropriate treatment. It also involves providing social support, acceptance, respect and dignity to those with these difficult disorders in a way that encourages recovery and improves the quality of life.

Human beings have a unique and inborn need to belong, to be close to, and to connect deeply with others. Developing deep, sustaining relationships with other people and feeling understood by them can ease both psychological and physical pain. Psychotherapy involves the development of a real (therapeutic) relationship shared by therapist and client that is genuine, honest and open, empathetic, and lacking in judgment. It allows for those who suffer from eating disorders, as well as other mental health issues and life challenges to declare their story, understand it through the exploration of their past and present, and work together with the therapist to construct a new voice that encourages positive change. This journey of self-discovery and empowerment can help reconnect individuals to their life passions, goals, joys, and accomplishments that their condition prevented, instill insight and hopefulness, and provide a pathway to recovery. Group therapy is a continuation of this journey in relationship with others who struggle, and can be place of significant social support, encouragement, and learning from the successes and failures of others.