"How Do I Change When I Have an Eating Disorder?"

Dear readers,

This morning I received the following question from a young lady who deeply and passionately loves the Lord Jesus, yet struggles to repent of anorexia. I am often asked this question in one way or another, and so I will post my response to her, in its entirety, below. She writes:

Hi Marie,
I know this is a really basic question, but once you saw your eating disorder as a sin and repented and died to self so Christ can live in you, how then did you actions change, did it happen all at once or was it still a process over time?

My response:

Well, first of all, to really understand what repentance is and how to implement biblical change (of the heart, which affects our actions), we have to realize that AS we confess something as sin (agree with God), concurrently our actions will change. Yes, it's a process in the sense we are NOT perfected overnight (sanctification is progressive), but neither are we honoring God if we sit back, take a passive role in our sanctification, and expect Him to mysteriously change us. There is an interplay between God's sovereign power (the Holy Spirit convicts and encourages the believer towards holiness) and our responsibility (we must actively work against sin in our lives). The two go together.

Let me give you an illustration of how this might look in the life of someone struggling with the sin of drunkenness. This was, in fact, a sin in my own life, which I turned away from at the same time as bulimia. Since alcohol is a more "black and white" issue than food addiction, it might help to clarify the principle.

If a Christian is enslaved to alcohol, the Holy Spirit convicts him that he is in sin. He does this through the Word of God, and impresses that drunkeness is disobedience to Him. The Christian agrees with God, gets on his knees, and begs God to grant him repentance. His sin is forgiven, Christ has paid it in full! Weak though He is, the Christian wants to honor God by his actions, and so he resolves to stop drinking. This is true repentance; he does not try to rationalize his drinking or strike bargains with God: 'I'll drink in moderation; I'll only have one on Friday nights.' He recognizes that he, personally, has become enslaved by this particular "lust of the flesh" and must forsake it.

Now, when he gets up off his knees, what must he do?

The next evening comes. He is tempted to drink. Does he say to himself, "Well, I'm the same man I was last night (true) with the same desire for a whiskey (also true). Since I still have this temptation, I may as well give in to it....clearly, Christ hasn't changed my heart yet. When He does, I'll just "yield" to Him and let Him have His way....but since I'm still weak, I'll just go have a drink. Anyway, I'm 'powerless' over this addiction. I cannot resist, so I'll just 'let go and let God'. When HE wants me to stop drinking, HE'll deliver me supernaturally!"

If this is the believer's understanding of repentance and he gives in to his temptation, goes down to the bar and gets drunk, he's going to wake up even more miserable than the day before. Plus, his faith in God and His power to save and sanctify will be even further eroded -- because He was not walking by the Spirit and determining in his heart to obey Christ's clear command.

What should he have done (besides pray and seek forgiveness)? Well, obviously he must not have any alcohol in the house. Leaving himself a constant temptation will make obedience harder. He, like all believers, "is called to holiness, and created in Christ Jesus to do good works" (Eph. 2:10). Secondly, he ought to identify those places and times of temptation to drink excessively, and plan to avoid them. "Submit yourselves, then, to God. Resist the devil, and he will flee from you," (James 4:7). As he begins each day, he should "put on the full armor of God so that he can take his stand against the devil's schemes," (Eph. 6:11; emphasis mine). Putting on that spiritual armor starts as he reads the Bible, prays and asks God to renew his mind, but it doesn't stop there. How does he "take a stand against the devil's schemes" (temptation to sin by getting drunk)? By actively resisting it.

In John 14:15 and 14:21, the Lord Jesus Christ affirms that if we truly love Him, our actions will show it. Now, love for God is not defined by actions, (in other words, you could do 'good' things, but not necessarily love the Lord), but if our devotion to God is sincere, that will affect the way we act. If my kids love me, they will obey me. If our Christian repenting of drunkeness truly loves the Lord, he will obey Him - by making those tough lifestyle changes. Besides 'cutting off' the alcohol, it would be wise for him to tell a Christian brother of his struggle and commitment to sobriety ("confess your sins to one another and pray for each other so that you may be healed"; James 5:16). Accountabilty is often an important part of repenting from a life-dominating sin. By extension, seeking biblical counsel from an appropriate counselor or pastor may also be a part, but again, the counselor cannot change the individual. Doing the hard work of biblical change comes out of a pure desire for holiness, and is something that each person individually must walk out.

How, then, do we apply this to eating disorders?

Well, we certainly don't have to whomp up any warm, loving feelings towards God in order to desire to repent. He has graciously granted us conviction, and in His kindness is leading us to repentance (Romans 2:4). The change in heart attitude towards the sin of anorexia or bulimia should, ideally, go hand-in-hand with changes in behavior. This is true repentance, and although a child of God may fall many times, there is going to be an overall tendency of change and more healthful behavior (whether resisting the urge to binge or faithfully eating and digesting meals) as one walks in obedience.

The process might look like this:

1.) Conviction ==> hatred of sin

2.) Prayerful determination to forsake it (end cycle of binge/purge; stop starving one's self) (Phil. 3:19)

3.) Renewal of mind (rejection of idolatry/obsession with food) WHILE re-establishing healthy eating habits (Romans 12:2; 1 Cor. 6:19)

Naturally, one must faithfully stay in the Word (prayerfully read the Bible daily) to truly be transformed and have the mind of Christ; the verses I cited above are only examples and are by no means the final word or "magic verse" that will combat eating disorders!

True, biblical submission entails a very real and active committment to DO the things we know are pleasing to God -- whether it be throw away drug paraphanelia, avoid the bar, eat a nutritious meal, or abstain from a fat and sugar-laden binge. We turn TO Him in the moment of temptation, asking for His supernatural strength and to give us a holy hatred for our sin; but we simultaneously turn FROM the sinful behavior as an act of the will.

When I was still struggling with the temptation of bulimia, not only did I avoid going into Dunkin Donuts or McDonald's; I'd catch myself as soon as the thoughts of planning my next binge entered my mind (2 Cor. 10:5) and reject it. Before eating (remember, eating disorders are harder to overcome than other addictions because we MUST eat to live); I would plan what, realistically, I ought to eat for nourishment and how much. Seeking the Holy Spirit's help, I would then discipline myself to stick to that plan, so that I would not spiral into "binge mode". See? Thoughts, prayer and action all go together. You cannot isolate repentance from obedience.

Many Christians have a skewed view of sanctification, thinking that if they just "yield" or "submit" to Christ, He will automatically change them. Of course, we should be living lives of surrender and constantly be yielded to His will - that is the picture of joyful obedience - but it is by no means a passive process. We must take an active role in our sanctification and practice discipline (1 Cor. 9) if we are to bring about changes that are pleasing to God. See "Godliness Through Discipline" by Jay Adams for a more thorough discussion of what this looks like when the rubber hits the road. Praise God for His Spirit within you, Who "works in you to will and to act according to his good purpose" (Phil. 2:13)!

"To repent is not to stay in the pig trough and carry on indulging in sin." -- Pastor Kevin Williams
For an excellent discussion of what biblical repentance is and isn't, listen to Williams' sermon "A Biblical Definition of Repentance".


Kristie's Testimony - Free in Christ!

An online friend of mine suffered for several years from an eating disorder called "orthorexia". Like anorexia and bulimia, orthorexia starts as an unhealthy obsession with food, and became life-threatening. As Kristie says in her interview, God had a plan for her life and was able to miraculously restore relationships and her health.

Interesting in Part II (below) to hear a medical doctor admit eating disorders are not "medical disorders", but rather behaviors:

Psalm 103, which Kristie read with new eyes in the hospital, became her life verse:
"Praise the LORD, O my soul; all my inmost being, praise his holy name. Praise the LORD,O my soul, and forget not all his benefits--who forgives all your sins and heals all your diseases, who redeems your life from the pit and crowns you with love and compassion, who satisfies your desires with good things" - Psalm 103
I completely agree with Rachel Ray and the doctor's "common-sense", all things in moderation approach. Let our minds be set on things above; not obsessing over food labels!


Verbal Cruelty and the Balm of the Good News

Next month, Dr. Laura Hendrickson, trained as a psychiatrist and now serving as a nouthetic counselor, will be presneting a workshop at the annual NANC Conference entitled "Counseling Women Who Binge and Purge". Needless to say, this is one of the six conferences I have registered for at the conference, and am looking forward to meeting her.

Dr. Laura herself is an abuse survivor. Those of us who have experienced deep pain and wounding at the hands of others are often able to better identify and feel compassion for those we counsel - and see what is behind the irrational self-abuse counselees practice. Recently, Dr. Laura posted an excellent entry on verbal abuse - what is the driving force behind mocking, sarcasm, and cruel joking at the expense of others. Shouldn't we, who have "been there", know better? Why do we cut others down? She writes:
Those of us who've been hurt are sometimes the first to hurt others in similar ways. It seems as though this shouldn't happen, yet it does. Why?

Many of us who've survived painful experiences struggle constantly with feelings of inferiority. Some of us were told repeatedly that we were of no value to the ones we loved. Others were treated by others in ways that told us that we had no value. Our memories of mistreatment send us powerful messages about our inadequacy and inferiority--messages we hope aren't true, but fear that they are.
Read more here: http://blog.drlaurahendrickson.com/2010/02/23/verbal-cruelty-and-the-gospel.aspx


"Cutting" and Bulimia: Striking Similarities

It is with interest that I just read Mark Shaw's booklet, "Hope and Help for Self-Injurers and Cutters" (Focus Publishing), as very little has been written about this growing phenomenon from a truly biblical perspective. Shaw, who is the author of "The Heart of Addiction", condenses extensive research into the physiological and emotional drives behind this maladaptive behavior into 29 pages of scriptural exhortation. This booklet is extremely helpful both to "cutters" who want to understand and break this dangerous habit, and to Christian counselors who are perplexed by "cutting".

While many young people involved in the stereotypical "emo" lifestyle may experiment with self-harm either for attention or to deal with very real pain, the fact is that "cutting" does become a very real addiction...very much like eating disorders. In fact,  the reason for my research stems from the high correlation between "cutting" and bulimia. Many bulimics who have written me for counsel (especially from the under-30 generation) are also "cutting". In the 1980's, when I was a teenaged anorexic/bulimic, "cutting" was unheard of. Now, partly due to the media and perhaps the sub-culture, it has become a self-destructive addiction for increasing numbers of young people.

Shaw explains the physiology of "cutting", and why it becomes so difficult to stop:
"The pain signal sent to the brain causes a pain relief response in the body. Natural pain relievers produce pleasure in the brain and body. An unpleasant action produces a pleasant feeling in a short amount of time. "Cutting" can be addictive because the endorphins, dopamine, and serotonin that are released by the body can feel similar to a drug rush, although to a lesser degree. Chemically, these neurotransmitters are very similar to many prescription pain killers."
Similar to the "endorphin rush" that follows a purge and generates an artificial sense of calmness, the chemistry behind the behavior produces a certain response.

After citing specific Old Testament passages that forbid cutting and other forms of self-mutilation (see Leviticus 19:20; 21:5 and Deuteronomy 14:1-2); I previously blogged about cutting in the New Testament here), Shaw illustrates seven ways in which modern-day "cutters" are imitating the idolatrous pagans who "cut" themselves ritualistically:

1. “Cutters” of today are responsible for their actions just as the pagans were for their actions.

2. “Cutters” are grieving that they are not getting what they want. God’s people have the hope of eternal life and must not allow their focus to be upon receiving satisfaction in this world alone.

3. The severe, strong emotions experienced by the “cutter” of today are very similar to those felt by grieving pagans as they experienced terrible, final, and traumatic loss of a loved one. Remember that those strong emotions are preceded by negative thoughts about God or about the person who offends and hurts the “cutter.” (MY NOTE: Or both – often Christians with addictions, like cutting, are angry at God because He “allowed” the abuse to happen).

4. “Cutting” is often planned in advance of the actual cut. The “cutter” places a knife or sharp object in a drawer in her bedroom with the intention of using it later if the desire to cut arises.

5. The “cutter” and the grieving pagan have lost control and cried until there are no more tears left. All of this occurs with no real resolution: the pagan’s deceased loved one did not return to life as a result of the idolatrous ritual the pagan performed nor does the “cutter” resolve the hurt in a biblical manner (Luke 17:3-10) with the person who hurt her.

6. Some “cutters” want to be discovered because they desire attention or are crying out for help.

7. “Cutting” oneself produces blood for both the ancient, grieving pagan and the modern “cutter”.
Reading this list (and the elaborations under each point) really clarified the connection between bulimia and "cutting" to me. The rage, pain, and shame felt are "transferred" to the cut - and then "released" physically. This is very much analogous to what the bulimic does when she vomits - she is attempting to "purge" herself of both the self-indulgence (the food consumed) and the negative emotions.
The cycle a "cutter" follows and the self-reliant reasoning behind it is similar to the bulimic's. The answer to the problem, of course remains the same. Rather than taking refuge in the temporary "rush" of self-injury, the "buzz" of drunkenness or the "high" of a binge, God wants the person enslaved by addictive sin to turn to Him for comfort and encouragement. This is a key factor in resisting the temptation of an eating disorder, and the importance of accountability is just as real to the "cutter" as to the bulimic.
Describing a counseling scenario of an adult "cutter", Shaw writes:
At first, Pam did not want to think of it as "grief" but she took the wrong that she perceived to have experienced at the hand of her parents as a serious oppression that caused deep distress and mental anguish to her 'teenage world'. Just as the 'cutters' who grieved over the death of a loved one in biblical days, Pam felt a type of grief: intense emotional pain that caused her to mourn the deep injustice she felt inside.
 The pain is real, and just as is the case with eating disordered women, there is a high correlation of abuse among "cutters". The answer to dealing with this pain, however, must be firmly rooted in Scripture in order for the "cutter", like the bulimic, find true and lasting freedom. Internalizing anger (justified or not) leads to bitterness, which only further fuels the addiction. Just as is the case in overcoming eating disorders, biblical confrontation and forgiveness of abusers plays an important part in the restoration of a "cutter".
As I do in my own book, "Redeemed from the Pit",  Mr. Shaw makes the case that "cutting" is a sin because it offends a holy God (and violates 1 Corinthians 6:19-20): "Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body." As I did recently, Shaw countered the oft-thrown criticism that calling these attitudes and behaviors 'sin' is harsh, or that it is preferable to think of "cutting" as being a 'mental illness'. Citing 1 John 1:9-10, he reminds the reader that in Christ, the sinner is forgiven (including the sin of self-injury). This should give the addict great hope, because A) the guilt associated with the life-dominating sin is also resolved; and B) by acknowledging her sin, the "cutter" is now free to experience the forgiveness and encouragement of a loving God.

As is the case with eating disorders, repentance from "cutting" must follow certain steps:

- "Putting off" the sinful behavior and habitual, idolatrous thoughts (Ephesians 4:22; Colossians 2:11);
- Renewal of the mind (Romans 12:2; see also my posts on the importance of renewing the mind here);
- "Putting on" new, God-honoring behaviors and thoughts (Romans 13:12). Often, addicts will inadvertently replace one self-destructive habit with another one. For this reason and in order to have the mind of Christ about her situation, the "cutter" must rely on consistent, deliberate Scripture reading in order to become more like Christ. Sanctification, which is the goal of all biblical counseling, does not happen automatically or passively.

Much like her eating-disordered counterpart, a "cutter" is stuck in a deadly, seductive cycle of trying to solve her problems and ease her inner torment by means apart from God. The addiction, whether purging or "cutting", will ultimately only bring more misery and alienation from God and others. By recognizing the futility in self-harm and seeing the compassion of the Father, both bulimics and "cutters" can find true hope, genuine renewal in heart and mind, and a permanently changed life.