Eating Disorders: Why is it so Hard to Treat Them? | Ilona Kajokiene | TEDxVilnius


Translator: Galina Mitricheva
Reviewer: Denise RQ Most of us like food and enjoy eating
as a very pleasurable experience. But sometimes, this relationship
with the food becomes an anxiety-provoking one. I would like to go deeper. And I will start
from my personal memories. It happened in 1994, my very first day
working as a psychologist. I, as a novice specialist, was sent
to talk with a thin, curly, redhead girl. She was very difficult to relate to,
and she bearly spoke, and she was angry,
and I was angry at her. And all team was annoyed with her
as she was sick with anorexia. After few months, she was sent out of the hospital
without any noticeable change. And you know, I still remember her name, and I remember my own helplessness
while working with her. And the question in my head,
“Why it was so hard to treat her?” Now, I have much more experience. Through over 25 years of my career
as a psychologist, psychotherapist I have found an answer. A very provocative answer. The answer is that eating disorders
are hard to treat because actually
they are not only about eating. But if they are not about eating
what they are about then? In essence, it is difficult to treat because it’s not just
a simple human behavior, eating, it’s [something else and it’s hidden]. But before we go to these complex things I would like first to just simply
describe you quickly what do we mean
by the title eating disorders. So it’s an umbrella term
for usually three mental illnesses. First is anorexia. Anorexia is characterized
by a very low weight and a huge fear of putting on weight. It’s the most severe eating disorder type and with long-standing consequences, and the highest mortality rate
of any mental illnesses. Next is bulimia. Bulimia is characterized by
a binging and purging behavior: it’s cycles of binging, guilty feelings, and unhealthy
compensatory behavior afterwards. This unhealthy behavior could be
laxative use, extreme sporting, could be dieting, and it’s there
for one reason – the one goal – just take the control, emotional
and body control back. The last one is the binge eating disorder. Actually it’s a very modern disease, officially recognized as a mental illness
only recently, namely 2013. And it could be diagnosed in a person
who in a very short period of time swallows huge amount of food
without being physically hungry and who does it alone. So after the swallowing
of this amount of food, the person feels disgusted with oneself. I want to stress here
that the binge eating disorder is not the same as chaotic eating or sometimes like when after holidays
we all overeat especially after Easter
or Christmas, you know that. But it’s a repetitive pattern, it’s twice a week or three times a week. So it’s a very severe mental illness. And because the person has
no compensatory behavior, it usually goes together
with obesity, too. And almost half of the patients who have binge eating disorders are male. So what is behind eating disorders? As I have mentioned, you could notice that
it has psychological and physical issues. And they are tightly interconnected. But despite a long history of medical history on eating disorders
and especially anorexia, – it goes back to the end
of the 17th century – and zillion research
on eating disorders and other types, we still don’t know how the psychology
and biology is interconnected. So I would turn
to the psychology part first. Eating disorder is very much
about emotions. And especially shame. Shame and other emotions could be controlled by starving,
or eating, overeating food. Because of this unbearable state,
the person overeats and this overeating could increase
even an emotional turmoil afterwards. Second, to have a mental illness
means to have a stigma. Especially in Lithuania. And to have a stigma means,
in eating disorders, to be a loser, to be worse than your family members,
than your friend, than a loved person, and nobody wants to go to treatment because nobody wants to be
officially recognized as a failure. It’s so hard to treat eating disorders. And this stigmatization
holds the person from treatment, and this stigmatization is even more
difficult to bear by the male patients. Because of this stigmatized image of
the eating disorders as a female disease, and you know this. For many, many years, the origins of eating disorders were
thought to only be psychological ones. And this lead to simplification
of the understanding, and this understanding lead
to some ineffective treatment that was to arrive. But I want to stress here: we have lots of myths
about the psychological issues, and one of them is that parents
or the family are responsible for children developing
eating disorder symptoms, or the social media and cultural attitudes
are to be blamed for it. I followed this particular misconception
at the beginning of my career, too. But not now. However, there is more
that just psychology, and I would like to talk about it. Sure, psychological and social attitudes
have an influence on the way we look at ourselves, the way we judge others, their appearance. But I want to stress that they don’t cause
eating disorder directly. And there is a hidden
biological mechanism to blame. And as I have said, biology and psychology
become interconnected, and all these factors could be divided
into three main groups; and I will explain this in detail. The first group is so called
the “predisposing factors”. These factors make us vulnerable
to eating disorders, and the evidence suggests now that our body weight, our body shape is determined by genes. In some regions of our brain we have signals, we have neurochemicals which send messages about hunger,
about our appetite balance, signals in our brain
and other sides respond to it. But what is interesting
is that for eating disorders patients seem
that they can’t recognize the signals or moreover, patients with anorexia are able to even ignore these signals, and this is why they could starve longer, and not recognize that they are hungry,
and suffer all these consequences, that’s why it’s more difficult
to treat them also. Genetics contributes to
some psychological personality features even before we start
to develop the eating disorder. Especially with anorexia. In childhood, anorexic people had this tendency to [inaudible] high aggressiveness,
obsessiveness, perfectionism, and these trends tend to stay
even after recovery. So all I have mentioned here is about these predisposing hidden factors, and they are silent, we don’t know
what we have in our brain, in our genes. Now we know that for eating disorders
there is nothing specific: our inheritability follows
the same not-specific pattern; many genetic factors
are responsible for it, like for depression, for schizophrenia. It’s why we have no specific medicines
to treat eating disorders. But all these biological factors
are hidden, are secret, until they are released by a second group of factors;
the triggering factors. These triggering factors
could be very simple. it’s all psychological or social factors. It could be like a critique
of your body shape, or someone who said you are too fat, or it could be an enormous stress of a job
or could be stress at school, particularly when ending school. It could be dissatisfaction with oneself,
and it could be losing a beloved one. It could be psychological trauma
– very much – and it could be sexual abuse, for example. And the social pressure to remain thin. So it’s about psychological factors
which release like a bullet these hidden biological mechanisms, and they all push toward
either binging either starving and all the biological mechanisms
that lay underneath. So the last group – I said
there are three groups of factors – the last group is so called
“maintaining factors”, and they are like anchors
for eating disorders. They make specifically harder
to make the disorder go away because of the physiological
consequences of starving, that become a vicious circle,
and it’s difficult to change habits. And these factors could be
psychological or social too. One of the main psychological factors,
you know, it’s the compliments a person gets from his environment
when he loses weight, “Oh, you look great!” And the person goes, “OK,
I reached a goal, I want to continue.” And that goes further and further
and slowly, slowly it develops, and the disease is maintained. The message I want to leave you with is
that eating disorders are hard to treat because slowly, slowly,
slowly these patterns overtake the person’s thoughts,
actions, lifestyle, and become the only way
to define themselves. It’s the only way to feel
the value of life. Slowly, it becomes an identity. And it’s not a disease anymore,
it’s a new identity. And getting better with treatment
for such kind of person means to lose one’s identity. And the patient asks,
“If I will be treated who I will be then?” It’s very scary to go to the treatment.
It’s very scary. You know, keeping this in mind
and the illusions the psychological security
that the eating disorders provide, I would like just to use the metaphor
of the woolen sweater: it keeps you warm but it starts to itch,
and you want to take it off. Bur it’s cold, and you want
to put the sweater on again. But it keeps on itching and it’s bad
enough that you take it off again. Or you need an alternative,
and if you have no alternative, you put this itching sweater on you again. Yes, actually it takes a long ti,me
to recover from eating disorders and my practice shows that it took four, five, seven, even twelve years to recover
from eating disorders completely. And just to finish my talk: what we do really seek
by having eating disorders? Consciously, we seek to improve
our experience, our physical self, but unconsciously,
we do seek love, admiration, we want to feel better than others. Sometimes, eating disorder helps to deal with aggression
or sexual identity issues. And it’s why it’s about
our unstable emotional self. Therefore, the opposite for
eating disorders is not a normal eating – you could guess already – the opposite is self-acceptance
and a high self-esteem. High self-esteem will not let all
these hidden mechanisms start working. And it’s why I ask you make a difference
and care about your emotional self and direct toward
more valuable goals in your life. Thank you. (Applause)