Food has long ceased to be merely fuel for the body. It is charged with emotions, memories, social messages. It can be comfort, reward, punishment, or compensation. Within this emotional and cultural space, eating disorders develop – Anorexia, bulimia, and binge eating – Complex phenomena created from a combination of genetic, environmental, and familial components, alongside difficult emotional experiences and at times trauma.
Over the years, a close connection has been established between sexual abuse and the development of eating disorders. Among female and male patients at the institute, there is a particularly high correlation between sexual trauma and the onset of the disorder. But sexual trauma is not the only factor in the background: Any experience of loss of control – An accident, violence, a terror attack, or an ongoing reality of helplessness – May turn the body into a battleground.
An eating disorder is not merely a “problem with food.” It is behavior that harms the body’s normal functioning, and at times begins at very young ages. When young people cope with significant pressures, emotional difficulty, or a sense of not being understood at home, and alongside this there is early personality sensitivity, the body and its basic needs become a focal point of control. There are very few ways to rebel against the body – And an eating disorder is perceived, unconsciously, as a way to rise above the basic need to eat, or alternatively as a way to lose control in an extreme manner through binges.
Vomiting as well, a physiological mechanism meant to protect the body, becomes a tool of emotional emptying. These behaviors may become routine – From once a week to dozens of times a week – And the health cost is very heavy. Anorexia and bulimia may lead to cardiac arrest and systemic collapse, and one in every 20 female patients hospitalized due to an eating disorder will not survive.
The public image reduces the disorder to extreme thinness, but the reality is far broader. There are those who develop an eating disorder from what appears to be a healthy lifestyle: Intensive physical activity and extreme adherence to “clean” nutrition. Modern society glorifies physical achievement, marathons and triathlons, and sees thinness as an ideal. Within this idealization, it is difficult to identify when behavior becomes harmful.
The age range of the female patients is particularly wide – From 18 to 80. Many of them managed for years to create an appearance of full functioning: Work, family, routine. But beneath the surface, food managed their lives. The children learned that mother disappears to the bathroom in the middle of the meal, or that food is a source of tension and anxiety. The routine was maintained, but the quality of life was very poor.
Since the events of October 7, a worsening in the characteristics of the disorders has been evident. More complex and extreme cases are reaching treatment, at times against a background of post-trauma, anxiety, and depression. Even when it seems that routine has returned, for this population the sense of instability has remained unchanged.
A long process, but possible
Treatment requires a different approach. A rational explanation about the damage of the disorder is not enough to bring about change. Understanding alone does not change behavior. In contrast, creating new eating habits within a supportive framework enables a gradual change in self-perception. In the therapeutic model, emphasis is placed on compassion – Toward the female patients and toward themselves.
Within an intensive day-treatment framework, the staff and the female patients eat two meals a day together. For many, this is an anxiety-provoking experience. The feeling that the food is entering the body may flood a real fear of immediate weight gain. The therapeutic space is careful to avoid triggers, and to provide close emotional support during meals.
Change is possible, but it is a long process. Five to seven years are required until new habits stabilize. About half of the female and male patients succeed in maintaining the achievements over time, at times after more than one round of treatment.
The family has a decisive role. Parental involvement in the process is important, and at times it is recommended that the parents also seek professional guidance. This creates at home an atmosphere that recognizes treatment as something legitimate and does not label the person coping as the family’s problem. At the same time, it is important to avoid judgmental references to the body – Even if they are said with good intentions.
Western culture sanctifies self-criticism as a means of progress. But when criticism becomes an unceasing search for flaws, it may feed the disorder. A central part of the rehabilitation process is learning self-compassion: To reduce hatred toward the body, to change the internal dialogue, and to allow an existence that is not managed by a constant struggle with food.
An eating disorder is an expression of deep distress – But change is possible. With consistent work, professional support, and an understanding family environment, it is possible to restore the body to its natural place: Not as a battlefield, but as a home.
Amir Zendakovich is Director of the Psychological Division and the Institute for the Treatment of Eating Disorders, Reuth Rehabilitation Hospital Tel Aviv
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