Eating disorders often present concurrently with other mental health disorders, like anxiety or depression. Bulimia nervosa and anorexia nervosa are the most prevalent, typified by restriction of certain or all foods in the former, and binging and purging episodes in the latter. Religion’s role in the development of eating disorders is likely not significant, but it does present some confounding variables in the treatment and recovery of religious patients.
Because many religions involve some aspects of food restriction or fasting (or both), and the imperative to participate in these traditions are often external, this can impose stress. A person who is suffering from an eating disorder not related to religious practice or experience might be wholly engulfed in the disorder if authoritative forces are driving them further towards restriction.
This is not to say that religious traditions of fasting or food restriction are psychopathological; many billions of people practice their faith and food guidelines each year without developing an eating disorder. The key element here is how religion factors into both the potential for developing an ED and how it can impact recovery. As religious observance is often critically important to those who practice, it can be seen as overwhelmingly imperative that they follow their faith, even if it’s to the detriment of their recovery.
We will look at some major religious food restrictions and how they can impact the development of an eating disorder in at-risk individuals. Furthermore, we will look at how religion impacts the ability to fully recover from an eating disorder, how to integrate religious practice regarding food into recovery, and also how religion and belief can help recovery.
Religious Practice And Food Restriction
Most of the major world religions practice some manner of fasting — Lent for Christians, Ramadan for Muslims and Yom Kippur for Jewish people are all examples of restrictive eating time frames. Under most circumstances, these are engaged in healthfully and without consequence. For someone who is at risk of developing an eating disorder, however, and for whom religious ideation might be a concern as well, these restrictive periods can push fully into disordered eating.
The difficulty of treating eating disorders within a religious framework is multifold, and are usually a combination of these and other factors:
- Typical stress factors that lead to eating disorders: trauma, social influence, difficulty integrating or pathological body image
- Incongruence between expected religious and cultural norms and secular society (this is more common in adolescents and teens)
- Authority within religious groups that downplays psychopathology, not just eating disorders but the consideration of any mental health diseases being “real”
- Deeply held religious beliefs that create a sense of “failure” should a person — even one who is suffering from disordered eating — not fulfill the requirements of restricted eating imposed by their faith
While resolving eating disorders in the general population requires intensive outpatient therapy and aftercare, within a religious framework the resolution of ED can be dramatically more complicated. On one hand, people with religious backgrounds tend to have a strong support system, but religious beliefs can just as easily create strict value sets that might inhibit recovery. Treatment is often a difficult line to walk unless the religious practice is integrated into recovery and the support system goes all-in on the treatment as well.
Basis Of Religious Belief And Causal Relationships To Eating Disorders
Patients who present with stronger extrinsic religious beliefs — that is, religion imposed upon then — have a much higher incidence of eating disorders than those with intrinsic belief. There are a variety of factors that go into this relationship:
- People for whom religion is cultural and involuntary are likely to have less feeling of control in their life and eating disorders are often an attempt at control. Particularly when there is not a strong support system in place, these people will restrict or alter their eating patterns.
- Directly related to this are findings that for people who feel strong intrinsic religious belief, their relationship with their God is much stronger. This creates a more powerful sense of completeness and less body dissatisfaction, which in turn causes fewer cases of eating disorders in that demographic.
- Religious observances of fasting periods where participation is seen as involuntary or where not participating is seen as sinful or socially maligned are correlated with a higher incidence of mental health disorders. These include bulimia nervosa and anorexia nervosa but can also include binge eating disorder when restrictive eating patterns are extrinsically imposed.
Eating Disorders And Islam
Because the fasting period of Ramadan is a month long and restricts eating from sunup to sundown, it can be difficult particularly for someone with binge eating disorder. Someone who is already likely to restrict and then overeat in a small window of time is far more likely to do it if there is religious imperative.
Culturally within Islam is the concept of modest dress and a prevalent theme that anyone who is suffering from body image issues can simply wear larger clothes. This is not a positive response to an eating disorder, as it simply masks the problem and the associated health risks are still present and dangerous. Modest dress is a confounding variable when it comes to treating Muslim eating disorder patients, mostly because it creates a social release from the pressure of internalized distress.
Furthermore, Muslim eating disorder patients have food restrictions within the concept of halal as well. This can make restrictive eating worse because access to food that is acceptable can be difficult. Unlike kosher practices within the Jewish community, halal requires the invocation of Allah’s name when the animal is killed and reliably finding halal foods adds a level of complexity to recovery from disordered eating.
Resolution Of Eating Disorders Specific To Islamic Patients
Maintaining halal eating practices and observance of Ramadan can interfere with the resolution of eating disorders. Psychological incongruence can arise if these are removed, particularly against the will of the participant, and extremely so when the religious practice is largely extrinsic. Therapy and treatment that provides solutions that integrate Islamic belief are therefore important.
One of the first considerations is impressing upon the patient and their family that Ramadan cannot be observed by people who are ill. This is part of Islamic law; Allah does not want you to participate if it would cause grievous harm. Restrictive eating disorders and Islam are likely underreported within that community but there is a prevalence that needs to be addressed in a culturally sensitive way.
Considering the importance of halal eating within Islamic communities, one step therapists might integrate is ensuring halal food is readily available for patients.
Finally, the support of family and friends within the framework of Muslim belief is critical for success. Out-patient cognitive-behavioral therapy is still the best treatment for eating disorders, and a successful program will integrate cultural and religious facets of the patient’s life. Understanding how recovery works within religious societies will also be a key component of aftercare, engaging general practitioners, therapists, and religious leaders.
Eating Disorders And Judaism
While the incidence of eating disorders within the overall Jewish community is not higher than the general population, one of the most confounding variables is underreporting. Particularly within ultra-orthodox and orthodox Jewish communities, there are several apparent difficulties in treating disordered eating:
- The extra pressure on young people to look a certain way for arranged marriages
- Unwillingness to recognize mental health disorders in general as valid
- The use of eating disorders for control over other mental health problems when treatment isn’t offered or other methods of coping (drug or alcohol abuse) would be seen and sanctioned
Additionally, among ultra-orthodox Jewish people, the incidence of eating disorders is roughly 1 in 19, which is far higher than the general population. Unlike with Islam, where extrinsic fasting seems to be a greater difficulty with the resolution of eating disorders, the main primary factor within the Jewish community seems to be extrinsic validation.
Because of internalized perceptions of how Jewish people “should” act or look, eating disorders can be more prevalent, even in Reform Jewish communities. On the other end of the spectrum, ultra-orthodox communities tend to dictate quite a bit of their members’ lives, including what should or shouldn’t be treated outside their group (including health conditions). Admittedly the desire to fit in because of extrinsic validation is a cultural concern, perhaps more so than religious, there is overlap between cultural Jews and religious adherents, so it is still a valid concern.
Resolution Of Eating Disorders Specific To Jewish Patients
This can be particularly difficult, because in ultra-orthodox communities, eating disorder patients might only be seen when they are on the verge of health crisis and often only to resolve that health crisis. Therapy for those in UO communities needs to involve parents and caregivers as well, and there needs to be committed adherence to aftercare or the recovery will surely fail.
External to UO communities — reform and semi-religious Jewish people, for instance — treatment is similar to the general population. It requires consistent treatment, ideally within an out-patient community that incorporates religious expression. While keeping kosher is a concern for some in the Jewish faith, around 80% do not observe kosher eating habits outside of high holidays, and as such it is not as critical to integrate within a treatment plan as eating halal is within Islamic communities.
Eating Disorders Recovery Within Religious Communities
Recovery of eating disorders is based on several primary factors:
- Consistent application of therapy, group therapy, working with a dietitian and involving family and friends
- The presence of a robust aftercare program and monitoring, often for years after the initial recovery
- Integration of religious or culturally important beliefs into the recovery program. This is particularly important for the support system since if any of them are hesitant or defiant, it is less likely that recovery will persist
Because of these factors, confounding religious beliefs need to be both integrated or solved-for in the greater interest of recovery. A minor patient who is on the verge of health collapse due to neglect within a religious community will not have success in treatment until they are removed from that community and placed in the care of people who will act in their best interest.
There are also the beliefs that not observing fasting periods and religious food restrictions will result in punishment or becoming a social pariah. Thankfully there exists within Islam the idea that one does not need to adhere to fasting protocols if one is sick, and within Judaism, dietary and fasting restrictions are a very small part of their faith. If the belief is intrinsic, then intensive counseling will be necessary to help resolve that guilt and faith burden. Again, if the beliefs are largely extrinsically imposed, then intervention within the community or family model might be necessary to prevent health decline.
Though religious belief can confound eating disorder recovery, it is not often the case that religion itself is a causal agent. Moreover, people who have strong religious communities can often rely on those friendships to reinforce and improve the chance of long-term recovery. Proper integration of religious belief into aftercare plans is critical to the recovery of religious adherents who are suffering from disordered eating.
