Eating Disorders and Physical Disability
Few people are aware that eating disorders are common in individuals with physical disabilities.* This lack of knowledge can cause difficulty in both general counseling and eating disorder treatment programs. In an effort to shed light on these issues, I will address the reasons why a disabled person may develop anorexia, bulimia, or other eating disorders as well as special issues regarding treatment.
Body Disconnection and Shame
Those of us who are disabled have a body that may appear or react differently from what is considered the norm. We rarely see images of ourselves and our experiences reflected in the media, and this can have a strong influence on body esteem. Disabled people know that their bodies do not fit the standards of physical ability—feelings of inadequacy, fear, and shame are common. Thus, an eating disorder may develop as a way to gain control and punish the body for failing to do what others can do with ease.
Typically, disabled people who struggle with an eating disorder have heard little positive feedback about their bodies and physical abilities. They often have heightened feelings of body disconnection and shame regarding physical weakness. Negative remarks made by personal attendants and society in general often lead to feelings that our bodies don’t deserve the same rights or care. For example, someone who uses a wheelchair may turn to anorexia in an attempt to become lighter and easier to lift and thus reduce the frequency of negative comments.
High Rates of Sexual Assault
The connection between eating disorders and sexual trauma has been well documented. The majority of disabled people have been sexually assaulted. According to a recent article written by Daniel Sorensen for the National Center for Victims of Violent Crime, people with developmental and other severe disabilities are 4 to 10 times more likely to experience sexual violence than the general public. This population is at greater risk of assault throughout their life span, and people who are disabled as a result of accidents are at higher risk of assault after injury.
Commonly, perpetrators will tell a disabled person that his or her disability is the reason for the assault. This creates self-hatred and a desire to rid oneself of the disability and is a major factor in the development of eating disorders. In addition to the body hatred and powerlessness assault often creates, it can exacerbate the physical effects of disabilities, creating more shame and confusion.
Unfortunately, a disabled person is less likely to receive eating disorder treatment. Most professionals are not familiar with treating this population, and those who are disabled often hesitate to address issues related to the impact of their disabilities. Confronting body image issues is often threatening and creates fears of being seen as incompetent or being misunderstood and judged. Treatment thus requires a deep shift in how the disability is viewed. One of the steps in reducing body image shame is to work on developing a sense of body ownership and pride as is. Disability activists stress that disability is a difference similar to that of race. This neutral perspective can provide a good, healing foundation.
The Importance of Validating Feelings
To help a disabled person in recovery, families, friends, and attendants need to be sensitive to a person’s needs and feelings. Negative remarks about body size, shape, and disability should be avoided. Comments about how difficult a person is to lift and move or how little they move are potential triggers at any stage of recovery. Families and professionals need to be particularly supportive of expressions of anger, shame, and sadness. Many people with disabilities receive the message that their feelings are not valid. When we express anger about our care level, disability, or experiences with others, we are often told that we need to look at things from another perspective. It is crucial not to do this. Eating disorders and poor body image are clear signs that a person is listening to other perspectives at the expense of his or her own.
Disability Culture and Pride
Learning about disability culture and pride is a good way to allow a disabled person to delve into the complexity of their experience without feeling it is taboo. Some resources appropriate for older teens and adults include:
• www.geocities.com/discool.geo/discool.htm (this site includes a section on body image)
• www.raggededgemagazine.com (this site has books and good general resources)
As long as people view these issues as something to avoid, disabled people will continue to be at high risk for eating disorders and body esteem problems. The ability to heal from eating disorders and disability shame is tough, but rewarding work, and recovery is possible with time and support.
*For the purpose of this article, “physical disabilities” refers to those people with mobility difficulty or limb disabilities. This includes those who use mobility aids as well as people who walk independently.
By Laura Minges, BSW
Reprinted with permission from Eating Disorders Recovery Today
2004 Volume 2, Number 5
©2004 Gürze Books
About the Author
Laura Minges, BSW, is a researcher, author and public speaker living near Los Angeles. She specializes in body image, disability, and bioethics concerns.