The Complexity of Spirituality in Eating Disorders

Article Contributed by Christopher D. Keiper, M.A.1 ~ River Centre Clinic

Spirituality in the treatment of eating disorders (ED) has become a widely-discussed topic among clinics and centers that specialize in helping ED sufferers.  One major reason seems to be a growing number of clients asking for individualized treatment that keeps their belief systems in mind; after all, people cannot simply leave their spiritual selves at the door when they seek relief from eating problems. Spiritual life is innate to many individuals’ self-understanding and identity, and to leave it unaddressed in treatment would leave these clients feeling as if their deepest convictions were pushed to the side. But how does a person’s spiritual world interact with her ED? In addition to having a possible benefit during therapy, are there parts of a person’s spiritual life that can contribute to or maintain an ED?  How can a person’s religious belief system help or hurt his recovery from an ED?

Research About Spirituality in ED Treatment

Until recently, spirituality in EDs had not been a frequently researched topic in treatment centers. It is now known, however, that engaging spiritual resources in treatment is essential for many clients in order to enhance their recovery. In one study, for example, interviews with women who had recovered from EDs have revealed spiritual themes such as salvation, self-image, and spiritual maturation affected clients’ motivation toward recovery (Marsden, Karagiana, and Morgan, 2007). Another study showed that increases in spiritual well-being over the course of treatment were associated with healthier attitudes toward eating, improved body image, improvement in psychological symptoms, and less interpersonal conflict (Smith, Hardman, Richards, and Fischer, 2003).

Additionally, there is evidence that spiritual approaches to treating EDs among the religiously devout are likely to be more effective than standard, secular treatments such as cognitive-behavioral therapy alone (Richards, Hardman, and Berrett, 2007). Richards and his colleagues (2007) added a spirituality treatment group that was theistically-based into ED treatment – that is, they tested whether a group designed to incorporate interaction with God into a comprehensive treatment program for EDs would have added benefit for clients. The group explored topics such as faith in God, adversity, forgiveness, and establishing spiritual harmony and identity.  They found that incorporating spirituality had a direct relationship in reducing depression, anxiety, relational distress, and eating disorder symptoms.

It seems clear that whether it is self-directed or as a part of a faith-based treatment program, engaging spirituality as a part of recovery is a positive and important experience for many religiously oriented ED clients. However, many people of faith who develop EDs do so within a religious context.  Is the spiritual background they interact with always positive? And can a person’s spiritual beliefs actually contribute to, or help to maintain, a clinical problem with eating?

Religiousness, Asceticism, and Eating Disorders

While there is not a large amount of research into the beneficial parts of spirituality in ED, there is even less about how spirituality may interact with someone’s development of eating problems. In research, religion seems to more often have beneficial links with eating behaviors than negative ones, but at times a person may have the beginnings of ED start in the context of religious belief (Boyatzis and Quinlan, 2008; Richards, Hardman, and Berrett, 2007).  For example, there have been several case studies of people with EDs that have shown “religious asceticism” toward eating in which their dietary restraint and restrictive lifestyle were tied to their religious beliefs. Asceticism, or the voluntary avoidance of physical pleasures, is an important psychological theme in ED and comprises one of the eight psychological constructs measured by the Eating Disorder Inventory (Garner, 2004). Religious asceticism, then, is thoughts, desires, and behaviors that are self-denying which directly interact with a person’s spiritual beliefs. Historical records of self-starvation- the beginnings of EDs- seem to have culturally-infused origins that interact with religious belief in an ascetic way. For instance, the books From Fasting Saints to Anorexic Girls (Vandereycken & Van Deth, 1994) and Holy Anorexia (Bell, 1985) investigated the roles of medieval fasting practices in women seeking spiritual purity and a way of transcending the physical world through self-discipline and life-simplicity.

One of these case studies was written by Caroline Banks (1992), in which she interviewed a woman named Jane who saw her eating behaviors as an extension of her spiritual beliefs. Jane was raised in a strict religious home and kept a detailed personal diary about her struggle with food and weight, talking about these in terms of faith:

            My soul is heavy laden.

            My body hurts with excess weight.

            I want to relieve myself of it.

            But it won’t be moved.

            I must try hard once more.

To Jane, her body was divorced from her spirit in a dualism that created a “good” spirit or soul while trying to escape a “bad” physical body that was burdened by food. Morgan, Marsden, and Lacey (2000) also describe four women who also understood their eating disorders in religious terms, and “attempted to subjugate their bodies to by restraining hunger in the name of faith” (p. 479).

Although religious asceticism is probably not widespread within eating disorders, for some, it may play a role in how someone thinks about and make sense of his or her dieting and eating behaviors. The role of how faith interacts with eating problems is still not well understood, but it may have to do with the ‘moral language’ that one adopts when thinking about quality of foods and dieting behaviors- “good” and “bad” foods, as well as the idea that being heavy or not maintaining the right dietary lifestyle is a moral failing. Rather, as a way of reaching spiritual purity and physical purity, people may try to transcend the physical world by restricting food, or purging food when they feel a sense of religious guilt. This type of religious stringency is theorized to play a component in people with people of faith with ED, but has largely not been researched in clinical studies.

Summary

It is clear that spiritual life plays a huge role for people of faith who struggle with ED, whether it helps them to cope with eating problems, aids in their treatment process, or interacts with their personal beliefs about the moral values of food, weight, and dietary lifestyle. For the most part, it seems that findings in research support the idea that religion plays a positive role in protecting people or helping them to recover from an ED (Boyatzis and Quilan, 2008). However, the complex nature of a person’s religious life point to the fact that religiousness may very well have a positive and/ or negative impact the individual with an ED.  Given the fact that spirituality has been shown to play such an important role in the belief system of many patients, it would be prudent for any comprehensive approach to treatment to incorporate interventions targeting this area.

 1 Clinical Psychology Ph.D. Student, Fuller Theological Seminary

References

Banks, C. G. (1992). ‘Culture’ in culture-bound syndromes: The case of anorexia nervosa. Social Science and Medicine, 34, 867-884. doi:10.1016/0277-9536(92)90256-P

Bell, R. M. (1987). Holy anorexia. Chicago, IL: University of Chicago Press.

Boyatzis, C. J., & Quinlan, K. B. (2008). Women’s body image, disordered eating, and religion: A critical review of the literature. Research in the Social Scientific Study of Religion, 19, 183-210. doi:10.1163/ej.9789004166462.i-299.61

Garner, D. M. (2004). Eating Disorder Inventory-3: Professional manual. Lutz, FL: Psychological Assessment Resources, Inc.

Marsden, P., Karagianni, E., & Morgan, J. F. (2007). Spirituality and clinical care in eating disorders: A qualitative study. The International Journal of Eating Disorders, 40, 7-12. doi:10.1002/eat.20333

Morgan, J. F., Marsden, P., & Lacey, J. H. (2000). “Spiritual starvation?”: A case series concerning Christianity and eating disorders. The International Journal of Eating Disorders, 28, 476-480. doi:10.1002/1098-108X(200012)28:4<476::AID-EAT19>3.0.CO;2-T

Richards, P. S., Hardman, R. K., & Berrett, M. E. (2007). Spiritual approaches in the treatment of women with eating disorders. Washington, DC: American Psychological Association.

Smith, F. T., Hardman, R. K., Richards, P. S., & Fischer, L. (2003). Intrinsic religiousness and spiritual well-being as predictors of treatment outcome among women with eating disorders. Eating Disorders, 11, 15-26. doi:10.1080/10640260390167456-2199

Vandereycken, W., & Deth, R. . (1994). From fasting saints to anorexic girls: The history of self-starvation. Washington Square, NY: New York University Press.

Article Contributed by our Sponsor ~ River Centre Clinic
Published Date: January 11, 2013

Last reviewed: By Jacquelyn Ekern, MS, LPC on January 11, 2013
Page last updated: January 11, 2013
Published on EatingDisorderHope.com, Eating Disorders Treatment Assistance