Chronic Pain and Eating Disorders | Carissa Hannum

The Battle of living with Chronic Pain and an Eating Disorder

March is Disability Awareness Month, and the week of February 21st was National Eating Disorders Awareness Week. Both are serious illnesses that can be interconnected. Living with a disability can be a lot of work and navigating finding help can be an exhausting process. A small subset of disability can include living with an invisible illness like chronic pain. Chronic pain can be a physically and mentally taxing experience. Finding ways to cope with chronic pain can be isolating and lead to feelings of helplessness. Although not always discussed, chronic pain can also trigger eating disorder symptoms to cope with or control pain. However, as an eating disorder continues to wreak havoc on the body this can lead to a person to having more intense chronic pain symptoms over time or even developing a chronic pain illness that didn’t exist previously. This blog post hopes to discuss the connection and raise awareness of eating disorders and chronic pain.

What is Considered Chronic Pain?

Pain is a somatic experience in the body. Many clients learn to describe their pain using several somatic/physical descriptors including stabbing, burning, shooting, sharp, pulsing, stinging, etc. Although pain can be more acute or sudden, some pain is considered chronic pain. Sudden pain can be a warning that something is “wrong” in the body, while chronic pain is an experience caused by disease or progressive illness or injury that can lead to continuous or sporadic pain.

Examples of chronic pain can include, but is not limited to:

Migraines and headaches
Nerve pain, such as neuralgias and neuropathies, such as fibromyalgia
Cancer pain
Arthritis and other joint/muscular pain
Back pain
Stomach or gastrointestinal pain, such as inflammatory bowel syndrome
Pain that affects women, such as endometriosis, vaginal pain, or other pain related to the menstrual cycle
Chronic fatigue syndrome
Bladder pain, such as cystitis
And many more- just because your pain isn’t listed above, does not make your pain experience any less valid.

The Severity of Chronic Pain

According to the National Institute of Health, 25.3 million adults suffer from daily pain, and 23.4 million adults in the United States experience “a lot of pain” daily. Chronic pain is a public health crisis. The US pain foundation has done extensive research within the medical community. Unfortunately, the struggles of those suffering from chronic pain are often overlooked. There are not enough board-certified pain specialists for individuals diagnosed with chronic pain. Right now, for every 10,000 people suffering from chronic pain, there is only one board-certified chronic pain specialist. In addition, funding for chronic pain studies and research for new treatments are highly underrepresented. The treatments that do exist only leave patients to feel an average of 30% reduction in their pain.

With the gaps within chronic pain treatments and medical professionals, many individuals living with chronic pain can feel as though they are suffering with both physical and emotional pain. The combination of physical and emotional pain can leave a person feeling hopeless, helpless, out of control, and frustrated with their options. Many of my own clients have turned to or developed an eating disorder as their own form of coping and way to feel in control of their health.

The Mind/Body Connection and Using an Eating Disorder as a Means of Coping

The mind and the body are connected and correlated with one another. Due to the mind and the body having a reciprocal relationship, daily functioning and mental health can be affected significantly due to pain. The more pain that an individual experiences, the more likely an individual can experience significant mental health decline and emotional dysfunction. Individuals’ that suffer from high levels of pain suffer from more suicidal ideation, sleep disturbances, family dysfunction, impacts to independent living, depression, anxiety, loneliness/isolation, grief, as well as discrimination.

Feeling Out of Control

These emotions, when left untreated, can feel out of control and chaotic. An eating disorder can become an ideal means of coping for a client that feels unheard, their pain overlooked, or not helped by certain medical treatments and/or professionals. The eating disorder, whether that be anorexia nervosa, bulimia nervosa, binge eating disorder, or any form or combination of eating disorder symptoms, can be a distraction from pain and means to control the immense pain a person is experiencing.

As stated earlier, chronic pain is a somatic experience in the body. Although understanding physical sensations in the body can be a helpful experience to identify issues or emotional needs, physical sensations can become confusing for someone experiencing chronic pain. For instance, a sharp shooting pain for someone that doesn’t experience pain daily can signal the need for rest or the need to go to the doctor. For someone with chronic pain, feeling as though there is always danger can lead a person to feel as though their body is an enemy. At times I have heard, “If I’m not feeling helped the medical treatments being recommended to me, I might as well take my health into my own hands”. Many

Disconnecting from Your Body

clients describe that the only way to control their pain is through disconnecting from their body through use of an eating disorder. In addition, for clients that suffer pain due to eating, a basic need such as fueling the body can be a traumatizing experience. Finding support to meet nutritional needs in all these situations is very important to recover from chronic pain and an eating disorder.

Eating disorders can also be contributed by stereotypical medical care and providers that aren’t versed in chronic illness and chronic pain. For instance, some clients will be told that a way to “fix” their pain is by dieting, prescribing to certain diets, or even losing weight. This can not only invalidate the severity of an individual’s pain, but also cause a client more emotional distress for feeling as though they are to “blame” for their pain. Shame can be a highly distressing emotional experience that leaves many clients feeling as if they were responsible for their pain. Again, the eating disorder becomes an emotional outlet to numb from both the physical pain and the emotional shame.

“Normal” Population

One of the most difficult concerns for chronic pain client is having to adjust to having different needs from the “normal” population. The sheer act of approaching a medical professional about pain is already a huge feat. So, when a client feels that these needs cannot be helped, they may feel as though their needs are “too much”. An eating disorder can feel as the only way of making needs go away. However, of course, this is not the case and needs continue to build up and lead to unexpressed distress. As discussed in the next paragraph and eating disorder only increases pain over time. Clients must learn to identify and find ways to meet both the physical needs of chronic pain and their emotions.

Can Eating Disorders Impact Chronic Pain?

Although eating disorders can lead to short term comfort for individuals experiencing chronic pain, eating disorders can lead to long term complications. For some clients, they may have never experienced chronic pain until the development of their eating disorder. Although eating disorders are a mental health diagnosis, they can cause an increased risk of physical complications. When left untreated, an eating disorder can cause chronic pain issues such as gastrointestinal issues, joint pain, headaches, fatigue, and osteoporosis to name a few.

In addition, because an eating disorder is not helping clients learn appropriate methods of dealing with pain, an eating disorder and chronic pain can be an endless cycle. The more pain, the more the need to use an eating disorder, and so on. The eating disorder can continue to intensify pain and emotional dysregulation, negative beliefs about self, increased difficulty in daily activities, and social isolation/disconnection. The short-term gains can lead to long term issues in daily functioning. The very disconnection that feels helpful at the beginning of the development of an eating disorder causes long term chronic pain complications and increased mood concerns i.e., depression, anxiety, shame, as well as difficulty accepting help for needs.

The Need for Treatment and Mindful Embodiment

Because an eating disorder can be about control and disconnection from painful experiences and emotions, mindful and embodied methods of approaching both the eating disorder and chronic pain is imperative. Learning how to accept the emotions related to chronic pain and their eating disorder can help ease physical pain overtime. The goal of psychotherapy for chronic pain is to help clients not only gain support and relief from their pain but also to accept the pain as part of life to ease psychological and emotional effects.

One form of therapeutic intervention that can be helpful for mitigating the effects of chronic pain is Acceptance and Commitment Therapy (ACT). ACT helps distinguish not only acceptance of the illness and chronic pain, but helps individuals distinguish between “clean pain” and “dirty pain”. Clean pain is the actual physical sensation that is associated with an individual’s pain. Dirty pain is the negative beliefs that we associate with our pain, such as “I’m lazy due to my pain” or “I’m not good enough due to my pain”, which can lead to continued emotional discomfort, shame, and suffering. Learning to label emotional pain separate from physical pain can be helpful to begin healing.

Other Treatment Methods

Learning how to become more embodied and mindful can be a scary process. Being in a body that at times has felt harmful is terrifying. Because this process of learning a relationship with one’s body can feel tumultuous, finding a team of professionals that can help treat both the chronic pain and the eating disorder is necessary. Other treatment methods can look like:

Developing a plan that allows for value-oriented activities. The client may need to “dose” their activities to not impact pain. Clients should not avoid these value-oriented activities fully, as this may increase emotional suffering and therefore, pain.
Implementing self-compassion strategies, especially when eating disorder symptoms have been used.
Identifying emotions when eating disorder symptoms would have normally been used.
Learning to find flexibility in beliefs related to “dirty pain” and increasing positive self-talk.
Developing mindfulness strategies to implement during pain flare-ups.
Understanding triggers to chronic pain flare-ups and ways to approach these triggers effectively versus turning to the eating disorder.
Finding ways to soothe the body during flare-ups, versus chastising the body when in pain with negative belief systems.
Allowing self to utilize day-to-day strategies i.e., back pillow that allows for increased comfort.
Developing new meaning as someone that suffers from chronic pain as well as working through any grief and loss associated with chronic pain.
Finding ways to celebrate what the body can do even when the pain feels as though it has taken away so much.
Allowing oneself to find healthy ways of expressing emotions associated with chronic pain, such as anger, frustration, sadness, loneliness, etc.
Learning how to label both emotions and physical sensations. Sometimes, learning how to name sensations can help tame these sensations in therapy. An eating disorder dissociates from these physical sensations, which makes learning how to tame them more difficult.
Psychotropic medication to deal with the effects of any depression, anxiety, or other mental health diagnoses.

Reach Out

If you are an individual suffering from chronic pain and an eating disorder please reach out to a therapist, doctor, or any other profession to inquire about treatment. It is a very brave thing to discuss both your eating disorder and your chronic pain. There are many professionals that understand the intricacies of both struggles. Whether your pain was a problem prior to your eating disorder or increased due to an eating disorder, it is essential to find a team of professionals who can help you understand the intricacies around how your chronic pain and eating disorder impact one another and your recovery process.