What are Eating Disorders Beyond 'Fear of Weight Gain'?

Eating disorders are frequently simply described as a ‘fear of weight gain’: an explanation used to explain what eating disorders are, how and why they manifest and what is required for recovery.

This explanation can be confusing to people with eating disorders if their experience of an eating disorder does not feel like it is a fear of weight gain. This might be because, rationally, they do not fear weight gain or even if they have discomfort at the thought of gaining some weight, it is not a fear to the extreme level that the eating disorder creates in them when they do try and eat more food or change other disordered behaviours.

In this post, I have put forward my understanding of eating disorders and what they are, above and beyond the simple 'fear of weight gain' description.

Firstly... An Explanation of Why Eating Disorders are Considered a 'Fear of Weight Gain'

With an eating disorder, no matter what triggers an individual's genetic predisposition to developing the eating disorder to switch on and activate in the first instance, once those genes have been triggered, the person is left with the illness.

The eating disorder then creates in them a biological drive to eat restrictively, engage in behaviours to compensate for eating and pursue all kinds of other behaviours that subsequently can result in more and more weight loss (although this does not mean a person necessarily drops to a very low BMI or even a BMI below the 'healthy' range but a weight that is less than their natural body should be). The person with the eating disorder also develops an aversion to doing any of the things required that might lead to them gaining weight and that aversion manifests as an incredibly strong fear response.

This does not mean that the person themselves, on a rational level, is scared of weight gain… but that their brain has mistakenly perceived anything that might lead to them consuming enough nutrition or not purging their intake in some way as a direct threat to their life.

Therefore, fear of weight gain or fear of things that might lead to weight gain is a very biological, deep, strong and baseline fear reaction in a person with an eating disorder, but that might not translate to them rationally believing that they don’t want to gain weight or that they want to lose weight.

This is an example of emotional / fear response brain versus rational brain where the fear response side of the brain wins battles if it perceives it necessary to take over the actions of the person with life saving measures (even if they are mistaken life saving measures, as is the case of the fear reaction created with an eating disorder).

Of course, weight gain is a very necessary part of recovery from an eating disorder for 99.9% of people and that is uncomfortable for many people and hard to accept, leading many to fear it, even on a rational level (largely due to the culture we live in) BUT the biological drive to avoid weight gain or even pursue further weight loss is so much stronger than anything the person might rationally think or believe.

This is where the explanation of eating disorders being a ‘fear of weight gain’ can seem very over simplified and difficult to understand, as well as potentially creating misconceptions about how dangerous and powerful an illness eating disorders are.

So then, beyond describing eating disorders as a baseline, inappropriate and strong fear response to weight gain or as a deep rooted, evolutionary response to a famine situation… what else are eating disorders in terms of their symptoms, the way they manifest and the ways in which they are then maintained and why they are so hard to recover from?

The answer to this is far from simple and ‘fear of weight gain’ is a very oversimplified description as to what eating disorders really are in their all encompassing and all consuming reality.

In truth, eating disorders are multi-faceted and made up of many layers, particularly when a person has been ill for any length of time. Below I will provide just a few of the layers that eating disorders can contain.

The Layers to All an Eating Disorder is Beyond 'Fear of Weight Gain'

An irrational, inexplainable and extremely powerful fear response to food related situations

These can include eating more food, different types of food, at different times, eating with people, not eating with people, using different cutlery, eating in a different environment... etc etc! It’s very hard to easily try to understand all these fear reactions (that are real and powerful) to be a simple deep rooted fear of weight gain.

The situations that create the fear response differ for each person with the illness, depending on what they have or haven't had ongoing exposure to during the illness, resulting in their brain perceiving any unknowns as an intense threat.

An irrational, inexplainable, powerful and strong fear response to being sedentary, not moving or not exercising

This doesn’t correlate for everyone to being a fear that, 'if I am still, I will gain weight'. For some, this might be the story they have attributed to the fear response.

The evolutionary response to famine theory for eating disorders does also provide another rationale for the movement compulsions so many experience - that it is derived from a baseline evolutionary brain, that on perceiving a food scarcity and famine situation is driving the person to move and migrate to find food. This is a theory with credibility, but to my mind, there are many complex reasons for what is causing this neuro-biological and physiological intense fear reaction in a person with an eating disorder when they try not to engage in movement than these theories alone.

An irrational, inexplainable and powerful illness that will create obsessions and compulsions to a range of things

People with eating disorders develop obsessions and compulsions to a range of things. These might be related to movement, ingrained habits or thought patterns or to food and eating (from buying it, preparing it, storing it, eating it) . Some of these come from the scarcity mindset that people who have eaten restrictively have too and some are less easy to explain but they are real and powerful and not always easy to correlate to even a deep rooted fear of weight gain or pursuit of thinness.

A powerful means to control difficult emotions, including stress, distress, anxiety, trauma in the past and more

Even if you don’t ascribe to the eating disorders stemming from trauma theory (which I don’t as eating disorders are more complicated than this and many people don’t have trauma in their past but do have eating disorders), it is true that when a person has had an eating disorder for any length of time, it becomes an incredibly powerful and learned means to control difficult emotions, stress or distressing experiences. Eating disorders are a powerful tool to numb emotions and to block out the distressing reality a person might be in and this is something that holds the person in the illness strongly once they have developed this very effective emotion regulation tool from the illness.

Recovery necessitates finding new ways to manage stressful situations and accept that other 'healthier' methods won't be quite as effective as the eating disorder behaviours of restriction, exercise or purging might be at instantly numbing.

Eating disorders are strongly ingrained and hard wired habits after any length of illness

Disordered habits, behaviours and thought patterns are more hard wired into the brain of the person with an eating disorder than most other habits will be. The brain wires in actions most deeply if they are linked to strong emotions, lead us to avoid situations that the brain has perceived as directly threatening (as has happened in the eating disorder) or help us avoid distress. Therefore disordered habits (behaviours and thoughts) will be so ingrained and instantaneous that your brain will fire off down those disordered pathways before you have had a chance to even begin to engage your conscious mind and realise what is happening.

This makes recovery not just about overcoming the irrational fear response but also overriding ingrained and strongly built habits and for anyone, even without the complication of an intense fear response, habit change is incredibly hard.

Developed and maintained by psycho-social and life experience complications

Tied in for anyone with an eating disorder are the added complications that stem from their life history; be that their relationships with others, experiences before or over the years of the illness or their deep rooted beliefs or values. These can all impact on how the person perceives the illness, what it means for them, what their particular fears are in terms of letting the illness go, and any complications related to this. For most people this makes the illness and recovery SO much more than a simple fear of gaining weight.

At the end of the day eating disorders are so complicated and we are only just beginning to scratch the surface of what eating disorders are, what they stem from and what is needed for recovery.

To me, the genetic and neuroscientific studies that are now bringing out more information offer hope, and the evolutionary response to famine theory as to how eating disorders might have evolved holds a lot of credibility. However, the causes of eating disorders and the complexities of eating disorders are still being understood.

In many instances, the theory of eating disorders as a baseline, irrational and powerful fear response to any situations that the brain has perceived might cause weight gain holds some truth. Eating disorders are much more complicated though in terms of what they stem from, how they manifest and the factors that maintain them than this explanation alone.

This post was really to encourage more open mindedness in understanding and considering this complex illness. To oversimplify it does not allow for wider thought, interpretation or further exploration of a particular person’s experience in the illness and it can downplay just how powerful and real the illness is to the person living with it each and every day.

For some people, for many people, the fear of weight gain is a very strong part of the illness but that fear of weight gain will only be a part of what the illness is for them, what is maintaining it now and why it is so hard to overcome.

I don’t think we always need to create a story for what a person with an eating disorder might be afraid of when they are attempting to eat more, eat differently or change other behaviours or habits. There is not a story that could ever be given that would even begin to explain the level of fear that people with eating disorders face when they have to change their eating patterns and disordered behaviors and thoughts in recovery… or even begin to demonstrate how much mental focus and mental and emotional energy the habit change to override the illness actually takes each and every moment of every day.

The fear reaction experienced with an eating disorder is real and so powerful and instantaneous but impossible to put a simple reason to, other than it being an intense, powerful and unexplainably irrational fear reaction to situations that the brain of a person with an eating disorder has attributed to be a direct threat to their life.

However, just because the illness is powerful and not easy to make sense of, does not mean that it is not possible to overcome those fear reactions, change those disordered habits, find ways to manage hard emotions, distress or even past trauma in new ways that will work and that don’t resort back to the eating disorder.

Yes, recovery will mean weight gain – that part is inevitable and I am not saying that the weight gain is going to be easy to tolerate. But I believe that you can deal with the weight gain and that your illness is not just fear of those gains… far from it. You can tolerate the weight gain and you can and will more than tolerate recovery, overcoming all aspects of this complex and poorly understood illness.