Therapist Blog

Fasting and Anorexia Nervosa

Fasting is a practice that almost all eating disorders sufferers participate in, using it to manage weight and gain a feeling of control. The anorectic tends to have the most extreme fasting practices, whereas the bulimic usually fasts for shorter periods. Fasting among binge eaters and food addicts is sporadic, with some individuals using it more than others.

The primary treatment for eating disorders is counseling and psychotherapy. For a psychotherapist treating someone with an eating disorder, having a thorough understanding of the practice of fasting could be a useful standard of care. Without this knowledge, it becomes more difficult to decipher the patient’s motivations and defense mechanisms pertaining to fasting. For the anorectic who has abused fasting to the brink of death, examining her bond with fasting in psychotherapy—much in the same way an alcoholic would with alcohol—could play an important role in recovery.

For patients who have not abused the practice of fasting, such as food addicts and compulsive overeaters, therapeutic fasting may represent a beneficial method with which to reframe an unhealthy relationship with food. These may be radical ascertains, but revolutionary ideas may be what is needed to win the battle against eating disorders, a group of psychiatric disorders with the highest mortality rate at 5.6% and whose research is grossly under funded. Individuals with eating disorders are at the highest risk of premature death (from both natural and unnatural causes) of all people who suffer from psychiatric disorders.

A common belief is that anorectics fast in order to lose weight or to maintain weight loss. Although this may seem like a logical conclusion, the motivation behind anorexic fasting is actually far more complex. Hunger has different meaning to an anorectic. After lengthy periods of fasting, many anorectics no longer have a normal hunger response.

While fasting rarely leads to anorexia per se, it can set into place a set of behaviors and schemas about food and body image that place a person at greater risk of developing anorexia. However, anorexia nervosa is not simply a product of dieting or fasting, but is determined by a complex set of variables such as family dynamics, other psychiatric issues, and temperament and personality factors.

Fasting is the most common form of asceticism and the association between anorexia and asceticism has long been noted by numerous eating disorder experts. A dialogue has arisen regarding the association between the anorectic’s religious beliefs, and the concepts of self-denial, asexuality, heightened sense of idealism, and renunciation of the body. Both the anorectic and the ascetic use fasting in an attempt to realize the following goals:

  • Transformation
  • Achieving an idealized self
  • Alteration of the body
  • Changing thinking and feeling

Self-denial, Renunciation, and Transformation

Just as medieval martyrs used starvation to demonstrate religious devotion, the modern anorectic fasts to show dedication to one or more personal causes. Such causes can include religious beliefs, achieving thinness, and improved health. Just as the ascetic practices rigorous self-denial, the anorectic uses active self-restraint as a discipline. The discipline takes on spiritual characteristics as the anorectic attempts to undergo a bodily transformation. At this juncture, severe self-denial is maintained by holding a vision of the idealized self. According to Gail Corrington (1986):

Both ascetics and anorectics strive for perfection . . . Striving towards the ascetic image is a source of satisfaction, and a source of liberation from imprisonment of the body (or from its definition by others) and its bondage to an unacceptable world. In both cases, askesis is not experienced as self-destructive, but as self-liberating. (p. 61)

Michelle Mary Lelwica (2002) described how someone with an eating disorder is, in some ways, seeking a spiritual experience (p. 109). Lelwica said, “Sometimes the terms and strategies through which the anorectic and bulimic women seek a transcendent source of power explicitly reference the models and tactics of traditional religion” (p. 109). Fasting, she said, is a way for any woman to experience “supernatural power” (p. 109). For the woman who feels she has no power in her life, it’s easy to see how fasting could make her feel like she has some control over the fate of her life. In her book, The Art of Starvation: A Story of Anorexia and Survival, Sheila MacLeod (1987) detailed the deeply transformational power of anorexic fasting, “The clearer the outline of my skeleton became, the more I felt my true self to be emerging, like a nude statue being gradually hewn from some amorphous block of stone” (p. 69).

Many anorectics use their religious beliefs to justify extreme fasting, using some of the same rationalizations of the ascetic (MacLeod, 1987). The religious anorectic and the ascetic have similar goals, such as:

  • Drawing closer to Divinity
  • Becoming more God-like
  • Becoming more worthy of Grace
  • Weakening the body in order to reduce or eliminate human appetites

Psychologists have suggested that the religious and spiritual beliefs of the anorectic should be thoroughly examined and taken into consideration in the development of a treatment plan. In her article Anorexia Nervosa: Some Connections with the Religious Attitude, Sarah Huline-Dickens (2000) noted,

It is argued that there exist many connections between the religious ascetic and the anorexic and that there are many psychopathological features common to both. Both anorexia and asceticism are considered to be connected conceptually in the process of idealization. (p. 67)

Health professionals have demonstrated an understanding of the importance of assessing fasting behavior in anorexic patients. According to Pamela K. Keel and Laurie McCormick (2011), the treatment of anorexia should contain an assessment of related features such as the “Presence of nonpurging weight control behaviors such as frequency, period, and intensity of fasting . . .” (p. 10).
There is a saying among mental health professionals, “You’re only as sick as your secrets” (as cited in Temm, 2010, front cover). This implies that holding onto secrets—as opposed to revealing them in a safe setting such as during psychotherapy—could potentially impede the recovery of the eating disordered patient.

Virtually every recovering anorectic has had a close relationship with fasting. If a therapist lacks a thorough understanding of fasting from spiritual, psychological, and medical perspectives, he or she could unintentionally allow the anorectic to keep their relationship with fasting a secret. Imagine the therapy session in this way; the anorexic patient is describing a personal experience about fasting, but its becomes clear to the patient that the therapist has only a peripheral understanding of fasting. The anorectic is now the expert on what is a critical feature of their psychiatric disorder and the therapist loses credibility when discussing the topic.

Dr. Randi Fredricks, Ph.D.

http://www.drrandifredricks.com

References

Corrington, G. (1986). Anorexia, asceticism, and autonomy: Self-control as liberation and transcendence. Journal of Feminist Studies in Religion, 2(2), 51-61.

Fredricks, Randi. (2012). Fasting: An Exceptional Human Experience. Bloomington, IN: Authorhouse.

Huline-Dickens, S. (2000). Anorexia nervosa: Some connections with the religious attitude. The British Psychological Society, 73(1), 67-76. doi: 10.1348/000711200160309

Keel, P. K., & McCormick, L. (2011). Diagnosis, assessment, and treatment planning for anorexia nervosa. In C. M. Grilo & J. E. Mitchell. (Eds.). The treatment of eating disorders: A clinical handbook (pp. 3-27). New York, NY: The Guilford Press.

Lelwica, M. M. (2002). Starving for salvation: The spiritual dimensions of eating problems among American girls and women. Oxford, MA: Oxford University Press.

MacLeod, S. (1987). The art of starvation: A story of anorexia and survival. New York, NY: Schocken.

Temm, D. J. (2010). You’re only as sick as your secrets: Sexual abuse awareness, prevention and intervention. Bloomington, IN: Balboa Press.