The Use of Spirituality in Eating Disorders Recovery
By Dena Cabrera, PsyD, CEDS
The word disorder in the dictionary is defined as “a breach of peace.” Eating disorders are just that: disorders that are a breach of peace in the soul. These are conditions of dis-order of life, body, food, and self. Not to mention, these disorders wreak havoc on relationships. It is no wonder that eating disorders are complicated and treatment is even more complicated. Every person is unique, and treatment varies with each person. A biological, psychological, and social approach has been standard in the treatment of eating disorders. However, treatment of the soul is needed for most everyone, and it is spirituality that brings the soul back to life and nourishes it.
Ask 1,000 people and get 1,000 different answers on how to define spirituality. It’s different, fluid, and unique for everyone. It can be an experience, a feeling, an interaction, a dream, a phenomenon, an object, or anything else the person experiences as spiritual. The dictionary says that spirituality is a “search for the sacred.” My thoughts are that it could be a “search for,” or simply it could just “be.” It could be a connection or attunement with God or a higher power, feelings of enlightenment, harmony with truth, oneness with nature or the universe. It could also be love, compassion, and honesty. It can’t be bottled up or put into a package. It has to be experienced.
The Mental Health Foundation (2006) reports that spirituality is composed of the following:
- A sense of purpose
- A sense of “connectedness”—to self, others, nature, “God,” or other
- A quest for wholeness
- A search for hope or harmony
- A belief in a higher being or beings
- Some level of transcendence, or the sense that there is more to life than the material or practical
- Those activities that give meaning and value to people’s lives
On the other hand, religion can be a little more defined. It differs from spirituality in that religion may involve certain religious beliefs, practices, feelings about God or a higher power, or other things that may be expressed with a religious affiliation, institution, or denomination. The two can certainly intertwine and overlap, and some people can experience them as one and the same.
A Place Setting for Spirituality With Eating Disorders
Does spirituality belong in eating disorders treatment? In my training as a psychologist, spirituality and religion are openly recognized as types of diversity that we as professionals are ethically obligated to understand and respect. More than that, in the treatment of eating disorders, we are doing a disservice if we do not look at and explore an individual’s spirituality in an effort to connect with the soul.
Spiritual treatment approaches encourage professionals treating eating disorders to address patients’ spiritual concerns when relevant and to use language, verbiage, and interventions that demonstrate honor and respect for the healing potential of their patients’ faith or spiritual connection.
Swinton (2001) argues that stress and anxiety have spiritual symptoms such as a loss of meaning in life, feelings of alienation and indifference, no sense of the future, and the inability to focus on God or to meditate. There is evidence that eating disorders and anxiety are significantly correlated. Thus, Swinton’s position may be applied to eating disorders.
Eating disorders affect identity, sense of self, and soul. I have observed a variety of spiritual and religious issues in my patients—lack of spiritual identity, negative images of God (punitive/shaming God), feelings of spiritual unworthiness, fear of abandonment from God, guilt over behaviors that are incongruent to their values and faith, difficulty with forgiveness, and a lack of grace for self and others. I have also seen a reduced capacity for compassion and forgiveness for themselves.
Those who struggle with food, hardship, pain, and shame tend to be external seekers and want tangential representations to prove they are enough. They tend to look for love in all the wrong places, focus on the mirror or others for approval, and become hostage to their thoughts and feelings. They want some certainty in the control of food.
“I have a lot of faith,” writes Anne Lamott (2005). “But I am also afraid a lot, and have no real certainty about anything. I remembered something Father Tom had told me—that the opposite of faith is not doubt, but certainty. Certainty is missing the point entirely. Faith includes noticing the mess, the emptiness and discomfort, and letting it be there until some light returns.”
When you feed your soul through faith and spirituality, you feed your sense of self-worth. The more you realize your spiritual worth, the less dependent you are on your body to define you. And this sets you free to sharpen and attune to your values outside of shape, size, and weight. Spiritual nourishment is as important as feeding your body. The soul is the lens in which we view life. It is art, song and dance, it is poetry, and it is love.
Part of spiritual connection and development is obtaining nourishment to regain or gain dignity and self-respect. Those with eating disorders experience significant loss not only in connection with the soul or self-worth, but in their dignity and self-respect. Michael Berrett has been inspirational in his work in spirituality and eating disorders. He shares in his coauthored book that “being true to the heart generates an inner strength in the patient that is expressed through dignity and self-respect. Dignity of self is expressed by increased confidence, faith, and determination to live life with real purpose” (Richards, Hardman, & Berrett, 2007). Spirituality is a powerful recovery tool, as it helps patients connect to the heart and find purpose and meaning in their lives.
And how do we feed it? By allowing light, not darkness, into our body, heart, and soul. I read a quote that stated, “The soul always knows what to do to heal itself. The challenge is to silence the mind.” The difference in working with eating disorders is that sometimes we have to lasso the soul back from the eating disorder.
In Women Food and God (2010), Geneen Roth talks about “when even a moment of that ‘spiritual’ part of them is experienced with food, there is a natural inclination to want to keep exploring, keep discovering, keep touching the place that has never known suffering—which is, after all, the function of any spiritual practice.” When we feed our soul with spiritual food, then we begin to connect with life. Carolyn Costin writes in her book, “Think of your eating disorder self and your soul self; the one you ‘feed’ will be the strongest. Getting better is about feeding, or strengthening, your soul self” (Costin & Grabb, 2012).
Below is a spiritual menu including tools and interventions adapted from the “Food From Heaven” chapter in my book, Mom in the Mirror (Cabrera & Wierenga, 2013).
When you feed your soul, you feed your sense of purpose, and spiritual tools can assist with that connection.
Truth: Everyone’s truth is different. The bible says the truth will set you free. Working with those with eating disorders has taught me that the lies we tell ourselves are the most destructive. Finding truth can be a pathway to the heart.
Prayer: It’s a great tool. There is no right or wrong way to pray. It helps you feel that you are not alone.
Humility: Do nothing out of selfishness—consider others.
Gratitude: Create a journal in which you can jot down what you are thankful for. Reminding ourselves of the simple gifts such as a hug, smile, food, shelter, and family always puts things in perspective.
Generosity: Give and then watch as, in turn, you receive.
Reflection: It is important to process and engage yourself in thought, to sit still and become connected to life. There are devotion books, mobile apps, mindfulness practices, and websites that can help with this.
Community: Creating a community of support and guidance is crucial. You must have support not only to survive, but to grow and develop as a spiritual person.
Compassion: Berrett says, “Compassion is ‘something we do’ and ‘eventually who we become.’” Compassion helps us transform our perspective on life, especially with those with eating disorders where the internal voice can be demeaning and negative.
There are many wonderful suggestions regarding spiritual interventions in Spiritual Approaches in the Treatment of Women With Eating Disorders (Richards et. al., 2007). Here are a few that I have incorporated into my work:
- Conduct a Spiritual Assessment: What is the patient’s faith or spiritual life? Obtain an understanding of the distorted and dysfunctional religious and/or spiritual beliefs.
- Integrate Spiritual Concepts: God’s love and grace, forgiveness, love, higher power (all concepts learned from the client in the spiritual assessment).
- Spiritual Journaling/Reading Scriptures: Bible studies, inspirational readings.
- Prayer: It can be a powerful and meaningful resource to assist patients in their healing, coping, and growth.
- Music: Incorporate uplifting and sacred music.
- Letter Writing: To the self, God, body.
- Teach Compassion Training: A great resource is A Fearless Heart: How the Courage to Be Compassionate Can Transform Our Lives by Thupten Jinpa.
- Mindfulness and Meditation: There are many books and resources on the subjects.
- The Big Book: The Twelve Steps can very useful and helpful.
Overall, working with individuals with eating disorders is about being willing to enter a dark place with them and pull them from the depths of the abyss. It’s about meeting people where they are at and learning what they yearn for in their life. We must follow their lead, respect their boundaries, and, through our own compassion, assist them in spiritual health.
About the author:
Dena Cabrera, PsyD, is a licensed clinical psychologist and a certified eating disorder specialist at the Rosewood Centers for Eating Disorders, where she is serves as the executive clinical director. Dr. Cabrera has spent her entire career passionate and committed to efficacy and quality of treatment of patients with eating disorders. Dr. Cabrera is the author of The Mom in the Mirror: Body Image, Beauty and Life After Pregnancy.
Cabrera, D., & Wierenga, E.T. (2013). Mom in the Mirror: Body Image, Beauty, and Life After Pregnancy. New York, NY: Rowman & Littlefield.
Costin, C., & Grabb, G.S. (2012). 8 Keys to Recovery From an Eating Disorder: Effective Strategies From Therapeutic Practice and Personal Experience. New York, NY: W.W. Norton & Company.
Jinpa, T. (2016). A Fearless Heart: How the Courage to Be Compassionate Can Transform Our Lives. New York, NY: Avery.
Lamott, A. (2005). Plan B: Further Thoughts on Faith. New York, NY: Riverhead Books.
Mental Health Foundation (2006). The Impact of Spirituality on Mental Health. Retrieved from https://www.mentalhealth.org.uk/sites/default/files/impact-spirituality.pdf
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.
Roth, G. (2010). Women Food and God. New York, NY: Scribner.
Swinton, J. (2001). Spirituality and Mental Health Care. Philadelphia, PA: Jessica Kingsley Publishers.