Elyse Fitzpatrick on Bulimia and Overeating ("Women Helping Women")

The required reading for the biblical counseling course I am currently taking, "Counseling Women", is the nearly 600-page tome "Women Helping Women: a Biblical Guide to the Major Issues Women Face", co-authored by Elyse Fitzpatrick and Carol Cornish. This is a practical, Christ-centered book that addresses many issues - from counseling mothers of children with learning disabilities to those with addictions - but for the purposes of this blog, I would like to zero in on Chapter 16: "Counseling Women for Overeating and Bulimia".

Elyse Fitzpatrick has written much on the subject of eating disorders before, and has counseled many women to victory throughout her ministry. In reading this resource, I was encouraged yet again to see that I am far from the only one writing about bulimia from an exclusively, unapologetically biblical point of view. Elyse lays out the principles given in God's Word on food and eating at the begining of the chapter, affirming that God created food for nourishment and pleasure (Psalm 104:14-15; Acts 14:17). She also points out the biblical mandate of thanksgiving, and condemnation of asceticism (1 Timothy 4:3-5).

It is when we fail to regulate legitimate physical needs and pleasure under His guidance that we get into trouble. Declaring independance from God's commands - rebellion - takes several forms in individuals with sinful eating problems:

- using food to declare independance

- satiating own uncontrollable desires for pleasure (being unable to stop)

- frequently worrying about food and drink (violation of Matt. 6:31)

- failure to prioritize (seeking to fulfill desires before His kingdom and righteousness)

This type of backwards-thinking lets greedy desires grow unchecked, which is idolatry (Col. 3:5). Elyse notes that when sinful eating habits become a life-dominating pattern, the one enslaved is "worshipping" the false gods of Taste, Pleasure, and Self-Sufficiency. The antidote to this struggle with greed and the flesh is, of course, to remind the counselee (or one's self) that she is not alone in her struggle with greed (1 Cor. 10:13) as she learns to recognize this heart issue.

These self-centered desires must be replaced with biblical, God-honoring motives for change. Elyse lists (and elaborates on) five ways Christian women struggling with disordered eating must learn to think about their bodies:

1.) Being Conformed to the Image of Christ. Dress size is unimportant to God. Having our old nature fully transformed is His priority, and it must be ours, as well (Romans 8:28-29).

2.) Everything is to be for the Glory and Pleasure of God. Obedience by glorifying Him with our eating habits must be primarily for His sake; not ours alone. (1 Cor. 10:31).

3.) Your Body is the Holy Spirit's Home. We belong to Him, body and soul, and need to be good stewards. (1 Cor. 6:19-20).

4.) All of Life is His. No activity is morally neutral - not even eating. Avoid the temptation of separating life into the sacred and secular - even the most mundane activities are either acts of worship or irreverance. (Romans 14:23).

5.) He Redeemed You from Slavery. Don't jump back into the pit (Romans 6:12-13). Elyse writes,

"As you begin to develop correct motives, you must remember that although these habits seem overpowering at times, you can change because of the work of Christ. Remember that one of the results of the work of the Holy Spirit is "self-control" (Galatians 5:22-23)."

To help spot motivating factors of excessive or out-of-control eating, Elyse recommends recording every instance of undisciplined eating and the emotional dynamics involved. This helps counselor and counselee identify problem patterns and "triggers" to which Scriptural principles can then be applied (lies confronted with the Truth from God's Word; using the "put off/put on" dynamic to overcome temptation when it hits). Elyse fully acknowledges how compelling the binge is:

"As she begins the binge she may not even taste the food. She may not consciously think about what she is doing as she crams food into her mouth. She may lose track of time and how much she has consumed. She may sit in front of the television and concentrate on some meaningless program while she shovels in baked potatoes, cartons of ice cream, boxes of cereal, or bags of cookies. She will experience a certain pleasure (euphoria) from eating. The pleasure is not simply from the taste or texture of the food, or the chemical reaction of raised blood sugar levels, but it is an experienced release and calm that comes after a hurried and frantic self-indulgence....Make no mistake - this compulsion to binge is as strong as any faced by the habitual heavy drinker."

She is right...that is EXACTLY what a binge feels like. I would add, however, that the compulsion feels even stronger than that of a heavy drinker. (Christ granted me repentance from both life-dominating sins. Bulimia was definitely harder.)

As difficult as total restoration is, Elyse gives biblical hope that it IS indeed possible. Once the heart's sinful desires have been identified and rejected, additional spiritual disciplines Elyse recommends include reading, memorizing and meditating on Scripture; daily prayer; deliberate thankfulness; and moderate exercise in conjunction with controlled eating. With the accountability provided by the biblical counselor, she may then begin to focus on the changes God wants her to make (goal-setting).

It's Not Glamorous!

An interesting note Elyse made is one that I have also often expressed:

"Bulimia and its sufferers have received a lot of press lately, especially high-profile celebrities such as Princess Diana and Jane Fonda. As the behaviors and dangers of bulimia are glamorized by models and ballerinas who confess they have used these procedures to control their weight, many young women will try it out for themselves. Talking about it, "educating" the public, ironically will probably cause more young women to experiment with it. Since it seems popular to be bulimic now, we will see more and more of it in our counseling rooms. We need firm, clear, biblical answers that speak to the heart."

I cannot say 'Amen!' loudly enough! ("Women Helping Women" was published in 1997, in case you were wondering.) Elyse's words have proven prophetic: I cannot tell you how many girls and women I have counseled who got the idea from "The Dr. Phil Show", "Oprah Winfrey" or some other such program designed to "raise awareness" of dia-bulimia and so forth. (I myself first read about bulimia in a pre-teen girls' magazine back in 1982, and I decided to try it.) I am convinced this subtle glamorization (or at the very least, sensationalizing) of "cutting" and bulimic behaviors is a big part of the reason why they are so prevalent today.

Elyse also pin-points the problem with "labels" for behaviors such as bulimia in biblical counseling. Because it tends to promote the "disease model", a counselee may make the mistake of thinking she has a "disease".

"I have bulimia," may be used by some people in the same way as, "I have diabetes." Instead of saying, "I practice behaviors of bulimia," which is more accurate, she speaks about her bad habits as though they were something over which she has no control."

This is true, although for simplicity and clarity's sake, even we biblical counselors tend to simply use the terms "anorexic" and "bulimic" as they defione counselees with a certain pattern of behavior. Since we only counsel Christians, (with a potential counselee who is unsaved, we can only evangelize and pray), we generally assume the counselee realizes the behavior is sinful and this is the reason she has sought counsel. After a brief synopsis of the differences between somatic problems or organic abnormalities which impair physiological functioning and eating disordered behavior, Elyse continues:

"Presently in the U.S. there are many behaviors which are being popularly classified as diseases. Behaviors such as alcoholism, anorexia, and bulimia are thought to be real diseases by the general populace. True, there are certain physiological effects of continually practicing bulimic behaviors, but there are no known chemical agents, genes, viruses, or bacteria that cause this behavior. My point is this: Bulimia is not a disease. It is a behavior. The label "bulimic" tends to cloud this issue."

I would also add that the 'chemical imbalance' theory has been disproven since this book was written, as well. There are real chemical imbalances, but when they are identified, they are given names (such as hypothyroidism; diabetes melitus; etc.)

Other problems with labeling one a 'bulimic' include the tendency for a counselee to believe God needs to "heal" her for change to occur; believing one has an excuse for her behavior; and the tendency to turn one's eyes from the truth (one is a sinner) to a deceiving, yet more palatable, euphemism (one has a 'disease').

After outlining these hard truths, Elyse turns to the biblical solutions for overcoming compulsions (which she describes as "greedy habits".) One rebellious motive in bulimia is pride: a desire for the appearance of surface perfection. A woman practicing bulimia hides the consequence of a binge by purging; she is pursuing thinness by self-destructive means. She might give in to binges because of her own self-imposed legalism (such as a woman who goes home and binges after eating a peice of candy at work.) She has broken her own self-imposed rule ("Thou shalt not eat sweets") and feels like she has blown it; she needs to do penance by self-abasement. Elyse juxtaposes this dynamic with a God-honoring response: humble reliance and confession of sin; desire to love and serve God and others for His glory. Worship of a "perfect body" must be replaced by worship of the Living God and obedience to His commands through the empowerment of His Spirit. Elyse emphasizes repentance rather than penance. Bulimics tend toward the latter, indicating a misunderstanding of grace.

Progressive sanctification (being totally transformed inwardly as our behavior glorifies God more and more outwardly) requires diligence. "Putting off" ingrained habits of gluttony and purging and "putting on" thankfulness, trust, joy in the Lord and resisting temptation (no matter how strong) is absolutely possible for anyone who is in Christ. Elyse gives a detailed agenda and steps to take in counseling (including accountability) to help a woman honor God in this area of her life.

This book (and this chapter especially) is extremely practical, theologically sound and helpful for anyone struggling in her walk with Christ, including with addictive sins such as bulimia and binge-eating. (There is an additional chapter which deals with addictions more generally). Although it is written primarily to biblical counselors, if you yourself are struggling with bulimia or another eating disorder it would be an extremely helpful resource for you, as well. After all, the Holy Spirit is our Counselor, and His Word is the source of all counseling truth! All the authors have done is systematize what God has said about proper use of food in the larger context of glorifying Him in all things, and outline His principles for holiness. This is a truly helpful and edifying book.


Responding to Feelings Biblically (Cravings and "Withdrawal")

It goes without saying that it is exceptionally difficult to overcome bulimic behavior and the out-of-control, obsessive thoughts that accompany binges and the pre-binge, planning stage. Unlike someone with an alcohol problem, whose "cravings" and strongest temptation to drink might be limited to Friday or Saturday nights, bulimia tends to cause entrenched thoughts about food and eating during nearly every waking moment.

Even after we've confessed this as sin and recognized Christ as the answer to overcoming the eating disorder, the feelings (of panic; of temptation; loss of control; guilt)are very real. How are we to respond to our feelings biblically in these situations?

First of all, even in the midst of temptation (to use food as "comfort" or tool to avoid pain), the Christian bulimic must remember what her goal should be. Her focus should not be on how she feels, but on pleasing God. Rather than using food as a drug to "stuff" those feelings and minimize them, the biblical goal is to provide victory (abstain from using food in an ungodly way) when feelings make it difficult. The "victory cry" of Romans 8:35 affirms that failure is not inevitable, even in difficult circumstances and intense temptation: "No, in all these things we are more than conquerors through him who loved us."

Rather than focusing on our feelings (or obsessing over entries in a "food journal",) we need to remember that the most satisfying thing in life is not feeling good; better; or being able to consume unlimited supplies of food - knowing that only guilt and despair will follow the binge - but in pleasing God. (See 2 Corinthians 5:9 and James 1:25). Of course, knowing and meditating on these verses does not mean that the anxious thoughts and cravings will immediately be removed, but having an eternal perspective means the bulimic will not be controlled by them (1 Cor. 10:13; Galatians 5:16).

Also, someone who is accustomed to being "feelings-driven" can learn to turn her attention from her feelings to how she may best serve the Lord. Concentrate on serving your family and others (without putting yourself in the way of unnecessary temptations, such as baking for the church bake sale!). This is not a distraction tactic, it is a deliberate choice to obey the Lord's command to look not only to one's own interests (or feelings), but firstly to the interests of others (Phil. 2:4).

The more we deliberately turn our attention from our feelings and cravings to how we may best please God, the less significant those feelings become (and consequently, the eating disordered-individual is no longer ruled by them.) Whether stuck in an eating disorder or any other habitual sin, shifting our focus from ourselves to God and learning to deal with emotions biblically is a necessary first step.


Counselor, Beware!

How NOT to counsel a bulimic Christian:

"Secular counselors advise you to only be supportive and not confront any sin. They claim that the depressed person is already feeling so guilty about many areas of [her] life, that dealing with sin will only make it worse. Of course this view ignores the very purpose of Christ's life, death, and resurrection. Following this advice allows the counselee to believe there really are no answers and takes away any hope he has to solve his problems.

The biblically victorious solution is to deal with sin through repentance and forgiveness, and then begin to deal with life from a biblical perspective. Rather than a further piling on of more guilt, it is removed through the cross of Christ. Then the spiral can be reversed. This gives a counselee great hope for the future, no matter how [she] feels. Being merely supportive encourages the person to continue in [her] miserable condition.

Just being supportive and failing to give one biblical answers for sin issues and [her] hopeless view of [her] life actually removes biblical hope. When real hope is gone, the person gets deeper and deeper into despair, concluding that there are no answers and that life is not worth living...Medications may change the feelings, but they do not deal with the real issues. Only the principles given to us by the Creator of life will really help a person change [her] actions." -- Dr. Robert D. Smith, M.D. (quoted from "The Christian Counselor's Medical Desk Reference", pp. 213-214