Psychologist specializing in eating disorders (ED)

Visit eating disorders are fairly widespread, particularly in the younger population, although a proportion of the adult population also suffers from these disorders, which generally begin around adolescence but can persist into adulthood, when they become more chronic. These disorders manifest themselves in an obsession with food, weight and appearance.

According to belgiqueenbonnesante.be; 11 % of the adult population show signs of eating disorders (compared with 8 % in 2013 and 7 % in 2018).  

These signs are more common in the 18-29 age group, and more frequent in women than in men. 

Also in Belgium, 40,000 hospital stays a year are related to eating disorders.  

What are EDs?

Eating disorders are extremely disabling. They shape a person's life, and are often linked to underlying depressive or anxiety-related problems. In the most serious cases, they carry a suicidal risk, as people feel powerless to control their behavior. 

They are characterized by a particular relationship with food, which is associated with great psychological suffering and is often chronic. If they become long-lasting, the consequences for the individual's health can be dramatic. They are also extremely isolating, which further contributes to psychological distress. 

Definition of ED

The WHO (World Health Organization) defines eating disorders as follows:
"Eating disorders, such as anorexia nervosa and bulimia nervosa, involve abnormal eating and an obsession with food, as well as prominent concerns about body weight and shape."

They lead to psychological and somatic disorders, characterized by an inaccurate representation of the body, influenced by social pressure and negative emotions such as anger, shame and self-loathing.

The most common eating disorders are anorexia nervosa, bulimia and binge eating.

What causes eating disorders? 

The causes of eating disorders are unclear and poorly defined. Some put forward the genetic hypothesis, but this is not very coherent, as no specific gene has been discovered. Instead, it would seem that the relationship with food can run in families, and that these habits are then passed on from generation to generation, even if the form may change. 

We often see whole families where obesity is omnipresent. These are often families in which food is an important part of the family dynamic. Family relationships are often organized around food, to the detriment of other activities. 

What is most prevalent in this type of disorder is the difficulty in experiencing and regulating emotions.  

Like all compulsive behaviors, there's a strong tendency to short-circuit emotions, either by "eating" them, as in bulimia or hyperphagia, or by completely shutting them out through absolute control behavior, as in anorexia. 

By strictly controlling their diet, anorexics also feel they can control their emotional world. The obsession with food, whether gobbled up or discarded, also enables them to control their mental and emotional world, as their relationship with food takes over.

The origins of eating disorders.

Eating disorders generally have their origins in childhood, although they don't usually manifest themselves until adolescence or adulthood. 

Above all, these illnesses reveal developmental difficulties in childhood, often from the very first months of life. Their origins may lie in problems linked to the construction of identity, forms of insecurity, dysfunctional parent/child relationships, intergenerational trauma, or physical or sexual abuse. 

There are usually latent conflicts with attachment figures that are difficult to let go of, for reasons specific to each individual's family history. 

All kinds of configurations are possible, often also linked to the psychological problems specific to the parental figures due to their own histories. 

As a result, the development of autonomy during adolescence becomes complex, and the subject is sabotaged by eating disorders because relational and psychological conflicts cannot be expressed.  

The dependence/autonomy conflict crystallizes around food, and as the disease develops, it entrenches the subject in a proven dependence, isolating him more and more from others and from himself. 

Depression is central to this process. Depressivity is linked in this case to the impossibility of mentally detaching oneself from parental figures without risking a psychic fall. 

The autonomy needed to build an adult life is experienced as an abandonment, and so the path towards a stable adult identity is thwarted. Food, in excess or absence, becomes a form of obsession, symbolizing the impossibility of empowerment and jeopardizing the subject's identity. 

A way of life is then organized, away from all human relationships. Engaging in human relationships risks reviving the threat of abandonment. Food as a substitute gives the illusion that everything can be controlled. 

From this perspective, eating disorders are to be understood as an unconscious attempt to control intense feelings such as anxiety, insecurity and often guilt. 

Eating-related behaviors, such as binge eating or bulimic excess followed by vomiting, are part of a self-calming process, similar to addictions. They are therefore a sign of failure to establish a stable identity. A sign of deep-seated anguish and a failure of self-regulation, they anchor the subject in a problem that rapidly becomes uncontrollable and terribly mortifying. 

What are the different types of eating disorders?

Eating disorders can take many forms. According to the DSM5, the main categories are :

• Anorexia nervosa.
• Bulimia.
• Bulimic hyperphagia.
• Le Pica.
• Orthorexia.
• Merycism.

Anorexia nervosa 

Anorexia nervosa is an eating disorder that most often occurs during puberty. It manifests as a categorical refusal to eat normally for a long period, in order to lose weight or keep it off (Inserm, 2024). It is most often triggered during adolescence. 

It is characterized by a specific way of eating, either by total refusal, restriction or avoidance of certain foods.

 It may be accompanied by vomiting, laxatives and intense physical exercise to control weight. Body mass index is generally below 17.5. Growth is often slowed in adolescent girls. Perception of the body is distorted, and the subject is in denial about his thinness, always seeing himself as fat.

It is particularly prevalent in subjects with a tendency towards perfectionism, generally low self-esteem and anxious or depressive traits. Around 40 % of anorexic patients suffer from psychiatric disorders (Inserm 2024).

It often begins at puberty, with the first manifestation being a restrictive diet. This will continue, leading to increasingly severe restriction. Traumatic life events such as separation, bereavement, physical or sexual trauma are frequently found before the onset of the eating disorder.

The anorexic phase lasts an average of one-and-a-half to three years, but can last up to five years. After five years, two-thirds of patients are cured. For the remainder, we speak of chronic anorexia nervosa. Eventually, half of those treated for anorexia nervosa in adolescence are cured, a third improve, 21% suffer chronic disorders and 5 to 6% die (Inserm, 2024). 

Bulimia

Bulimia is an eating disorder characterized by the compulsive intake of a very large quantity of food in a short space of time. The person very quickly loses control over his or her food intake; it's a compulsive behavior that the person can't control. This is followed by a feeling of discomfort, followed by compensatory behaviors to control weight gain. 

In the vast majority of cases, people make themselves vomit immediately after the attack, compensating by taking laxatives or appetite suppressants, periods of youth or high-intensity exercise. 

Bulimic hyperphagia 

Hyperphagia resembles bulimia in every way, but is not accompanied by compensatory behaviors. In most cases, the sufferer is overweight or morbidly obese. 

Le Pica

This is an eating disorder that involves eating inedible products that are not food (paper, earth, clay, etc.). 

Usually, what people with Pica eat doesn't put them at risk. Sometimes, however, what they do eat can cause complications, such as constipation, digestive tract obstructions, lead poisoning from ingesting paint chips, or parasitic infection from ingesting soil (The MSD Manual, 2024).

This behavior doesn't usually interfere with the individual's social functioning, as it's usually done out of sight. However, this disorder is never isolated, and more often than not, reflects an underlying psychological illness such as autism, intellectual deficiency, schizophrenia, severe depression, and so on. 

Orthorexia

It's a compulsive behavior characterized by an obsession with healthy food. The subject spends most of his time planning his diet to reduce excessively his intake of fat, salt, sugar, or any other food that may be considered harmful to his own health. This disorder is accompanied by an equally rigid program of physical exercise. It's a progressive disorder, with the person following increasingly restrictive dietary regimes that can lead to extreme thinness, total social isolation, often leading to chronic depression of which the subject is not really aware. 

Merycism 

This is an eating disorder characterized by the regurgitation of food shortly after a meal, which the person chews involuntarily or not, and then swallows again. It can have dramatic consequences for the individual: weight loss, dehydration and ionic imbalance. It can be linked to emotional deficiencies, abuse, mental pathology or physical illness. This illness, which usually develops in childhood, can persist into adulthood, leading to social isolation.

Treatment of eating disorders.

They must be taken very seriously and treated as soon as possible after detection, as they are associated with considerable psychological distress. Suicide attempts are common among people suffering from this type of disorder. 

Anorexia is the condition associated with the highest mortality rate, with some studies estimating that 10 % of patients die within 10 years of the onset of the disorder. 

In the most severe cases, hospitalization is essential. Hospitalization cannot be in a general psychiatric unit, but in a specialized center, given the specific nature of the disorder and its similarity to addiction disorders. Indeed, the phenomenon of compulsion often impairs the will to get out of it, and sufferers often refuse treatment because they don't want to get out of the spiral. 

A multidisciplinary approach is essential. It requires :

• Medical follow-up with a specialist doctor to monitor and compensate for any deficiencies caused;
• A nutritionist to support and re-educate the patient towards a balanced diet.
• In the most serious cases, medication and psychiatric follow-up are required.
• Psychotherapy by a psychologist specializing in this type of disorder.  
• In the case of young individuals, individual care must be accompanied by family and sometimes group interventions. 

Psychotherapy for eating disorders. 

Psychological treatment must take place on two levels: behavioral and psychotherapeutic. Behavioral, to stop harmful eating habits, and psychotherapeutic, to deal with the associated psychological suffering. 

Psychotherapy with someone trained in this type of disorder is crucial. Beyond the obvious symptomatology, it explores the underlying causes motivating the eating behavior. 

The aim is to retrace the patient's history, to understand the key moment when the disorder began to manifest itself, and to grasp its evolution. 

Creating a trusting relationship in which the patient feels sufficiently supported is fundamental.

Every symptom has a function. Eating disorders are defenses against psychological suffering that has become unbearable, and each story is unique. Whatever the case, at the root of the disorder is always a predominant anxiety linked to major depressive experiences.

We'll need to help the person to reconstruct the thread of his or her history and understand the existential malaise at the root of the disorder. Whether it's due to a family dysfunction, trauma, transgenerational dynamics or a combination of all these factors, treating the underlying anxiety and depression will enable the person to break the compulsion mechanisms, re-establish a sense of belonging in life, rediscover satisfying social relationships, and restore the self-esteem and self-esteem that have been lacking. The key to treatment is to uncover what the compulsion of the eating disorder was trying to annihilate. 

A somatic approach such as meditation, Breathwork or EMRD can also support this work.