This week (March 2-8th) is eating disorders awareness week. It is both sad and shocking that eating disorders amongst young people in the western world seem to be on the rise. Whilst many in the developing world are starving, more and more children and teens in the developed world are starving themselves. If they are not starving themselves, many have come to have a disturbed relationship with food and eating. This may cause a daily misery.
The causes of eating disorders are many and varied. They are also relatively poorly understood. Studies point towards a combination of genetic predisposition, psychological and sociological factors. Trauma and difficult family relationships are known to also play a part. But in my experience of working with young people, the seeds of an eating disorder lie in emotional dysfunction. The emotional dysfunction is the root; the disordered eating is the manifestation. An eating disorder is an expression of internal unhappiness. It is a misguided, and sometimes dangerous, way of expressing emotions that, for a variety of reasons, are not able to be either managed or expressed verbally. The young person may not even be conscious of them.
One particular case illustrates this point. I treated a 13-year-old girl who had orthorexia (an obsession with eating only extreme ‘health’ foods) and who had rapidly lost an alarming amount of weight. She was under the care of CAMHS who had put her on a strict weight gain programme. Whilst this was necessary in order to preserve her physical health, it did not address any underlying, dysfunctional emotional patterns. What struck me about the girl when she spoke was the mismatch between her words and her demeanour. She was pathologically polite and did not admit to having any angry feelings at all (even towards her father, who had recently left the family, not responded to her attempts at communication and not acknowledged her thirteenth birthday). Yet her eyes were hard, her voice clipped and I saw flashes of anger across her face.  Through dialogue and acupuncture treatment to bring balance to the Wood Element (which, in Chinese medicine, is associated with emotions in the anger family), the girl began to recognise that she did in fact feel angry and then to be able to express these feelings. The more she expressed the feelings, the less she controlled her eating.
Somewhere along the line, this girl had completely disconnected from her feelings because they felt overwhelming, too painful to sit with or because she had imbibed a value that feeling angry is in some way not ‘good’ or ‘acceptable’. In her case, the predominant emotion was anger. But it could be sadness, fear or a feeling of unlovability, and is very often a mix of many different feelings. When a child disconnects from or ‘packs away’ an emotion over an extended period of time, she will no longer have much consciousness of it being there at all. At this point, the spirit of the young person becomes compromised and a pathological behaviour often arises. This may be disordered eating, self-harm, addiction or OCD, for example.
There are always multiple risk factors for the development of mental illness, as well as multiple protective factors. As parents, we can influence some of these factors but not others. For example, we cannot stop our children’s exposure to images of ‘perfect’ bodies on social media and in the press. But one area where we can have a positive influence is to support our children in becoming comfortable with and adept at verbalising and expressing a wide range of emotions. Some possible ways of doing this are:
- With young children, giving them a word for a feeling we think they may be experiencing. For example, ‘I wonder if you feel jealous that Tommy got that scooter you had been wanting for his birthday’.
- To avoid ever saying to our children ‘don’t be sad’ or ‘you don’t need to feel angry’. This conveys the message that the child is somehow wrong to have this feeling. Sometimes we shut down these emotions in our children because we, the parent, can’t bear the thought that our child is unhappy or because we feel hurt or angry when the emotion is directed at us.
- To model to our children that we, the parent, experience a wide range of emotions and are OK nevertheless. For example, to say that we have had a bad day at work and are feeling frustrated as a result of it, rather than saying ‘I’m fine’ when we are patently not. We can show them that, despite the frustration, we are fundamentally ‘OK’. Our frustrated feelings haven’t prevented us from coping, and they will pass.
Food and eating are so often intertwined with emotion, and eating disorders are especially so. Even though serious eating disorders are mental health conditions, the seeds of them usually lie in emotional dysfunction. Helping our children to express a wide range of emotions, and supporting them to become more emotionally intelligent, will lessen the chances of them expressing their unhappiness through disordered eating.
Cicero wrote that ‘diseases of the soul are more dangerous and more numerous than those of the body’. Eating disorders may mean our children’s bodies are poorly nourished but in order to prevent or heal these common and distressing conditions, we need to nurture our children’s souls.
 In Chinese medicine, we use subtle signs such as the tone of voice, the subtle hues in the complexion and incongruent expression of emotion to diagnose imbalances in a person’s qi.