My name is Kimberly Clark. I have been counseling biblically since 1999. I got certified in 2002 and did about 12 years of one-hour counseling. Then, for the last eight years I’ve been doing intensive biblical counseling, which involves seeing people for three days and then sending them out with a plan. I am now with Known By Him Ministries and continuing in that same vein.
When I first started counseling—especially with the intensive counseling—and people with more severe problems were coming in, I could easily say that the area where I felt least confident was eating disorders. Part of that lack of confidence came from being so distracted by what I was seeing. Seeing people come in with their bones sticking out, with doctors telling them that they’re about ready to die if they don’t change something, with so many strange behaviors, and with such self-deceit was glaring. Yet these people totally believed that what they were doing was the right thing to do and they were willing to do anything to achieve their goals.
I quickly learned that I was in a territory where I needed some help. I’m going to take you on this journey that I’ve been on, and I hope that I can bequeath wisdom to you related to any deficiencies that I’ve had in this area. I want you to finish reading this feeling like, “Okay, the next person I meet with an eating disorder, I am ready to go.”
General Information (Statistics, Definition, and Symptoms)
The statistics say:
- In 2019, there were 30 million people in the United States with an eating disorder.
- 51% of nine- and ten-year-olds say that they feel better about themselves if they’re dieting.
- People with eating disorders are 56 times more likely to commit suicide. I’ve seen a number of these women who had tried to commit suicide because they felt like a failure.
- People with eating disorders are 4 times more likely to be abusing substances.
We’ll use this definition from the Mayo Clinic as a helpful starting point, though I would tweak it a little bit if I were writing it: “Eating disorders are a serious condition related to persistent eating behaviors that negatively impact someone’s health, emotions, and ability to function in important areas of life. The most common eating disorders are anorexia, bulimia, and binge eating.”
In my experience, a lot of times the loved ones or husband of the woman with the eating disorder were the ones who were telling me what was going on but was not obvious. The reason for this was that the women who were entrenched in the disorder were trying to cover up all of the things that they were doing. I want to share some typical examples of behaviors or signs that you might see with people with eating disorders:
- Being very secretive and pretty manipulative
- Having bones sticking out, a lot of times in a really grotesque way
- Losing their concentration and having difficulty even thinking or following through with a thought
- Making excuses for whatever eating issues are going on
- Wearing multiple layers of clothes so that they can disguise how thin they really are, especially if their loved ones are getting on to them
- Recurring constipation
- Strict observance to very restrictive diets
- Excessive focus on healthy eating
- Making their own meals, rather than eating what the family eats
- Withdrawing from normal social activities
- Persistent worry or complaining about being fat and talk of losing weight
- Frequent checking in the mirror for perceived flaws (note the key word perceived)
- Use of dietary supplements, laxatives or herbal products for weight loss
- Excessive exercise
- Calluses on the knuckles from inducing vomiting
- Problems with loss of tooth enamel that may be a sign of repeated vomiting
- Leaving during meals to use the toilet
- Pushing food around on their plate to make it look like they’re eating and make it look like they have more on their plate than they actually do.
- An inability to sit comfortably or instability in walking because there is a deterioration of muscles in the legs
I’ve had women come in with layers and layers of clothing despite the fact that it was super, super hot outside and not all that cool inside. I tend to run cold and be the coldest person in the room, but looking at these people I would think, “I don’t know how you’re doing it right now. You’ve got to have your own personal sauna going on.” Some women will just read and read and read anything that they can get their hands on about what healthy eating means. You know how often those guidelines change and how many opposing voices there are.
Examples from Counseling Experience
Now I want to tell you about a couple of the women that really stand out to me in my counseling career.
I had a woman who tried to show and explain to me how she kept track of her eating. She counted calories, carbs, sugar, and a few other things that I forget right now, in addition to counting the number of bites. She even had a way to graph this. Her every waking moment was analyzing what she ate last and then planning for her next meal. She was so stressed out about whether she thought she had failed with her last meal or if she was going to get it just right with her next meal. Can you imagine her thinking? Her thinking was racing. It was exhausting to watch her. She had a really hard time carrying on a conversation with me because her brain just wanted to keep going back to reviewing, reviewing, and reviewing her meals. Leading up to lunch time she got more and more stressed. There was also the question of whether or not she was going to feel condemned or like she deserved a reward for how she had done on the last meals that she could remember. Most often it was condemnation.
Another woman I worked with dealt with severe constipation because of years of an eating disorder. Her husband had to put her in the bathtub every night to get warm water on her and massage her belly so that she could relieve herself. It was extremely painful. She hated the hours leading up to that bath. She was so fragile that there was no way that she could get in that bathtub by herself. Yet she was still fully persuaded that she needed to stay on her “diet.” She was not in counseling because she thought she needed help; she was there because her husband was desperate. With that particular woman, I found out way into Day 2 that she had been sitting on a secret sin for years and had been so fearful for anybody to ever know about that secret sin.
I’ve worked with numerous women who have tried to commit suicide because their rigid way of following their own rules leads them to feel like a failure. Catch that: it’s not because they have an eating disorder that they want to commit suicide; it’s because they’re not able to follow their own rules.
The Root: Gaining Control by Following a Law
Now I want us to try to look at the root of what’s going on with these individuals. At some point, these people felt like life was so out of control that they had to figure out a way to get control. I think we can all relate to times in our lives when we just felt like everything was falling apart, and if we could grab every straw that we could possibly think of, we would. These people really did decide at some point that eating was the only area of their life that they could control. On hearing their stories, sometimes I would think, “Okay, yeah, that makes sense to me. Life was super out of control.” But for them, no one is going to make them eat. The thought process for these women is: “They can make me do everything else, but they can’t make me eat. That is one area I can control no matter what the consequences are.”
Then we have these outside forces that are constantly barraging us with the message of what we need to look like. Unfortunately, some families are sending horrible messages to their kids. There have been times when I have sat in a counseling room choking back tears hearing what some parents have said to their kids, whether the parents thought that their kid was chubby or that their kid just wasn’t measuring up. As a result, this child felt like the only thing they could do to measure up was to lose weight.
I haven’t experienced anorexia. I haven’t experienced bulimia. I’ve overeaten, believe me, but I think I just like food too much. As a result and with all that I’ve mentioned above, I questioned how to relate to these women. I started to ask the Lord, “Help me to understand this area of eating disorders. I feel like I’m falling so far short. How do I relate to these women?”
One thing that is consistent from the descriptions that I’ve given you is that these women are following a law. We have a book in the Bible that speaks directly to this issue. I have become madly in love with the book of Galatians. When Paul was talking to these Galatians, what was he upset about? He was upset about the Galatians going back to Judaism and to the law and serving the flesh. That sounds like what I’ve described with the eating disorder. As I studied and plumbed Galatians, I loved it and I’ll probably continue to plumb it until the day that I die. I’ve seen more and more of how this book directly speaks to those with eating disorders.
Lessons from Galatians
One of my first observations from Galatians is that I see Paul spending almost two chapters telling the Galatians why he’s qualified to talk to them. At first, I’m thinking, “Okay, Paul, we get it. You’re an apostle; God spoke directly to you. You went to God school for three whole years. I get it.” But there was a reason why he was telling this to the Galatians, and the reason was for him to be able to make the case to the Galatians that they needed to listen to him. He needed to persuade them why they should listen to him of all people. What was his dependency? It was Christ. He said over and over that Christ gave him his message directly and that he even got it verified by the other apostles. It’s not like it was something that was made up in his head.
How do we apply that to us? That is a very good question. I’ve already told you that I have not had these issues with starving myself or making myself puke. If I look at a gallon of ice cream, I’m going to get pretty sick pretty fast at the thought of eating the whole gallon. My overeating is more of a general all-day eating. Here are some questions that I think we as counselors need to be able to answer to be able to help us relate to these women and present why we are qualified to talk to these women:
- When have I relied on the Law rather than the Spirit?
- When have I been tempted to think that my way would be better than God’s way?
- When has it seemed like following God was too hard and my way of doing things seemed more right?
- When has it seemed that there was a better way to get acceptance, approval, and value outside of the gospel?
- How is it that the gospel has saved me over and over and over again?
Those are the questions that I think you need to be asking yourself and be ready to give an answer to these women as to why God has qualified you to be their counselor. I always tell my counselees something about my struggles at an appropriate level. Below is an example for you, and it might sound funny but it’s been a genuine struggle for me.
There is a lady at our church who is mentally challenged and collects pop can tabs. Every time you come into church, she’s hunting you down and wants your pop tabs. I drink seltzer water and my husband indulges in other pop drinks, so we have a fair number of tabs. I feel like I need to save every one of those tabs. Every single one of those tabs needs to go in a bowl. In our kitchen, I have a designated cupboard for that. When I leave town, I have a pocket and I keep putting them in my pocket. I become obsessed about those pop tabs.
Just today, I said to myself—and I’ve told myself on other trips too—”You have to stop.” I would like to go into the trash cans and get other people’s tabs because I know that would make her really happy. She gets so excited to take those to our children’s hospital. However, it becomes a burden to me because I’ve made it into a law. You would not believe the relief that I get when I finally recognize what I’m doing and say, “Kim, it’s okay if you throw away a can that has a tab on it. It’ll be okay.” I am not pleasing God more when I keep that tab.
But what’s going on in my heart? I don’t want to disappoint her. That’s fear of man. Is she going to know that I didn’t collect every tab? No. But I still feel bad, as if it were a flaw. I put that burden on myself. Today I just realized I’m not carrying tabs in these pockets. I don’t have a pair of jeans on today with a pocket in the back. It’s okay. God is just fine with me putting that whole can in the trash.
That’s just a simple illustration as to how we can make our own laws and start to bow down to them without even knowing that we have slipped into this law camp.
Galatians is all about talking to a group of people who had once proclaimed the gospel and had started to backslide by trying to keep and rely on the law. They wanted acceptance; they wanted value. Until you really start to see the correlations between the person with the eating disorder and the Galatians, it’s probably not going to make a lot of sense.
Paul confronted Peter in front of everybody. Can you imagine confronting Peter? Probably not, but Paul did it in front of everybody so it must have been a pretty serious thing. The whole book is about this topic. Here is Peter having meals with the Gentiles and eating unclean food in his freedom in Christ. He was witnessing to these Gentiles and they were being won over to the gospel. Then, the Judaizers—the circumcised Jews—came into town. What were they saying? In disgust, they would say, “You’re with the Gentiles and you’re eating with them. Whoa.” Then Peter quickly moves away and who else comes with him? Barnabas. That means that Peter was leading others astray. Paul then says, “You have just nullified the grace of God.” That’s how serious this is.
Now let’s think about the perceived benefits for Peter and Barnabas to leave the camp where they had freedom in Christ to move back into the camp of works, the law, and the flesh. What did they see as the benefit? Acceptance; no persecution; approval; and status.
Do you remember the deal about, “Oh, you’re a Gentile.” How were Gentiles seen? As dogs. How were Jews seen? As children of Abraham. Galatians says that they were observing seasons and holidays. They were really embracing this whole idea of who they were, or in other words, their identity. What does identity focus on? Identity focuses on me, self, and flesh because identity is going to draw attention to what I’m doing instead of Christ increasing as I decrease.
In whom do those in the camp of freedom in Christ put their trust? God.
In whom do those in the camp of the law put their trust? Self.
The irony of this is that there’s a lot of condemnation in the camp of the law because we’re never going to follow this law perfectly. There’s also going to be a lot of sense of reward because now we think we deserve reward and so we’re either going to hold that against God—because He withheld reward from us—or we’re going to reward ourselves.
When I start to break all of that down, what’s going on for this person with the eating disorder makes a whole lot more sense to me. I realize that this thinking has been progressive. It wasn’t that she woke up one morning and all of a sudden had this great idea that made her decide to be enslaved to this type of thinking and eating for the next 30 years.
Two passages in Galatians that are so helpful and that I think we can use as biblical counselors are:
- Galatians 3:1-3: “O foolish Galatians! Who has bewitched you? It was before your eyes that Jesus Christ was publicly portrayed as crucified. Let me ask you only this: Did you receive the Spirit by works of the law or by hearing with faith? Are you so foolish? Having begun by the Spirit, are you now being perfected by the flesh?”
- Galatians 4:9: “But now that you have come to know God, or rather to be known by God, how can you turn back again to the weak and worthless elementary principles of the world, whose slaves you want to be once more?”
Aren’t those verses convicting? You have a woman who wants to control something in her life and wants to be thin. These verses show the truth about that quest. How do we, as biblical counselors, translate that into our counseling? What do we do with this information? What I do is gently dig towards the answers to the following questions:
- What happened?
- How did you decide that approval, acceptance, and value would be gained from following these rules?
I’m not going to come right out and ask these questions first thing. Rather I try to come in the back door, the side door, or the trap door—however I can be trying to get these answers. I want to know what she’s doing and eventually genuinely help her to see that and the trigger that caused such a drastic bewitching.
The other questions that I ask myself the whole time are:
- What is the lie that she’s bought into?
- What has Satan promised her?
Those answers will ultimately spell out her law system and what it is that she’s going after. Paul was adamant that this way of living and thinking was a perverted gospel and that individuals that go down that path were under a curse. That’s pretty strong language. I’m going to tell you that when you are dealing with somebody who is deeply entrenched in this, you will confirm with Paul that they’re under a curse. This is very serious.
As a word of caution to us as counselors, heed Galatians 6:1 that tells us to be gentle and watch ourselves lest we too be tempted. Also heed Ephesians 6:10-20 that tells us to put on the whole armor of God. We should always be doing that, but I’m just going to remind you that in these situations, you do not want to forget that.
All of us have a propensity to want to self-craft our identity. We see this in extremes right now with our culture. We see people wanting to reassign their gender or their race. It’s really being pushed to a great extreme. However, re-crafting our identity is integral to understanding how this law system works because these people and we ourselves are all guilty of this to some degree or another. We have visions of what we think we should be.
How many people do you hear wishing to look a certain way or lamenting over flaws or parts of them that they don’t think look right. I hear it all the time. They wish they could have a better body, a better face, wealth, position, or respect. What would it deliver or give them? There’s something behind those desires that they’re driving for whether they realize it or not. For many girls and women, the promise is that if we could have the perfect body or the perfect face, we’d have everything. We would have power and we would have control. Wouldn’t that be sweet? We don’t say it quite that directly, but that quest is very, very present even in our churches. This is not just out there in the world.
There’s this quest. This temptation is constantly presented to our flesh: “Be more, be better, be beautiful, be a certain type.” We see it everywhere we go. You can’t stand in line at the grocery store without seeing what we’re all supposed to look like. I thought that temptation would go away once I got older. Now I’m finding out that when I watch commercials about special potent skin products that will make me look younger, I find those products appealing. Then I think to myself, “You wanted to be old. You are old. It’s okay. Enjoy it. You’re old, get over it.”
That temptation to self-craft our identity is something that we will have. From that standpoint, we can relate to these individuals with eating disorders. I’ve worked with a lot of women that identify with past abuse and are trying to run away from that identity. For them, that puts more fuel on the fire because whoever the abuser was could have said different things to them about their looks. Those words and however they have perceived their identity post-abuse have great ramifications. You want to be able to check that out and see what about that experience is causing them to try to recreate their identity.
Remember, when we are trying to recreate our own identity, we are nullifying the grace of God. That is so convicting for me.
In Isaiah, nation after nation was judged for what they did with their power. Over and over, it came down to how they treated the oppressed, such as widows and orphans. Isaiah 3:16-24 describes women who were haughty and wantonly with their eyes, mincing along as they went, tinkling with their feet. God was going to take all of their beauty tools and make them rotten. Instead of beauty, He was going to give them baldness, a skirt of sackcloth, and branding.
An identity of beauty for the use of power is certainly an abomination to the Lord. Help the woman you are counseling and help yourself first to be able to see what this quest for beauty is all about. For example, think about women who are trying to use their beauty to get a man to love them. How many have been guilty of that, whether or not that was something we said out loud?
Paul again makes this super, super clear. He says that our identity as Christians is that we are children of God. Period. End of story. Anything else will take us to the law camp. The truth is Jesus plus nothing. Paul says that the Galatians were going back to pursue the worthless elementary principles of the world and He instead has called us to freedom in Christ.
What are we free to do?
- We are free to say “no” to sin. We’re no longer underneath the obligation to say “yes” to sin. In Christ, we can say “no.” We don’t have to submit to a yoke of slavery.
- We are free from condemnation. Law-living produces a lot of condemnation. It’s an awful place to be. When you’re presenting this to these dear sweet ladies, remember what you’re calling them to. There are so many benefits in Christ.
- We are free to have peace. That’s Romans 15:13. We have God’s grace for the whole walk.
- We are free to love. This is huge. Paul talks about the fact that the difference in walking in the Spirit is that now we are free to love. He sums up the law as being “love your neighbor as yourself.” There’s great freedom in me loving God and loving others. The alternative in the law camp is: “I’m so afraid. I am so fearful. I don’t know where God is. I don’t know if He really cares and I am so afraid of what you’re going to think of me. I’ve got to hide somehow. I’ve got to re-craft myself.”
Make sure that you’re not communicating that there’s no struggle. Life in Christ does not mean that we are free from struggle. Some people will say, “Oh, I’m going to follow Christ and there’s not going to be any struggle.” No, I didn’t say that. Paul certainly doesn’t say that. Scripture doesn’t say that. Our fight really begins at conversion, but we’re fighting the good fight. After conversion, we are called to demonstrate the fruit of the Spirit. Paul goes on to say that producing fruits is in keeping with being saved, and not producing fruits—if you’re continuing in this sin—should lead to questioning one’s salvation.
Below I will flush out some of the typical things that I do with people once I’ve understood the situation and the root of their behavior and once I’m in the process of helping them see what’s actually going on underneath the surface.
1. Using the tree diagram, replace the fruit in the diagram with all of the presenting issues. Then work your way down through emotions, meditations, motivations, values, identity, and theology.
2. Take Galatians, section by section, putting their life and their words over Galatians and helping them to see what God’s Word would say directly to them in their situation.
3. At some point, with wisdom, ask for repentance.
All I mean by repentance—and I tell people this all the time—is that I ask them to agree with what God says and to agree that they’re going to follow God and turn away from their old ways. I do not ask that they be perfect.
4. Get them into a regular reading of the Word.
This is so important and I can’t stress this enough. The power for them is in the Word. The thinking of people with eating disorders has been so perverted. If they’ve been doing this for years, their mind is racing non-stop. I don’t want them to read the Word just for the sake of reading the Word and checking off a box and saying, “Oh yeah, I did it.” I don’t want that for them. I want them to be able to read the Word and start to understand and question the Word. I put a little activity with their reading of the Word. I have them buy a new journal and write down what they learned about God and what they learn about their identity in each passage. I want them to keep telling me what they’re learning.
5. Ask them to do some Bible art.
When I do this, I get all kinds of objections about what a terrible artist they are and that they’ve never been artistic. I don’t care. I tell them that they can go on Google and find a cartoon and trace it. It doesn’t matter. The point is that I want them to think about the meaning of the verses that I have assigned. I intentionally assign verses and want them to think about the meaning of those verses because this is going to re-shape their view of who God is. I want them to see the goodness of God. I want them to see what God says to His own child. This has been a marvelous tool. Even the people that go down kicking and screaming end up loving it.
6. Make a plan out of Galatians.
Part of Galatians talks about how there is a lot of strife and envy in the lives of people who are underneath the law. Similarly, a lot of times, people who are struggling with eating disorders have a lot of broken relationships. Can you imagine years of being in this type of living? Can you imagine the experience of their family or friends and what it is like for them to be in relationship with somebody with this level of deceit who is being totally enslaved to a specific diet?
I want to tell you about my friend Florence. I changed her name and looked up a 1920s name to use in place of her real name. Florence was pursuing the identity of skinny. She had tried to commit suicide several times because she felt like a failure. She had a horrible childhood. If I were to rate her childhood compared to other stories that I’ve heard, I would consider her childhood pretty traumatic or pretty horrendous. Her family regularly referred to her as a mistake. For most of her childhood she did not know who her biological mother was. The biological mother was presented for years as the aunt that didn’t live in the home. She never knew who her biological father was. There was tons of abuse. Later on, when she got married, her husband and her children knew very, very well about her obsession to be skinny. In her mind, she needed to be the perfect mom that she never had. The ideal in her head was to be skinny and to be the perfect mom.
When her children got to an age where they didn’t need her anymore, the world came crashing in. She ended up falling to pieces. The eating disorder got much, much worse. She ended up going to a psychiatrist and a psychologist and taking lots of medicines. She had Scripture tattooed all over her body. Nothing was working. Her husband was just beside himself. He had tried everything to love her and love her well, and he couldn’t get through. She reluctantly agreed to spend three whole days with me. Can you imagine?
It was super difficult. There were many times that I did not know if we were going to make it through the whole three days. Any time I started to suggest or maybe even get close to intimating that maybe she had made a mistake—I wasn’t even using the word sin yet—she would get so angry because any perceived failure on her part was the same thing as condemnation. She could not separate them.
By God’s grace, we made it through the three days. God started to uncover things for her and she started to see. She went and got a pink fuzzy journal that she used to start doing her Bible art. There were so many times that I was just choking back the tears as I continued to meet with her because the Scriptures were coming alive to her. She felt like she needed to confess to me that she needed a little Google help on some of them. I replied, “I could care less. The fact is that you’re getting these truths.” That has been a super fun situation.
I tell you all that to be able to say that there are creative ways that we can get people into the Word. I’ll share with you about her tree chart.
- Her fruit: She had these unhealthy eating rules and was essentially starving herself. She was staying in bed for inordinate amounts of time. She had absolutely no hope. She saw everything through a negative lens. She had fractured relationships all across the board—immediate family, extended family—and it was just a mess.
- Her emotions: Sad and angry. She went back and forth and sometimes she could do both.
- Her meditation: “I need to be skinny. I need my family to need me. I need God to be okay with me.”
- Her motivations: “I want to be approved of. I want to be accepted by my family.”
- Her values: “I want to be a good mother. I want to be skinny. I want to have a husband who thinks that I’m the most beautiful woman.”
- Her identity: Beautiful, skinny, mother, and wife. That’s what she wanted.
- Her theology (how she saw God): “God doesn’t care. He’s too difficult to please. He wants me to be fat and He doesn’t care if I suffer.”
She wouldn’t have come in saying any of the above, but as we worked through and got closer and closer to being able to unearth these, then she was able to see them.
Even after we were getting through some of this, in her mind everything would all be good if I could just help her become better at obeying her own rules. I’d have to keep going back to telling her that she was nullifying the grace of God and that God says she was not following Him. I would say, “Here’s the truth. God is good. God does want good for you even if you put some pounds on.” She wasn’t real thin so it wasn’t like she was in any kind of danger of dying, but she was pretty sure that she was super fat.
I had to ask her to agree to give up her psychologists for six months and meet with me instead. She was very afraid to do that because it had been years since she had not been with a psychologist, but she agreed. I said, “Hey, what do you have to lose? It’s Jesus and His Word. Let’s see what Jesus does.”
It’s been way past 6 months and she hasn’t mentioned a psychologist. She is out there telling everybody that she knows, “Jesus is the Way and you’re under law. You don’t know it, but you’re under law.” She has a message and she is ready to tell everybody. She has the Scriptures tattooed on her as well so it’s easy for her to reference Scripture quickly. She’s forever telling me that I need to get on her church website and listen to the sermons. The sermons have come alive to her. I’m pretty sure the sermons didn’t just overnight get good.
One thing that is so common and that I want you to know too is that these people who are overcoming eating disorders start to want to pursue Christianity with that same works mentality. She started to lament to me that she doesn’t have a ton of Scripture memorized and can’t debate the Scriptures like “all those other Christians.” She would love to be able to debate the Scriptures like “those other Christians.” She thought that all of us have Scripture memorized and that all of us can debate. We’ve had to go back to, “Okay, what are you doing now? What is this?” I keep telling her that the Christian walk is to repent and have faith. That process of repentance and having faith is no different for anybody else. We’re all on the same journey of repentance and faith.
I just want to encourage you and hope that the next time somebody says, “Hey, I have somebody with an eating disorder and she has been doing this for 20 years. Her husband is ready to check into a place for husbands that can’t take it anymore. Would you take her?” I want you to say, “Yes, Lord, I will, because I know the Lord and I have a book in my Bible called Galatians.”