This diagnostic and statistical manual of mental disorders fourth edition has identified three categories of eating disorders that individuals could be diagnosed with. These categories are anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. (Treasure, J., Claudino, A., & Zucker, N. 2010, 583) As of 2003, “eight million Americans suffer from eating disorders” (Lintott as quoted in Douglass 2009, 126). Although these three categories of eating disorders differ from one another, they do share common symptoms that make them identifiable as eating disorders. “For example, extreme dietary restraint, binge eating, and overvalued ideas about weight and shape can be present in all forms of eating disorder” (Treasure, J. et al, 2010, 583).
Recently, there has been a progressive movement towards integrating “nontraditional, awareness-based therapies such as yoga” (Douglass 2009, 126) into the treatment of individuals suffering from eating disorders. According to Swami Muktibodhananda (2008) “the main objective of hatha yoga is to create an absolute balance of the interacting activities and processes of the physical body, mind and energy” (7). This objective may be important to individuals suffering with eating disorders as “extreme body image disturbance and eating disorders can be conceptualized as a dualistic split between mind and body or a spiritual crisis (Dittmann, K.A., & Freedman, M.R., 2009 274). Much of the research done on this topic agrees that using yoga as a means of balancing the body and mind, and therefore eliminating this split, may be a step towards recovery for those suffering from disordered eating. However, this may only be possible if yoga is presented in the correct context, with a specific cultural lens.
More Americans suffering from eating disorders are women, opposed to men. Lintott, as quoted in Douglass 2009 states that 90-95% of Americans with eating disorders are women. Women growing up in this western culture are “sexually objectified more often than men in visual mass media” (Daubenmeir 2005, 207). Everyday they are bombarded by messages of how they should look, and the body they should have, and could have if they tried. Most women do not have the culturally ideal body, and were not born to ever have it. This creates a struggle in which the woman is constantly trying to manipulate and control her body, to make it do or be what she wants it to be. The body becomes an object, separate from the self.
Research suggests that traditional forms of yoga can aid in the treatment of eating disorders by removing the focus from what the body looks like, to what the body feels like. Dittmann & Freedman 2009 explain a woman’s objectification of her body as coming from the fact that she has learned to view herself as an outsider of her body, and therefore “this may create distance between a woman and her internal bodily cues and sensations” (274). Essentially, the woman with an eating disorder is so disconnected from her physical body that she can no longer sense it; therefore, her “disordered eating may result from a lack of awareness of cues regulating food intake, a lack of responsiveness to these cues, or both” (Daubenmeir 2005 208).
In yoga practice, the teacher often tells the students to move “mindfully” through the practice. It is through this mindfulness that a transformation may occur, and an eating disordered patient may begin to become aware of her body. Krishnamurti (1999) writes about stillness of the mind. He says “there is only observation out of complete stillness of the mind” (85). In our yoga practice we work to achieve this sense of stillness and observation by focusing on our breath, and the way that it feels. We focus on the sensation of breathing. Yoga practitioners are encouraged to move based on their “internal awareness, rather than outward appearance” (Daubenmier 2005 208), and are trained to respond to felt bodily sensations. All of these things may help an eating disorder patient become more attune to her bodies needs, and help to “unify mind and body by immersing ones self in subtle sensations of the body” (Shiffman as quoted in Daubenmier 2005). On the other hand, this kind of awareness of the body can be uncomfortable for individuals with eating disorders. Often these patients have separated themselves from their bodies because as one patient told Douglass 2009, “I just don’t like being in my body” (130). This sudden focus on the body can be overwhelming and actually have a negative effect.
The western culture of yoga practice is largely focused on the body, which may also have a negative effect on the health of women with eating disorders. Women on the cover of Yoga Magazine are often thin, toned women wearing small, tight clothing. They are often portrayed in positions that are not possible for a beginner yoga student to put their bodies into, but are intended to look like everyone could do it. Although the focus of yoga is not traditionally supposed to be on the effects of yoga on the physical body, yoga is often sold in the United States as a way to get fit. Yoga is portrayed as a form of exercise that will tone muscles, stimulate weight loss, and increase flexibility. For women with eating disorders who have a “preoccupation with weight, shape or both” (Treasure, J. et al, 2010584), this focus in the yoga practice could do more harm than good. These individuals use the way that they look to in “determination of self-worth” (Treasure, J. et al, 2010584), and therefore, will be prone to comparing themselves to the other practitioners, to their teacher, and to the images of yoga practitioners that they see around them. The benefits of traditional yoga practice may be buried under the comparisons and self-objectification.
Individuals with eating disorders engage in restrictive behaviors. These behaviors include cutting back on the amount of food eaten, strict rules about eating, prolonged fasting, ritualized behavior associated with food, and eating little variety of foods. These behaviors are associated with a sense of control and with manipulating the body. Part of the typical treatment of eating disorders is to remove these restrictive behaviors, and help the patient to find more freedom with their ability to eat. It is interesting that yoga is used to treat these disorders, when traditional yogis in the eastern practice of yoga follow many of these restrictive behaviors.
For example, in the film “Fire Yogi”, the yogi portrayed in this documentary eats very strictly. For the past almost thirty years he has sustained himself on consuming solely a banana and a glass of milk twice a day. Like an individual with anorexia, the fire yogi restricts his intake of food, and does not receive adequate nutrition. He also weighs less than 100 pounds, which is a very low body weight for a grown man, and low body weight is a symptom of anorexia. When he does eat, he has a very particular ritual around they way that he consumes his food. Preparing it just so, and eating it is a calculated way. The fire yogi did not perform these actions as a form of an eating disorder, although in the west we would call his eating disordered, his reasoning was a spiritual one.
The fire yogi is not unlike traditional eastern yogis. In Hatha Yoga Pradapika Swami Muktibodhananda explains, “the stomach should never be overloaded, it should be half filled with food, one quarter with water and one quarter with air” (134). He writes that a yogi will eat cautiously” (134). This is reminiscent of an anorexic patient’s attention to what they are consuming, and their restrictions on the amount of food they will let themselves consume. Something that is extremely similar between a patient with an eating disorder and a traditional yogi is the little variation of foods in the diet. “A yogi’s diet should be simple and bland” (Muktibodhananda 2008,137). “The foods which are prohibited (for the yogi) are: those which are bitter, sour, pungent, salty, heating, green vegetables (other than those ordained), sour gruel, oil, sesame and mustard, alcohol, fish, flesh foods, curds, buttermilk, horse gram, fruit of jujube, oil cakes, asafetida and garlic” (Muktibodhananda 2008, 137).
Although a patient with an eating disorder may not be practicing yoga with any thoughts of become a traditional eastern yogi, they may easily find themselves coming across this information in their study, or in any impendent research they decide to do. If they are practicing outside of a clinic with other patients, and in the mainstream yoga culture, they may even hear this from a yoga teacher. Although the yogi is not practicing these restrictive behaviors in order to manipulate the body to look a certain way they may be almost identical to behaviors of the patient. If the patient notices this, it may be a type of reinforcement that these restrictive behaviors are not unhealthy, especially considering how healthy the fire yogi appeared to be.
This creates a dilemma for me, in the use of yoga for the patients with eating disorders. In the West, the culture shapes yoga to focus a lot on the physical body. Although the focus should be on integration of the mind and body, and of the felt sensations of the body, due to Western culture in general, there is a great emphasis on the way the body looks, and what the body can do. “A glance at the yoga marketplace of today shows just how complete the operation has become, with ‘yoga’ now virtually being synonymous in common parlance in the West with posture practice” (Singleton 1972, 113). These postures that are common today are not unlike traditional postures, however, postures that once were meant to purify the mind, are now meant to beautify and improve the body. However, there seem to be patterns in the eastern philosophy that would also be unhealthy for eating disordered patients. “Yoga classes and their instructors very widely in terms of emphasis on the physical versus the spiritual. Some yoga classes could reinforce the very self destructive beliefs and cultural values that we are trying to extinguish” (Boudette 2006, 167).
Binge eating is an interesting disorder that has shown results through its treatment with yoga. According to the American Psychiatric Association as quoted in Mciver, McGartland AND O’Halloran 2009, “binge eating is typically characterized by several criteria, including consuming large amounts of food, accompanied by feelings of lack of control” (1234). Dittmann & Freedman 2009, found that women’s abilities to trust their bodies and to read their own signals improved, thus decreasing their binging episodes. During a yoga class I was once told “ if you can hold this pose for another thirty seconds, it will carry over into your life outside of class and you will have the self control to do what you want.” Much of postural yoga, the common practice in the West, is focused on self control, and the ability to hold onto a pose for just a little bit longer, and on the ability to sense what the body wants and what it needs.
Unlike bulimia, binge eating disorder is that the disorder is not influenced directly by body shape and weight (Hoeken, Veling, Sinke, Mitchell, and Hoek, 2009, 595). In this disorder, the focus is on self control, or lack of it. Binge eating occurs often times due to anxiety. Yoga may help in the treatment of this disorder because it “introduces many patients to a new sensation: relaxation” (Boudette 2006, 167). Some patients that Boudette (2006) spoke with patients who expressed feelings that their anxiety over small things no longer felt daunting, and they could look at things in a new perspective (168). In Western culture yoga is sold as being a relaxation technique. Through the use of controlled breathing, and postures that stretch out the body, practitioners often feel a sense of relaxation after finishing a class in the West.
It has not been proven that the use of yoga as a treatment of eating disorders is either effective or not effective. It may depend on the individual, and it may depend on the specific class that that individual is taking. Western styles of yoga may place too much of an influence on the body and the manipulation of the body to really benefit an eating disordered patient, in fact they may even do harm. However, Eastern traditional yoga has an emphasis on the restriction of food that too closely mirrors anorexia to be totally comfortable either. There are problems with this treatment, but there are also benefits, such as relaxation, and allowing the patient to realize that their body is powerful. When the integration of mind and body occurs, it could be an extremely powerful moment for a patient, and may create some great change. Finding the correct balance to help foster an environment that will allow this change to occur may be the difficult part.
Resources
Boudette, R. (2006). Question & Answer: Yoga in the Treatment of Disordered Eating and Body Image Disturbance: How can the Practice of Yoga be Helpful in Recovery from an Eating Disorder?. Eating Disorders, 14(2), 167-170. doi:10.1080/1064
Daubenmier, J. (2005). The Relationship of Yoga, Body Awareness, and Body Responsiveness to Self-Objectification and Disordered Eating.. Psychology of Women Quarterly, 29(2), 207-219. doi:10.1111/j.1471-6402.2005.00183.x.
Dittmann, K., & Freedman, M. (2009). Body Awareness, Eating Attitudes, and Spiritual Beliefs of Women Practicing Yoga. Eating Disorders, 17(4), 273-292. doi:10.1080/10640260902991111.
Krishnamurti, J. 1999, This Light in Onesself: True Meditation. Boston: Shambhala Publications
McIver, S., McGartland, M., & O'Halloran, P. (2009). "Overeating is Not About the Food": Women Describe Their Experience of a Yoga Treatment Program for Binge Eating. Qualitative Health Research, 19(9), 1234-1245. Retrieved from Academic Search Premier database. 0260500536334.
Muktibodhananda, S. 2008, Hatha Yoga Pradapika. India: Yoga Publications Trust
Singleton, M. Yoga Body: The Origins of Modern Posture Practice. New York: Oxford University press
Treasure, J., Claudino, A., & Zucker, N. (2010). Eating disorders. Lancet, 375(9714), 583-593. Retrieved from MEDLINE database.
Vasan, M (Director). (2007). The Fire Yogi: A Story of an Extraordinary Journey [DVD].
van Hoeken, D., Veling, W., Sinke, S., Mitchell, J., & Hoek, H. (2009). The validity and Utility of Subtyping BulimiaNnervosa. The International Journal Of Eating Disorders, 42(7), 595-602. Retrieved from MEDLINE database.
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