Not Just About Food

Anorexia nervosa, bulimia nervosa, and binge-eating disorder are increasingly understood not as mental illnesses, but as existing on the extreme end of a continuum of dieting behaviours that are considered normal for women. Preoccupation with weight reflects a cultural focus on the body as the primary source of self-esteem.

At 30, Julia Civka is an accomplished young woman. A public health nurse, fitness instructor, and advocate for eating disorder prevention, Civka comes across as totally confident. Her contagious smile defies her history, that of an anxious and passive girl who hid her eating disorder for nearly a decade.

The youngest of four sisters, Civka recalls searching for a unique identity. Her high school years were fraught with not fitting in and being bullied repeatedly by a former friend. Finally finding her niche in ballet, Julia followed her dream all the way to her final year of high school, when she took professional training far from home. She persevered, despite being told at the age of eight that she was “too chubby” to be a dancer.

Exercising control

Like many people prone to disordered eating, Civka had few skills to cope with emotions. Peer exclusion and aggression left her frustrated, disappointed, and angry. These feelings expressed themselves through her body in the form of stomach pain and lack of appetite. Not eating was, at first, an instinctive response to physical discomfort but, as she explained, “eventually I used it for a sense of control, because I couldn’t control what was going on in my life.”

After a traumatic family crisis stripped away stability, she avoided her feelings by dancing 10 hours a week, running regularly, and severely restricting calories. Civka’s quest for control of her own life had led to an inflexible, rigid way of life that fixated on control of her body.

Disordered relationships with food and exercise develop for both men and women, but in Canada 90 percent of those with diagnosed eating disorders are female. The diagnostic criteria for eating disorders includes opinions such as viewing weight loss as a sign of extraordinary self-discipline or weight gain as an unacceptable failure of self-control. Yet these are acceptable values in many women’s lives, reinforced daily by media messages and modelled by others.

When celebrities starve themselves down to an industry-accepted degree of thinness, they are not diagnosed with a mental illness but paid the highest career wage available to women, and they are held up as role models for adolescent girls.

Piecing together the puzzle

Sadly, girls are paying for the Hollywood illusion with their lives. The death rate for eating disorders is high, due to medical complications or suicide. The annual death rate associated with anorexia is more than 12 times higher than the annual death rate due to all other causes combined for females between 15 and 24 years old. Digestive problems, osteoporosis, and infertility are common long-term outcomes even for those who recover.

Cultural ideals of beauty are only one piece of the puzzle. The most recent research indicates that for anorexia, genetics are a strong factor in determining risk. Personality characteristics such as low self-esteem, perfectionism, impulsivity, and high anxiety are also common traits among those who are diagnosed.

A healing journey

While the causes and manifestations of eating disorders are varied and complex, so are the treatment options. Medical stability is the critical first step. The most ill may require hospitalization or an intensive day-treatment program. Ongoing support may come through community-based support groups, individual counselling, or self-help programs.

For long-term recovery and relapse prevention, a holistic approach to wellness must be considered. Treatment may include nutritional counselling, individual therapy, bodywork, acupuncture, or cognitive behavioural therapy. Eating disorders are rarely just about the food, so therapy is necessary to identify the underlying issues that led to bingeing or restricting food.

Civka’s healing journey began during university, when a compassionate doctor asked her if she was ready to get help. Until that day, no one had ever named her eating disorder. Several years of therapy, including in-patient treatment at Manitoba’s Health Sciences Centre, taught her how to find balance in her life and new ways of coping. Learning to express emotions in therapy and in supportive relationships was critical.

Civka’s recovery included the need for structure. Menu planning was an essential step in establishing normal eating patterns. After treatment, Civka said she needed a backup plan. For her, that meant having someone reliable to call every time she had the urge to go for an exhausting run or to fall back on another destructive behaviour.

Hope and inspiration

Julia Civka’s story inspires hope. Today her life includes satisfying work, a healthy relationship with a loving partner, and a great deal more open communication with her family. Civka intentionally nourishes her body with food and self-care. Physical activity is still an essential aspect of her healthy lifestyle, but now she is more likely to practise yoga to quiet her internal critic and bring her emotions back into balance.

Winnipeg social worker Lori Peters claims that recovery can be a lifelong process. Peters facilitates a weight preoccupation support group where participants learn strategies for balance in their lives. Group members learn about flexible eating, which includes respecting the body’s nutritional needs, but also making room for the pleasurable and social aspects of food. Recovery includes learning how to regulate feelings without bingeing or restricting.

Peters teaches women to be compassionate and curious when their bodies send cues that they are moving out of balance. As a woman strengthens her core identity and learns to accept the beauty of an imperfect body, her eating disorder has less room to flourish.

Eating disorders across the life span

Children Self-esteem and body image is shaped by early family relationships.

• Feelings of inadequacy may lead to low self-esteem and body image problems.
• Children as young as 10 may develop eating disorders.

Adolescents The most common age for developing eating disorders is between 14 and 25.

• Anorexia affects one to two of every 200 teenage girls in Canada.
• Bulimia affects one to three out of every 100 teenagers in Canada.

Adults Women develop eating disorders in their 20s, 30s, 40s, and beyond.

• Three percent of Canadian women will suffer from an eating disorder.
• Seventy-nine percent of women who die of anorexia are over 45 years of age.

Seniors Over 60 percent of 60- to 70-year-old women were unhappy with their weight, according to a 2006 study.

• Four percent reported at least one symptom of an eating disorder.
• Older women have difficulty seeking help due to the perception that eating disorders don’t affect seniors.

Recognizing eating disorders

Signs of anorexia

• Feeling fat but not being overweight
• Losing a lot of weight in a short time
• Cooking for others but not eating
• Eating only low-calorie, low-fat foods
• Having food rituals, e.g. measuring food or cutting food into tiny pieces
• Exercising excessively
• Dressing in layers to hide weight loss
• Becoming withdrawn and secretive
• Spending less time with family and friends

Signs of bulimia

• Feeling fat but not being overweight
• Losing a lot of weight in a short time
• Becoming secretive about food
• Stealing food or hiding it in strange places
• Eating excessively
• Spending time planning the next binge
• Making frequent trips to the bathroom after eating
• Using laxatives or diuretics
• Experiencing tooth loss or decay

For a list of treatment and prevention programs in your area, contact the National Eating Disorder Information Centre at nedic.ca or 1-866-633-4220.