Much more than a problem with food
Eating disorders (EDs) are often compared to an iceberg. In this analogy, the visible part of the iceberg represents what people observe about the ED—that is, the symptoms related to food, weight, or body image obsession. The submerged part of the iceberg represents the unseen causes or motivations behind the disorder, which are related to emotions and insecurities (more numerous and complex).
Only 10% of the iceberg is visible in our behavior, while the remaining 90% is submerged. This submerged portion relates to each person's personality and life history. It's where we find aspects such as perfectionism, low self-esteem, emotional regulation, or emotionally stressful situations.
For this reason, during treatment it is essential to address the invisible part of the iceberg, as this is what triggers the eating disorder behaviors. We must focus our attention on tackling all the causes of the disorder to ensure a comprehensive therapeutic plan.
Eating disorders as an emotional refuge
The origin of eating disorders is multicausal and there are different risk factors that can predispose some people to develop this disorder.
Risk factors for eating disorders:
- Biological factors. Genetics can explain up to 60-70% of the risk of developing anorexia nervosa.
- Psychological factors, such as self-demand, perfectionism, and low self-esteem.
- Social factors. Currently, we have a beauty ideal that values thinness; there is a lot of social pressure regarding body image, and social media reinforces these ideals.
- Family factors. The family should be a healthy role model in terms of body values and eating habits.
- Triggering factors. These are related to a negative emotional experience, such as the lockdown caused by COVID-19.
On the other hand, there are protective factors within the family that can prevent the onset of an eating disorder, among which we highlight:
- Boosting the self-esteem of our sons and daughters.
- Promote a positive body image.
- Promote positive eating habits.
- Have at least one meal a day as a family.
- To provide tools to develop a critical sense towards information.
- Promote communication within the family.
- Share leisure activities.
- Reject aesthetic ideals.
- Promote autonomy and avoid overprotection.
- Warn about harmful content on the Internet and social media.
A workshop to find out what's underwater
With the users of the eating disorder day hospital at Sant Joan de Déu Hospital in Barcelona, we conducted a workshop to address the iceberg of eating disorders. The objective was to illustrate what people see and what they don't see in an eating disorder.
The tip of the iceberg represents what is generally thought of as eating disorders: problems with food (eating or not eating). But there is a very important part of the iceberg (represented underwater) that is invisible to many people.
An eating disorder is not just a problem with food, it is much more than that, and what the users of the day hospital represented was: sadness, insecurity, low self-esteem, fear of failure, body distortion, lies, compensatory exercise and negative thoughts.
To address the less visible aspects of the iceberg, we focus on perfectionism, self-esteem, emotional management, and interpersonal difficulties. For perfectionism, we enhance the personal worth and self-confidence of our clients, encouraging them to recognize their strengths and values beyond the demanding standards of beauty or success imposed by society. For self-esteem, we agree to foster it through empathy, understanding, compassion, and patience. For emotional management, we learn to experience and accept all emotions. And finally, to address emotional difficulties, we promote the development of social skills.
It is essential to remember the importance of addressing all aspects represented in the iceberg with specialized professionals to ensure a complete recovery. Eating behavior is how a person expresses their distress, and this expression varies from person to person.
If people affected by an eating disorder, their families, and those closest to them understand the less visible aspects of these disorders, they will be able to act more appropriately and help in the recovery.
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