Understanding Eating Disorders in Young Women Athletes - An Interview with Dr. Deanne Pearson
By Catherine H. Knott, Ph.D.
Dr. Deanne Pearson grew up on a ranch in the western mountains. She rode horses, herded cattle, and swam in the creeks. Her athleticism grew to include school sports such as basketball and volley ball, and she went on to get her master’s degree and doctorate in sports psychology. Now a successful coach and nutrition counselor, she lives on another ranch in one of the wildest mountain areas in Montana, with her husband and two small children.
The less well-known part of Dr. Pearson’s story is that, as a result of childhood psychological trauma, she also suffered from an eating disorder, which lasted 12 years. Working out a solution to her bulimia helped her develop a method for helping other athletes to heal. These experiences and her subsequent research and practice in helping other women athletes with eating disorders became the subject of her master’s thesis and doctoral dissertation.
She completed an extensive survey for patients recovering at Bermuda, an eating disorder treatment center, for her master’s research. Her doctoral dissertation, titled “The Experiences of Five Division 1 Collegiate Athletes with Eating Disorders,” followed five university women sports stars from the beginning stages of the disorders through recovery.
“I found out that eating disorders had the highest fatality rate and the lowest recovery rate of any psychological disorder at that time,” Dr. Pearson says. “These athletes, like others who suffer from eating disorders, find themselves in a very serious physical and emotional state. Fortunately, there is a possibility of good recovery, but traditional therapy and counseling methods do not work. You need to use an addiction model.”
Dr. Pearson also encourages women to combine treatment with pursuing spirituality of their own choosing, because it allows them to relinquish the control that becomes an obsessive part of the eating disorder.
The athletes’ desire to have control over themselves and their eating habits to an unhealthy degree was one of several themes Dr. Pearson extrapolated from her five case studies. Each of the five women, despite the fact that their personalities and healing trajectories differed, expressed the feeling that a “monster” took over their daily decision-making. This “monster” seemed to take over their being and determine their thoughts, making them compulsive in their management of eating and exercise regimes.
“It is as if the control monster is constantly saying, ‘Got to eat,’ or ‘Got to run,’” says Dr. Pearson.
She stresses that it is important that parents understand this “monster” that takes over the personality, and realize that anything they say to their daughters “will be taken and used against them.” This element of the eating disorder frequently confuses parents, in Dr. Pearson’s experience. As parents try to say helpful things, they find that their words are rejected over and over again. But, Dr. Pearson says, they should realize that the “monster” control element that has taken over their daughter’s personality is rejecting them, while their daughter, trapped in a prison of self-destruction, loves and needs them very much.
Another metaphor that Dr. Pearson uses to help people understand the power of an eating disorder over a person’s life is that of a locomotive going down the railroad tracks, when the driver suddenly changes. In essence, the out-of-control driver takes over the train, or the personality, driving it where she wants to go. The real engineer – the daughter whom parents may feel they have lost – is forced to be silent, while the strange driver takes over her thoughts and actions.
One star college athlete with whom Dr. Pearson worked came in second in the nation in her sport at U.S.-wide competitive events. Yet even after doing so well, she was self-destructive. Her rationale, or rather, the rationale of the “monster” controlling her actions, was based on a slight correction offered by her coach. Her response to the correction, blown out of all proportion to the intended meaning, was to sink deeper than ever into her eating disordered behavior.
Effective Individualized Treatment
Dr. Pearson worked with students who participated in volleyball, cross-country, track and field, tennis, diving, and cheerleading. While she saw similar patterns of behavior in athletes from a wide range of sports, she urges parents to understand that each case is highly individualized, because each person is unique and will respond differently to the eating disorder and to treatment.
While many of the girls and young women she talked to shared similar issues such as a need to control and feeling emotional wounded, many did not fit into the standard model used in most treatment for eating disorders. A couple of the young women had been through extensive counseling before meeting with Dr. Pearson, but with little or no success. Based on her research, Dr. Pearson believes the lack of change was due to the fact that the counseling models predicted uniform patterns. If the patient’s responses did not match the treatment goals, the whole process derailed.
Dr. Pearson emphasizes the importance of using an addiction model, and one that assumes the patient does not have access to healthy responses within her. With an eating disorder, everything that happens to the person suffering from it leads toward the response of self-destruction, whether through bingeing and purging, self-starvation, or compulsive over-exercising.
Eating disordered patients need an outside source that can give them healthy responses, so that they begin to make better choices, says Dr. Pearson. A counselor must help them with restructuring and reframing their responses to daily events. Because the “control monster” programs unhealthy and self-destructive responses to each outside event, counselors and parents must assume that the eating disorder sufferer has no healthy responses she can access on their own.
Instead, the patient must receive help in restructuring her thoughts to re-create healthy emotional and physical habits. In essence, she must be taught all over what healthy responses are. In fact, says Dr. Pearson, in the early stages, counselors must teach eating disordered patients to respond in ways opposite to their feelings, because self-destructive thoughts have taken over their natural instincts.
Cognitive Awareness and Change
Dr. Pearson outlines the different states that sports psychology recognizes as affecting eating disorders and their treatments:
1) Cognitive – the early, thinking state, which helps people to plan ahead;
2) Associative – thinking and feeling at the same time; and
3) Automatic – a state in which there are feelings and nothing else (a state that athletes are encouraged to be in when they are performing in competition).
The later stages must actually be unlearned, Dr. Pearson says, for the eating disordered athlete to go back to the cognitive stage and identify what her healthy options are.
Finally, getting a conscious awareness of their actions and the consequences helps eating disordered patients, including athletes, resist the impulses toward self-destructive behaviors. Dr. Pearson says that even if the first inclinations to go back to the cognitive level occur three days after a bingeing/purging episode, she encourages eating disordered patients to go to that level and restructure their thinking, analyzing what their responses were, and what would have been a healthy response.
Counselors can help provide guidance on what healthy responses would include. Eventually, Dr. Pearson says, the time gap between the self-destructive behavior and restructuring her thinking will diminish, until finally, the patient will be able to think her way to healthier responses before she acts in self-destructive ways.
Athletes and others with eating disorders need professional help, Dr. Pearson emphasizes. They and the professionals treating them need to understand and use an addiction model. A counselor or therapist who has had an eating disorder and has healed from it can provide the patient with invaluable insights.
Dr. Pearson also recommends that parents seek out a professional with a wise, even spiritual, perspective on the challenges of dealing with a controlling personal force that urges self-destructive behavior. A spiritual outlet of any kind, as long as it is based on positive self-acceptance, allows the person with eating disordered behaviors to release her need to control to a higher power in the universe; at the same time, she receives encouragement to accept herself as she is.
Camps and treatment centers where the patient receives at least four to six weeks of treatment at a time can be essential for recovery. Some patients will need to repeat treatment several times.
A New Nutritional Outlook
Dr. Pearson’s current work with nutrition has given her new insights into the dangerous physical and nutritional changes that eating disordered athletes go through when they have engaged in self-destructive eating habits for years. Many athletes and other eating disordered patients have denied themselves essential fats, while bingeing so often on carbohydrates that they have, in effect, become “carbohydrate junkies.”
The doctors and nutrition counselors Dr. Pearson now works with recommend doubling intake of essential fats such as pure fish oils when the eating disordered patient first begins treatment. They have discovered that unbearable cravings for carbohydrates disappear within 24 hours of receiving these high, recuperative doses of essential fats.
From there, Dr. Pearson works with eating disordered patients and others to construct a healthy diet not based on the high-glycemic foods that trigger carbohydrate addiction. She teaches patients to eat raw fruits and vegetables at the start of meals while stressing that they must break down the stereotypic thinking that blames essential fats, rather than carbohydrates, for weight gain. The opposite is true – and once eating disordered patients are eating healthy diets, many of their unhealthy compulsions disappear quickly. Nutrition regimes high in fresh fruit and vegetables help patients to let go of cravings for carbohydrates, while stabilizing their weight in new and healthy ways.
