Eating Disorders in Women from the Christian Point of View

Eating disorders are the number one cause of mortality among mental disorders. A significant portion of women in America suffer from eating disorders. This paper describes these disorders and identifies common, practical and theoretical approaches to eating disorders that are used by counselors, therapists and care givers to help women overcome their struggles. It discusses some of the causes of these disorders. Finally, it identifies the how the Christian perspective and faith-based interventions can be used to help women obtain a better, healthier, more positive, and more realistic image of womanhood to help them deal with the social and peer pressures, the unhealthy emotions, and the mental afflictions that can cause them to develop eating disorders. This paper concludes with the affirmation that the Christian perspective on healing can be an effective approach to helping women who suffer from eating disorders.

According to Le Grange, Swanson, Crow and Merikangas (2012) eating disorders impact approximately 30 million Americans every year. Moreover, of all known mental illnesses, eating disorders have the highest rate of mortality (Smink, Van Hoeken, & Hoek, 2012). For women of all ages, eating disorders are particularly problematic. Roughly 13% of women over the age of 50 exhibit some form of behavior associated with an eating disorder (Gagne, Von Holle, Brownley et al., 2012). 3.5% of college age women develop eating disorders (Diemer, Grant, Munn-Chernoff et al., 2015). Approximately 8% of women in the military have eating disorders, while nearly 1% of all women in the U.S. are anorexic at some point in their lives, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD, 2018). Approximately 1.5% of women are bulimic at some stage, and almost 3% of all American adults engage in binge eating (ANAD, 2018). In short, eating disorders are prevalent in the West and especially among women. Many strategies and treatments are available for treating women who suffer from eating disorders, but this paper will analyze the problem from the Christian perspective and provide a Bible-based, Christian approach to treatment for women who have an eating disorder.

In the West in the modern era, the image of woman has become erotically heightened and sexualized to an impossibly idealized extent, with female models posing as the emblems of fashion and sensuality—even though their images are typically and routinely modified using airbrushing techniques that remove blemishes, shrink figures and expand and amplify other parts of the female anatomy in order to allow the image to conform with the unrealistic ideals generated by advertising agencies in modern times (Tavel, 2013). With the stigma of being fat and the threat of fat shaming weighing on the minds of many modern women (Bailey, 2010), along with the threat of obesity spreading at pandemic levels throughout the world (Hruby & Hu, 2015), some women can develop a mental obsession or disorder that causes them to swing too far in the opposite direction: instead of risking becoming obese, they risk becoming too thin or engage in behavior that reflects an evident eating disorder (Cederstrom & Spicer, 2015).

The unrealistic expectations placed upon women in the modern era, thanks to advertising and cultural norms propagated through the media (Unger, 2010), contrast sharply with the image of woman as presented in the Old and New Testaments as well as with the image of spiritual perfection as represented by Christ in the New Testament. Instead of focusing on virtues, principles, duties and vocation, women in the modern era are subjected to a barrage of images that convey to them the need to look a certain way in order to be respected and admired. The result is that women adopt unhealthy eating habits that are symptomatic of a mental disorder, associated with trying to fit into the hypersexualized, unrealistic body image of fabricated imaging promoted all over popular media.

1 Timothy 2:9-10 states “that women should adorn themselves in respectable apparel, with modesty and self-control, not with braided hair and gold or pearls or costly attire, but with what is proper for women who profess godliness—with good works.” This urgent call from Timothy to the early Christians gives the Biblical perspective on how women should see their actual image—not as ornaments to attract the “male gaze” but rather as focusing on “good works,” which are appropriate for godly women. And what are these good works that should be the focus of women? Timothy explicitly states that women “will be saved through childbearing, provided they continue in faith and love and holiness, with modesty” (1 Tim 2:15). In the modern era, women are pulled away from Timothy’s exhortation to women to grow in faith, love, holiness and modesty and to seek to become mothers: women are instead urged to put themselves alongside men (instead of in the kind of submissive role advocated by Timothy). As a result, they are conflicted. Instead of “eating for two” as the saying goes, they starve themselves to match the skinny, skimpy idealized models of modern womanhood; or they overeat in order to compensate for the depressed feelings that they experience in the wake of their pursuit of goals opposite to those identified by Timothy as the goals they should seek for themselves.

Eating disorders that are common in the West include: anorexia nervosa (weight loss or low weight gain characterized a person deliberately avoiding eating or taking in the necessary calories appropriate to the individual’s body mass index); bulimia nervosa (the disorder most often associated with consciousness of body image and the obsessive desire to lose weight; characterized by overeating, depression and self-induced vomiting, purging or fasting); binge eating disorder (characterized by prolonged periods of excessive eating due to emotional distress); purging disorder (characterized by routine self-induced purging or vomiting of food eaten earlier); night eating syndrome (characterized by the consumption of most of an individual’s calories after the dinner period and before the breakfast period—i.e., late at night or throughout the night); atypical anorexia (which is described as anorexia without having a low body weight), and low frequency bulimia (bulimia occurring at a lower rate than normal).

Practical approaches to understanding eating disorders stem from various scientific backgrounds. The psychological approach focuses on the underlying or associated issues or feelings that typically accompany a woman’s eating disorder—such as feelings of anxiety, depression, isolation or low self-esteem. The behavioral approach focuses on activities that women with eating disorders tend to also display in conjunction with their eating disorder—such as a penchant for over- or compulsive exercising, using diuretics, or feeling a need to engage in eccentric food activities, such as baking sweets constantly or always wanting to cook for other people. A high degree of impulsivity is also found among women with eating disorders, according to the behavioral approach to the subject (Lundahl, Wahlstrom, Christ & Stoltenberg, 2015). There are also physical approaches to consider, such as a woman’s potassium levels, blood pressure levels, metabolic rate, heart rate, and gastrointestinal complications. The cessation of the menstrual cycle can also be an issue in the cases of severe anorexia. Thus, from emotional to psychological to physical issues, any approach to treating eating disorders in women must be considerate of the range of factors that can cause and emanate from the disorder.

Typical theoretical approaches to understanding eating disorders include: sociological/environmental theory, family systems theory, and psychogenetic theory. Sociological/environmental theory posits that women suffer from eating disorders as a result of social pressure put on them by media publications of idealized figures of womanhood that emphasize body image (instead of virtue, which is more in line with the Christian perspective).

Family systems theory posits that individuals are not acting independently on their own but rather as a result of and in response to complex familial issues and interactions that are part of a family dynamic. Titelman (2016) states that family systems theory “encompasses the considerable relationship complexities of families without imposing one-time married family models or expectations on them” (p. 356)—which means that this approach is effective at helping to understand the role that other people play in the life of a woman with an eating disorder.

Psychogenetic theory posits that eating disorders stem from one’s family history, genetic factors, or one’s inherited psychological make-up. These can include defective neurobiological processes that would ordinarily work to control a person’s eating habits. In an individual with an eating disorder, this theoretical approach suggests that the disorder is the result of a genetic failure.

Common treatments for eating disorders include: inpatient and outpatient treatment, counseling, therapy, and pharmacology. Inpatient treatment is typically needed when a woman suffering from an eating disorder is having health complications due to the severity of the disorder and requires 24-hour care for a duration of time in order to have her condition stabilized and an approach to care developed that will help her and her family to address the disorder adequately. Outpatient care can be delivered using similar means and methods but is typically geared towards an individual who does not require intensive care or 24-hour oversight.

Counseling and therapy are two more options for treating eating disorders. The difference between the two is that counseling is typically shorter in duration than is therapy and often focuses on helping the patient to achieve a target behavioral goal, whereas therapy might last for many weeks or months more than a usual counseling session and may allow the patient and therapist to uncover underlying reasons for why the patient is suffering from this disorder in the first place. Types of counseling and therapy that can be effective include: Family counseling, family therapy, behavioral therapy, cognitive behavioral therapy, and psychotherapy.

Pharmacological intervention can also be helpful if the woman’s body requires stabilizing through the use of medicine or prescription drugs. These can be used to help control impulses, stabilize moods, and address depression (Milano, De Rosa, Milano et al., 2013).

The Christian perspective offers a faith-based approach to healing that has been adopted by a number of therapeutic practitioners and facilities. Timberline Knolls for example is a residential treatment center for women that offers individualized treatment plans that focus on “faith and spiritual renewal for every woman” (Timberline Knolls, 2018). At the center “each resident works with an expert team to chart her own unique path of recovery, and to heal her whole self from the inside out” (Timberline Knolls, 2018). The facility provides treatment for eating disorders as well as other disorders such as alcohol addiction along with trauma, mood disorders and so on. The benefit of being a Christian or being a religious person is that it allows one to include the spiritual component of healing in the treatment plan.

Researchers have also shown that having an attachment to God or a religious perspective on life can actually reduce the risk of developing an eating disorder for women (Homan & Lemmon, 2014; Henderson & Ellison, 2015; Strenger, Schnitker & Felke, 2016). However, as with anything else, the attachment to God has to be secure and stable, because the more instable the attachment or the faith, the less likely it is to help a woman cope with social pressures to conform to an unrealistic image of beauty and perfection as displayed and projected in popular media (Strenger et al., 2016). In order for faith to be effective in combating social pressures that would contradict with the teachings of faith, one’s attachment or trust in God has to be secure.
Henderson & Ellison (2015) point out that when a woman treats her body as though it truly was a temple of the Holy Spirit, she is less likely to abuse it. They show that “religious involvement—organizational, non-organizational, and subjective religiousness—moderates the effects of eating disturbances on mental health, particularly for self-esteem” (Henderson & Ellison, 2015, p. 954). The reason for this is simple, especially in terms of the Christian perspective: John 14:6 teaches that Christ is “the way and the truth and the life” and no alternative “way” or “truth” propagated by popular media is going to convince a woman of strong faith otherwise. In other words, a woman who has conviction in her Christian faith and knows her Christian teachings will not allow a false teaching or false image of womanhood to distract her from she knows is right or to weigh on her mind and emotions to the extent that she develops an eating disorder. In terms of sociological/environmental theory, the Christian perspective can act as an antidote to false conceptions of womanhood by teaching a moral, ethical and religious viewpoint of womanhood, rooted in virtue and practiced through expressions like motherhood, charity, and obedience.

From the Christian perspective, Christ offers the opportunity to see the world in terms of the ultimate goal, which is the “imperishable crown” (1 Cor 9:25). Or, as Eph 6:12 states: “Our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this world’s darkness, and against the spiritual forces of evil in the heavenly realms.” This type of teaching from the Christian perspective can help to support women suffering from eating disorders even if they have not been raised in the Christian tradition. One of the main purposes of the religion is to evangelize those who do not have the faith—the reason being that the faith offers support for people who do not have the keys to overcome their own personal struggles.

Counselors and therapists interested in using the Christian tradition have found even that engaging in ritualistic prayers that are part of the Christian religion can have a beneficial effect on people seeking treatment (Gilbert, 2014). Prayer can produce in patients a very positive feeling of peace and it can help to lift the stress that is weighing on one. This concept is even taught in organizations such as Alcoholics Anonymous, where members use prayer and petition to ask for the strength from God to overcome their battles. They recognize that they do not have the power to do it on their own and that only God can give them the strength they need. This turn to religion can facilitate the process of rejecting the social pressure and lurking voices that call some women to engage in destructive patterns of eating behavior.

Not all women will respond the same way to the Christian perspective, and this is to be expected because not all people responded the same way to Christ when He lived on earth and taught and healed. Some are drawn to His message and grace and others reject it. To prevent hostility from rising up in a counseling or therapeutic session, a therapist or counselor with a therapeutic orientation that is Christian-based should 1) advertise him or herself as such if the professional aims to include this basis in the counseling or therapy sessions; and 2) should ask if the patient wants to approach the issue from this perspective. If the patient agrees to or wishes to be counseled from the Christian perspective, the Christian prayer tradition may be used to introduce the concept of seeking strength and guidance from Christ. If not, the Bible teaches that even Christ Himself did not force His grace on to those who did not want it from him: Matthew 8:34 clearly shows that when Christ was asked to leave by those who were frightened by His powers, He did as they asked. For some patients who are not yet ready to embark on the spiritual side of their healing, there can be a process involved that must be conducted before that plain can be reached. For instance, Maslow’s hierarchy of needs shows that before a person can attain the ability of self-actualization, lower basic needs must be met first—such as shelter, food, love, friendship and so on. Patients who are not yet ready or willing to commit to a Christian approach to therapy may still require some of their more basic needs to be met first. Of course there may be other reasons preventing them from signing on, but it is not up to the counselor or the therapist to force this perspective if it is refused out of hand.

For counselors and therapists who would still like to utilize the Christian perspective in their treatment of women suffering from eating disorders, the Christian principles can be used to inform a cognitive behavioral therapy (CBT) approach in a way that is non-intrusive but ultimately very effective. CBT is a method of intervention that focuses on identifying good or positive patterns of behavior that the patient can pursue instead of pursuing the self-destructive patterns of behavior associated with the eating disorder. CBT does not focus on the underlying questions of why the patient suffers from this disorder in the first place in the way that traditional psychotherapy does, but it is effective in promoting a habit of action that has the end goal as one in which the patient is no longer demonstrating an eating disorder and instead has made eating healthily and naturally a habit long-term. In other words, it focuses the attention of the patient on transforming the life through daily practice of routine actions that guide the patient away from the troubles, whether they are impulses, thoughts, suggestions, environments, pressures, stressors, and so on. Identifying the problem areas for each patient is essentially like identifying one’s weaknesses in the Christian tradition so that they are known, one can take ownership of them, and begin to find ways to overcome them through fruitful counteraction.