The Struggle Continues

Today I bring you the fourth and final part of my chapter on the relationship between religious belief and anorexia nervosa. For the earlier parts just click on the links, Part I, Part II, and Part III.

Many women who do recover from anorexia nervosa consider their faith and spirituality as major factors.  Several articles and books have been written containing firsthand accounts of spiritual influences on recovery.   For individuals who present with pre-existing religious beliefs, spiritual interventions are often recommended in the treatment of many mental disorders, including anorexia.   In some cases, it is necessary to address the content of an individual’s beliefs, particularly if they affect or reinforce the disorder.  For example, in a case series presented by Morgan, Marsden, and Lacey, three patients with anorexia nervosa discussed questions about their belief systems as part of their treatment.   Although the outcome in each case was different, the process of spiritual examination proved useful in continuing recovery.   It is difficult to draw broad conclusions from this study because of the small sample size.  It is useful, however, to augment the other studies discussed in this chapter.
A religious worldview can play a part in the treatment of eating disorders.  In their volume, Spiritual Approaches in the Treatment of Women with Eating Disorders,  Richards, Harrison, and Barret present a theistic model for treatment similar to Richards and Bergin’s  approach to psychotherapy.  The purpose of their approach is to foster a spiritual identity in the patient, and “affirm their…worth as creations of God.”  They particularly focus on the heart as a metaphor for spiritual healing and as a means of trusting themselves.   They recognize spiritual growth as a gradual process and not an immediate or quick fix treatment. Richards, Harrison, and Barret argue that a theistic model allows for change and healing of the whole person.   The theistic approach is intended to be flexible in order to address the specific needs of the patient. Much like other clinicians, Richards, Harrison, and Barret advocate a multi-dimensional approach that recognizes the importance of spirituality.  Their argument is supported by the evidence cited in this paper, and reinforces the necessity of a well-formed theology of the body.
In addition to the clinical approaches listed above, there have also been a number of books and articles written on the nature of anorexia and the role of spirituality in recovery.   Michelle Mary Lelwica argues that anorexia is particularly the result of spiritual emptiness.  This position is similar to Richards, Harrison, and Barret in that it recognizes a role for spirituality in anorexia. However, whereas Richards, Harrison, and Barret advocate using a theistic mode of treatment to heal the whole person, Lelwica focuses on the lack of an internal spiritual life as the primary cause of anorexia.  Her theory is related to feminist and sociological explanations for eating disorders.
There are three criticisms of this research. To start there is some difficulty in quantifying religious belief. There does not appear to be one definitive method for measuring religious belief, and as such, the various studies have used different tests to measure religiosity. The studies cited acknowledge the complexity of the task and all use more than one measure.
In 1999, Lelwica wrote that there was a lack of research into the relationship of religion and eating disorders.   This chapter has referenced some of the many studies that exist.  Bell’s book, which addressed the connection, was published in 1985. Although more research needs to be conducted, there is a large body of existing studies.
The final criticism concerns the size and composition of the sample groups used in the studies. For example, Macias et al. included a sample of only 44 nuns, while the larger studies did not exceed 500 participants. Since females are more likely to develop anorexia nervosa the majority of the cited studies focus on female populations. These sample sizes are quite acceptable for psychology studies. Despite these last two criticisms, the four broad conclusions asserted in this chapter are supported by the available research: 1) religious belief influences body image both positively and negatively 2) the “thin ideal” is not the only cultural cause of anorexia nervosa 3) being religious does not guarantee protection from anorexia nervosa 4) a deep spiritual life has the potential to assist in preventing the development of anorexia nervosa.
The final two conclusions above seem to contradict one another. This is not the case because while members of religious communities do develop eating disorders, there is evidence that suggests that explicit religious teachings about the body can influence body image both positively and negatively. This influences the incidence rates of anorexia nervosa.  The general findings, presented by the various studies, supported each other.
There are currently many clinicians incorporating spirituality into treatments for anorexia.  More research is needed to conclusively say what role spirituality plays at each stage of the illness, but there is little doubt that a relationship exists.  By understanding the role of religion in the prevention and development of anorexia, religious leaders can develop strategies for combating poor body image and disordered eating within their communities.

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