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)?