The Fat Phobia
by Nancy S. Tessler, Ph.D.
"Yuk," said my son as he looked over my shoulders at the gaunt young woman with pale skin gracing the cover of a fashion magazine. Those were my sentiments, too, as I traced the model's skeletal frame, visible through her sheer clothing, with disbelieving eyes. This, I reminded myself, is the kind of look for which too many women strive and starve.
The haunting outline of this model also came to life in the person of a young woman in her twenties whom I was seeing in therapy--- a woman not unlike others I have seen through the course of my clinical practice and from whom I have drawn this composite. She sat perched on my sofa, with huge eyes and a body that showed the effects of rigorous fasting and exercise. She was not seeing me specifically for the eating disorder I may have diagnosed, but rather for complicated relationship problems. However, one could see that many of the problems she was experiencing with her boyfriend and friends were inextricably tied up with the secrecy and obsessive behavior surrounding her eating.
Her story was a variation on a familiar theme. As the Duchess of Windsor famously proclaimed and generations of women subscribe to, "You can't be too rich or
too thin!" For this young woman, much of her life and daily living revolved around the avoidance of food and a desire to retain a pre-adolescent figure, one without breasts, hips and any suggestion of fat. As she self-consciously confessed, "I saw a skinny, boyish-looking girl with no curves and I wished I were her." Towards this end, she barely consumed any food, subsisting on a daily diet of non-fat yogurt and a small plain salad. She awoke at 5 A.M. in order to exercise, running five or six miles a day or working out at home. Any interruption in her strict regimen produced intolerable anxiety.
Her life involved circumventing certain activities, such as dining out where others might notice her strange eating habits or compel her to eat more than the daily quota she allotted herself. Sometimes, she resorted to "making myself sick" (throwing up) as a means of weight control. As long as she felt "overweight", she did not feel pretty, worthwhile or lovable, even refusing to go out if her clothes felt tight. Her ruminative thoughts about food and weight often precluded her being able to put full energy into her job and being with friends. Her obsession about her weight and appearance had thus come to consume much of her life.
The path this young woman took to this point in her life is not an unfamiliar one to many young women today. It started with a diet to rid herself of the extra poundage she acquired with her developing adolescent body, along with initiating a rigorous exercise program. Later, there were periods of food binges, alternating with purging through inducing vomiting or the use of laxatives. (This cycle of compulsive bingeing and purging in association with extreme preoccupation with weight is known as bulimia.) Throughout high school, my patient maintained a dangerously low weight which alarmed her parents, who came to see her as anorexic and on a suicidal course. (There were medical sequelae as well, including dental problems and irregular menstruation.) Now, ten years later, this woman sees herself as having achieved some control over her eating disorder; her episodes of forced vomiting have diminished and she can maintain a weight of 105 lbs. without becoming "suicidal." I still view her as "anorexic."
It has been estimated that as much as 3% of the female population suffers from bulimia, including school age girls as well as college students. In my practice, the majority of my female patients, without necessarily being anorexic or bulimic, ruminate about their food intake; typically, food has been used as a way of self-soothing, but the ensuing weight gain invariably leads to feelings of guilt and self-loathing, creating a vicious cycle. In general, we women cannot assess our appearance accurately, with one study claiming that over 90% of women overestimate their body size. But why should we be so surprised with women's obsession over body weight? After all, we grow up in a culture which values women as sexual objects, where a woman's physical attractiveness is equated with success.
The more extreme versions of this obsession with weight fall into the diagnostic categories of anorexia, eating disorders not otherwise specified, bulimia nervosa (with vomiting, over-exercising or laxative abuse) and compulsive over-eating. These eating disorders, while partly driven by cultural norms, are also associated with perfectionism, rigidity, dysfunctional family systems, depression and a biological predisposition (with family histories of addiction). They certainly have an addictive component, in that they serve to numb feelings, reduce anxiety, provide comfort and a sense of control. Very often, they become someone's preferred mode of coping in times of stress. But, of course, they have major psychological, social and medical sequelae (e.g., bone loss, heart and bowel problems), even leading to death (a not uncommon occurrence).
The following are some signs and symptoms of eating disorders that you, as family or friends, need to recognize:
- Hoarding food
- Not eating at regular mealtimes with the family
- Spending unusual amounts of time in the bathroom (e.g., vomiting)
- Excessive exercising
- Cycles of alternately stuffing oneself and fasting
- Large sums of money spent without being able to account for such expenditures (e.g., hoarding and consuming huge quantities of food)
- Social isolation
Treatment is available so that eating disorders do not have to rule your life. This usually involves a multi-disciplinary approach with a team of specialists, including a psychologist, nutritionist, group therapist and a psychiatrist. Recovery involves an intensive process, but it can literally save your life.