What Makes Anorexia a "Harder Case"?

Earlier this week, I was chatting with Martha Peace, who is working closely with me on my book and discussing revisions with me as we go. I very much consider her a mentor, and the depth of her experience in the biblical counseling field helps me to learn about how to best minister to young Christian ladies. (Not to mention, as a bestselling author, her writing suggestions are much appreciated)!

During the course of conversation, she mentioned a book she and several other recognized biblical counselors, including the brilliant Stuart Scott, are compiling on hard counseling cases. The topic on which Martha will write, for her contribution to the anthology, is anorexia nervosa. (Needless to say, I am looking forward to the book's release - I want to be as well-prepared as possible when I am a fully-certified NANC counselor).

Now, bulimia is quite a bit more common than anorexia, but this project is to zero in on the toughest cases of all.

This got me to thinking: why is it, exactly, that anorexics are more difficult counseling cases than bulimics? This was not a subject I got into in my own book - I did not focus on the differences too much between the two disorders, but rather dealt primarily with the root sins contributing to both behaviors. Moreover, most anorexics end up becoming bulimic at some point, anyway...it is much harder to continue to starve than it is to give in to the urge to eat, and then purge as an "escape hatch".

However, there are women who maintain anorexia long-term without ever giving in to bulimia. I have known of women to go well over a decade as anorexics, while their body tissues slowly disintegrate, still pursuing that elusive "thinness". This scenario is much rarer than the more common one: a low-to-average weight woman who binges and purges in secret, or an overweight lady who habitually overeats and cannot seem to moderate her eating habits.

What is it about anorexia that makes it harder to counsel? Here is my theory (and it is just that; my somewhat-educated opinion): the level of self-delusion in anorexia is deeper.

A bulimic knows that what she is doing is wrong. She feels shame constantly, even when she has been purging for so long her conscience is desensitized. Even before she seeks counseling, inwardly, she knows it is sinful to gorge and vomit up food. She knows the risks of laxative abuse, and is filled with disgust and self-loathing. She wants to stop the binge/purge cycle, but on the other hand is conflicted: 1) the frenzied act of eating/purging retains some sort of "reward" to her that she is reluctant to give up; B) she is deathly afraid of gaining weight. As with her anorexic sister, the bulimic has made weight her idol. Nevertheless, she rarely has any delusions that bingeing and purging is anything less than sinfully self-destructive.

The anorexic Christian, on the other hand, is less likely to really see her self-starvation as wrong. Anorexia seems the more "noble, stoic" of the two eating disorders -- after all, it takes enormous willpower to consistently refuse food. The anorexic is typically very proud of "overcoming" her baser human instinct - the need to eat for survival - and sees herself as of stronger, more self-controlled stock than other women. She has never eaten food only to "get rid of it"; what's the problem? she may reason.

Add to this the grossly distorted body image more common to anorexics, and you would have a hard time convinvcing them that they need to gain weight. I remember when I was anorexic in 11th grade, looking in the mirror (at 5'5" and 90 lbs.) and seeing a normal-weight girl. Interestingly, in photographs of myself I saw how emaciated I was; but anorexics do not see themselves realistically in "real time". For this reason, I highly recommend meeting with a nutritionist as well as a biblical counselor during the re-feeding process. A nutritionist provides an objective, science-based eating plan according to biological, nutritional needs. In my experience, this was helpful in giving me the confidence to eat nutritionally-balanced, if small, meals and to gain weight without freaking out.

A third reason anorexics may present tougher counseling cases than bulimics is the connection between asceticism and "religion". I use " " around the term 'religion' to distinguish this way of thinking from true, biblical Christianity. The ascetics were an ancient group that believed in subjugating the body (believing all matter to be evil, like the Gnostics) in an attempt to reach a higher level of 'spirituality'. This way of thinking was also rampant in Medieval Catholicism (see my post on 'holy anorexia' and the contemplative nuns of the Middle Ages) where flagellants and penitents would beat, starve, and sleep-deprive their bodies mercilessly as "penance".

The notion of "penance" is antithecal to the Gospel, which teaches repentance. Repentance is godly sorrow over sin; trusting in Christ's finished work on the Cross as atonement; and dependance on Him to turn away from the sin. Penance, on the other hand, is self-inflicted punishment or man's attempt to "make it up to God" by performing some act. This is the height of pride (thinking that we can add something to our redemption, on top of Christ's sacrifice); it is also a gross perversion of the true motivation for the spiritual disciplines (including fasting).

A Christian anorexic could easily justify her habit as "holy", by calling it a "fasted lifestyle". The secular media certianly reinforces this mindset, by glorifying women who successfully lose weight through "willpower" (the secular term for "self-control"). Self control is certainly a fruit of the Spirit, and fasting is something Christians are expected to do in seasons of intense prayer, but the anorexic mindset perverts them both. Although she is called, as a believer, to "put on the new self", she is in fact giving reign to vanity and self-absorbtion. Paul writes:
"Therefore if you have been raised up with Christ, keep seeking the things above, where Christ is, seated at the right hand of God. Set your mind on the things above, not on the things that are on earth. For you have died and your life is hidden with Christ in God." (Colossians 3:1-3)
The anorexic's mind is most definitely not set on "the things above", nor is she walking in the Spirit. Her mind is set on the carnal desire for unnatural thinness and audulation; she ruminates about food day and night. Her lifestyle and habits "sow to the flesh" (Galations 6:8). However, it is much more difficult for her to see her true spiritual condition through the eyes of faith than it is for a bulimic, whose purgeing habit is more obviously sinful (gluttony; waste; destruction of the temple - 1 Corinthinas 6:19). Anorexia is just as grievous a sin against the body as bulimia is, but for these reasons I believe it can be harder to convince an anorexic that this is, indeed, the case.

What are your thoughts on this? I am especially interested in feedback from some of you ladies who are (or have been) struggling with anorexia. Do you see this as a life-dominating sin, or something that makes you "purer" (even if only in your own eyes)? Do you consider jeopardizing your health by self-starvation as wrong as overeating; or do you see it as "virtuous" (even if only secretly)?


  1. i think this article is ridiculous. it is hard to fight an eating disorder. period. by saying that anorexia is "harder" to treat, you are minimizing the difficulty of fighting bulimia. And i think that this article is pretty harsh when it comes to telling girls over and over throughout the article that what they are doing is a sin. i am sure that they know this is not the way God intended for them to go through life, but i don't think they need it to be pushed in their faces over and over. I am a Christian and i was turned away. I don't believe bullying people into recovery by telling them they are sinning is right. suffering from an eating disorder is a struggle. and i am sure if you asked them there are plenty of girls in treatment for eating disorders that want so badly to be able to stop their eating disorder behavior and be in recovery, but it is such a struggle. every day is so hard. i think you could have been a little more compassionate towards eating disorder sufferers in your writing of this article.

  2. Hi anonymous,

    Thanks for your comments. I'll address your concerns one by one, as it seems either my position or intent was misunderstood.

    First, rest assured that I am NOT minimizing the difficulty of fighting bulimia AT ALL. Eating disorders (of all stripes) are notoriously difficult to overcome, but it is a medical fact that anorexia has a lower treatment success rate than bulimia. If you would like statistics, I can certainly provide them for you as I did extensive research in this field when preparing my book, but it was really not the point of the article.

    My focus is on WHY anorexics are, typically, harder to get through to than bulimics in the counseling room, and I also differentiated between proven fact and my own opinion (based on both experience and theology of counseling).

    I am not "bullying" anyone into "recovery" (actually, "repentance" is a more accurate term, since eating disorders are not organic illnesses). I do, however, help those who seek out help - NOT by pressing my own opinions or agenda onto them, but rather by opening the Scriptures to them. FWIW, bulimia is a sin Bulimia is wrong for two at least two reasons: first, it can cause serious medical problems such as damage to your esophagus and your teeth. Second, it is a sin because overeating is gluttony, throwing up is a lack of self-control, and wanting to be thin so badly that you are willing to sin is idolatry.

    There are numerous manifestations of pride underlying eating disorders, including:
    i. Fear of man/insecurity
    ii. Vanity
    iii. Idolatry
    iv. Seeking control and/or independence from others
    v. Lack of self-control/gluttony
    vi. Perfectionism
    vii. Lack of prayer/undisciplined thought life

    d. Accompanying sins
    i. Jealousy/envy
    ii. Anger
    iii. Unteachable/hypersensitive to criticism
    iv. Unforgiveness

    Why is telling someone they are in sin "insensitive"? Did the Lord Jesus Christ not do as much? Any sin can be repented and forgiven. That is the truth of the Gospel, for those who have ears to hear. I can tell you from my years of experience as a biblical counselor that gently leading someone to see her sin as God does - through His eyes - and seeing the solution to that sin in Jesus is the most freeing, joyful and compassionate thing you can do for them. As long as you help them continue to make excuses and stay where they are, they stay in bondage.

    Lastly, please do not accuse me of needing to be "a little more compassionate towards eating disorder sufferers", because the irony of that comment is lost on you. You don't know me, so I totally forgive you for it; but allow me to "introduce" myself to you so you see the picture a bit more clearly.

    I became anorexic in 10th grade, and was then bulimic for 17 years. Seventeen years is a long, long time to be living life over a toilet bowl. I nearly died in my late teens. My potassium level, which was as low as 2.0 at one point, caused health problems. I binged and purged, on average 3-4 times each day. I was certain that bulimia would kill me.

    At age 32, I got on my knees and begged God to forgive and restore me from this life-sucking, destructive bondage. No deals; no bargains; no caveats. Just honest, humleness of heart and repentance. I did seek out others for intercessory prayer, but for the most part I just stayed in His Word and trusted Him. In about 5 months, I was totally freed - mind, body and spirit. BECAUSE I RECOGNIZED IT WAS A SIN, AND TRUSTED GOD TO CLEANSE ME. I determined to obey Him in this area, and He gave me the strength.

  3. Last part of my response to anon)

    Now, you know what I do? Write. (My book is coming out this fall). And study counseling through NANC's program (at my own expense), AND, like all NANC-certified counselors, I counsel - FOR FREE. I pour myself out into serving every young woman who comes to me, broken and with tears in her eyes, because she's living the same hellish, shameful secret that I used to know. And I have the answer - repentance and seeking God, because only He frees. Since I have begun counseling, I have seen quite a few women completely transformed by the power of God, and walk away completely from their eating disorders.

    So if you see that as a lack of compassion...well, I don't know what to tell ya. Examine your own heart; it may be pride speaking.

    In love,


  4. I'm 41, and, have dealt with eating disorders for 24 years. I love the Lord, I am a follower of Christ, but, I struggle. Bullimia, has always been my first choice. You can eat, in front of people, no questions asked. They are happy to see you eat. Anorexia, is harder. You don't eat, so everyone wonders why. They go hand in hand. Dealing with both right now, anorexia is more noticable, because you don't eat. Bullimia, is easily hidden, because you eat in front of others, throw up/take laxatives later. Either way, I'm playing the hypocrite.

  5. Anonymous 1:30 PM,

    Thank you for your comment; I believe you are right. Since bulimia is more easily concealed than anorexia, the prospect of confessing it to another person looms more frighteningly, as well.

    I remember in the early days of my eating disorder how I'd get the worried looks/comments when I didn't eat (or subsisted on salad); it seemed to placate them when I'd eat "normally". Then I got to the point where I couldn't eat normally -- every meal was a binge! It's a vicious, out-of-balance cycle.

    Please e-mail me if you would like a recommendation for a biblical counselor in your area. There is always a way out.

  6. To say that treating one type of eating disorder over the other is "easier" is incomprehensible to me. What factual evidence or statistics do you have to support that claim?

    Also, eating disorders (and their inherent behaviors) are not sins, they are psychological illnesses. people who suffer from these illnesses also suffer from a significant amount of guilt, please do not pile on more guilt by claiming an eating disorder has anything to do with the concept of sin.

    Finally, if you plan on helping people you should educate yourself first, or you're going to be flipping burgers at McDonald's. I've been in therapy for my issues for almost 15 years and if I heard this from my therapist, I would run as far as possible in the opposite direction.

    You're entitled to your own opinion though, and I wish you luck.

  7. To say that treating one type of eating disorder over the other is "easier" is incomprehensible to me. What factual evidence or statistics do you have to support that claim?

    First of all, anon, I never said that "treating" one type of disorder is "easier" than another. What I actually did was quote a well-respected author and NANC counselor, who has over 30 years experience in the field, about a book project she and a colleague, Stuart Scott (who holds a PhD) are working on. It will focus on the most difficult counseling case studies. In her extensive experience, as in my more limited experience AND study in this area, it is generally more difficult to enable anorexics to do the hard work of biblical change than it is other eating disordered counslees because of the depth of self-delusion.

    I then offered my own well-informed opinion (carefully labeled as such) as to why this may be the case.

    Also, eating disorders (and their inherent behaviors) are not sins, they are psychological illnesses.

    Oh, really? What factual evidence or statistics do you have to support that claim?

    If EDs were organic illnesses, as you claim, they would be diagnosed by one of the following: tissue biopsy; blood culture; urinalysis; nuclear imaging; tomography; or one of the other diagnostic tools used by the medical field. How are they diagnosed? Same way depression is - on the basis of behavior and feelings. You accuse me of ignorance, but anon, I spent several years researching the biochemical claims the psych fields have tried to make over the past few decades, and they have come up short. There is absolutely NO evidence that either anorexia or bulimia is caused by a pathogen, genetic mutation, or any other organic source. Labeling EDs "diseases" helps people like yourself rationalize your behavior, and blame-shift to factors outside yourself.

    Finally, if you plan on helping people you should educate yourself first, or you're going to be flipping burgers at McDonald's.

    I have two college degrees, thanks; and a satisfying career outside of biblical counseling (for which I have studied and been mentored more than adequately). Throw pot-shots all you like; you can't argue with results. I've seen more young women conquer depression, eating disorders and other life-dominating sins in the last two years than I would have ever thought possible. I praise God that He's allowed me to be a part of that.

    I've been in therapy for my issues for almost 15 years

    You just proved my point about the uselessness of secular therapy for heart issues. :) If it's so effective, why are you still in therapy after 15 years?

    You're entitled to your own opinion though

    My opinion is totally irrelevant. The Word of God is inerrant.

  8. Part 2 @ Anon:

    Since you asked for statistics comparing the relative recovery rates of anorexia and bulimia, here are some quick stats from the EDSA (not a Christian site; lest I be accused of bias):

    Bulimia - "The statistics on bulimia tell us that as many as 80 percent of bulimics who receive treatment achieve remission within three months. However, relapse is common. As many as 25 percent continue to meet the diagnostic criteria for bulimia a year later."

    Okay; follow so far? This is not even addressing mortality rates; just overall behavioral change following some kind of therapy. 80% get into remission and of those, approx. 3/4 stay there.

    Now, compare this with the stats for anorexia treatment:

    "Anorexia statistics show that with treatment, only 60% make a full recovery. About 20% make a partial recovery, meaning that they may be able to hold a job and maintain some superficial relationships but remain very focused on food and weight. They may continue to abuse laxatives or diet pills. They remain underweight. The final 20% stay dangerously underweight. They are seen frequently in emergency rooms, mental health clinics, inpatient hospital units, and eating disorder treatment programs."

    Did you get that? About 60% make some kind of recovery; but of those, fully 1/3 only make "partial" recovery - meaning the ED continues to hold sway over their daily lives. (As I point out in my book, "recover" is somewhat of a subjective term, but I wouldn't consider that recovery at all).

    So you're looking at about 40% of anorexic patients in recovery vs. 80% of bulimics, who acheive remission in a much shorter period of time.

    Hope that helps.

  9. Marie,

    I just wanted to tell you how much your site has helped me. I have been bulimic for along time, but thanks to you I am now seeing a nouthetic counselor in a church near my town. For the first time, I really feel like I can overcome this because of GOD!! His Word is truth and maybe some people like anonymous don't like to hear that, maybe they feel convicted but God is good. One verse my councilor had me memorize was John 14:15 "If you love Me, you will keep My commandments" and 14:21 which is like it. We talked about how loving God and obeying him go together, and how the holy spirit gives you the strength to obey. Oh, she showed me something like the "Y" chart you have on your blog, too. It helps me get my thinking in line more.

    I can't say I never struggle with thoughts about purging and food, but its a lot better then it was. I have been going for almost 5 weeks, and it is so helpful! Praise God! Don't let negative people bother you. They attacked Jesus for telling them the truth about their sin, too, but it was so they could be FREE and healed! The love and caring you have for people is so clear. Once again, THANK YOU and GOD Bless your ministry!

  10. Thank you, Terri, for your kind words and sharing your progress. I am so excited for you! Praise God, indeed...I ams o glad that you are turning from this destructive cycle and letting Him renew your mind.

    No, the attacks don't bother me; if we're standing for the Truth, they are bound to come. As you said yourself, Christ was attacked for pointing up people's need for a Savior (because we are all sinners); and He Himself said A slave is not greater than his master 'If they persecuted Me, they will also persecute you' (John 15:20). This isn't even persecution though, really; it's just denial and lashing out.

    Personally, I'd rather know that I am guilty of a sin than have an incurable disease -- sin HAS a cure! It was effected on the Cross 2,000 years ago; all we need to do is confess our sin and receive it! The most loving thing you can do is help someone overcome their sin and grow closer to God. It is a bit disconcerting when professing Christians cannot see this, BUT, I know that I am not the one who opens their eyes and calls them -- that is ALL the Holy Spirit.

    So happy for what He's doing in your life!

  11. Dear Marie,

    Thanks so much for allowing the Lord to use your past to help others now. I think your book will be well recieved among the counseling community. Good luck with that.

  12. I feel called to minister to others who struggle with anorexia, bulimia, overeating, self-harm. But I'm still enslaved myself. Please pray I will humble myself and let Christ free me.

  13. Dear Anon 11:44 am,

    Absolutely, I will pray for you. God has given you that desire for a reason - and if you repent, He will totally free you from this bondage. I really think that particularly in the area of life-dominating sins, (ie addictions), those of us who have "been there" can really approach those counselees who are struggling in the same way with the patience and compassion that they need (while still holding out the truth of change and renewing the mind, of course).

    God redeems the past, and I believe He will use this chapter in your life for His glory. Keep seeking; keep striving and depending on Him to help you change. This is not the end of the story!

  14. Hey Marie. I am very encouraged to hear you call these things sin. I have had a very long battle with food, and binging and purging. I'm only 23, but a pre-occupation with food, weight, and image started very early with me. My idolatry has taken many different forms, but my main ways of purging have not been to throw up (by God's grace, I have no gag reflex), but instead to work out obsessively and take copious amounts of diet pills. From what I am seeing, this all stems from the fact that I want to be God. God says that by the blood of Christ I am pure, and yet I want to be the judge of that and use food as the way I incriminate myself, so that I can be the one to cleanse myself. I have sat in the sauna until my face goes numb and all the salt gather around my hairline. I have stayed on the elliptical for hours until my knees ache and I burn every calorie I've eaten. I have drank so much water after a binge to try and cleanse myself, that I am afraid I will burst. I've taken detox pills or teas, tried veggie fasts, and feverishly gulped down as much hard alcohol as I need to to puke up my excess consumption. The one I've used the most in the last 6 months or so is diet pills. The ones I take say not to take more than 6 in a day, and I have been progressively taking more each day, my highest being the total of 20 I consumed yesterday. I'm going to kill myself at this rate, and I keep throwing out the pills and buying them again. The strange thing is that I can do life just fine on them. I have two jobs and have had limited complications at work. I need to repent, yet I don't believe I can (or don't want to???) stop, and am not really sorry. I know that my attempts to purge are just as sinful as my binging, because I am trying to cleanse myself and pay for my own sin. Yet knowing it has not brought me to my knees yet, and this is terrifying. I recently discovered that my 17 year old cousin, who I'm very close with and loves Jesus as well, has started similar binging and purging habits. She is going to a counselor yet I don't know if her counselor believes she is in sin because she seemed to focus on managing it. I want to be able to walk her out of this, not just get together to analyze and relate about our perpetual sin. Yet if I am being honest, I have to admit to her that I am not over this yet. I want to start claiming Christ's victory in my heart and to stop seeing myself as dirty because I ate a doughnut (or 3) or clean and justified because I sweated ever toxin out of me and burned every calorie. What books do you recommend on viewing and approaching food in a Christ-glorifying manner? I want to start a women's group on this topic. Also, if I were sitting in front of you in your office, what would you tell me?

  15. Hi Janessa,

    Thank you so much for your heartfelt comment. I need to get ready for work, but I wanted to let you know I had received and read it. Please send me your e-mail at marie4thtimemom@yahoo.com so I can reply to all of your questions, giving them the time and discussion they deserve! Thanks!

  16. Thank you Marie for sharing your experience,I am very greatful for the gift you provided by connecting such bondage with the one and only. (God,who can heal us from this awful bondage. Thank you, thank you, and God Bless all those who suffer with eating disorders.

    Tammy V. <3

  17. Thanks for your thoughts. I logged on to learn more about these issues, but thought the picture of the young woman in her underwear was very immodest. could you remove it? Thanks for your understanding.

  18. Hi Anon,

    Sure, no problem. It's gone!


Thanks for visiting! Please leave me a message, share your testimony, or feel free to ask questions. Anonymous comments are welcome. Or e-mail me privately at marie4thtimemom@yahoo.com.