Eating Disorders and Spirituality

BY: Emma Miller

DATE: 22 August 2017

Associations between eating disorder symptoms and religiosity have been documented for centuries, but only extensively examined within the past few decades. This association gained popularity in the sixteenth and seventeenth century with a new emphasis on fasting as a form of spiritual observation. In the Puritan/Calvinist faith, menstruation was associated with sin, which compelled women to fast. In modern times, the association between eating pathology and spiritual beliefs in Judeo-Christian cultures has been examined; however, non-western religions such as Islam and Hinduism have not been included in this research. To address these concerns, a recent study by Akrawi and collegues1 investigated associations between disordered eating pathology (DEP) and spiritual and religious beliefs within a more inclusive sample of religious backgrounds.

Participants were 687 female college students from two universities in Sydney, Australia. The mean age was 21.19 years (SD=3.18; range=17-35 years). Participants completed questionnaires about eating pathology as well as religious and spiritual beliefs. The DEP behaviors assessed were drive for thinness (i.e., preoccupation with weight and an intense fear of weight gain), bulimia (i.e., engaging in bouts of uncontrollable overeating), and body dissatisfaction (i.e., discontent with overall shape and size of specific regions of the body). General levels of religiosity and spirituality were also assessed, and respondents provided information on their religious and existential beliefs. Religious beliefs are the individual’s faith and connection with a transcendental being, which is defined as powerful entities who live outside the spatial universe, such as God in the Christian faith or Allah in Islam. Existential beliefs are representative of the individual’s spiritual and personal beliefs apart from a transcendental being and include “hope and optimism”, “meaning and purpose”, and “inner peace” as part of one’s quality of life.

Women had a mean body mass index of 23.67 kg/m2 (SD=5.02; range=16.14-45.72). The majority of participants (69.9%) held some degree of religious belief. Even more, (85.3%) reported some degree of spiritual beliefs. Religious affiliations among participants were varied, with the largest portion (44.9%) having no organized religious affiliation at all. Of the remaining 55.1% of respondents, 33.8% identified as Christian, 7.5% as Muslim, 3.7% as Hindu, 0.9% as Jewish, and 0.7% as Buddhist. The remaining participants (3.08%) failed to indicate their religious affiliation.

Both high existential beliefs and having a religious affiliation were associated with lower drive for thinness, bulimia, and body dissatisfaction. However, existential beliefs alone were more strongly associated with lower DEP than religious affiliation. This may be because strong personal beliefs offer a sacred or superior meaning to daily life events, which in turn provides individuals with a greater ability to cope with life stresses. Akrawi points out that although religious beliefs highlight the individual’s faith and connection with a transcendental being, existential beliefs are more representative of the individual’s spiritual beliefs apart from a transcendental being. This may lead them to be more focused on emotional qualities such as hope and peace.

This study examines existential and religious ideals and how these may be incorporated into eating disorder treatment. Currently, the field is becoming more open to interventions or adjunctive treatments that are influenced by spiritual or religious thought. For example, dialectical behavioral therapy incorporates Eastern meditative traditions, such as mindfulness meditation borrowed from Buddhism. Yoga, meditation, and mindfulness have been shown preliminarily to aid in eating disorder recovery3. Acceptance and mindfulness based therapies, practicing non-judgment, and promoting perspectives of self and spiritual transcendence are all being offered, but clinical research is needed to determine their efficacy. In some ways, what is important is what makes individuals with eating disorders feel better about their recovery. Indeed, in the earliest days of the Center of Excellence for Eating Disorders at UNC, we established an optional spirituality group on the inpatient unit at the request of our patients. For many—but not all—individuals with eating disorders, attending to spirituality can be a welcome and important component of treatment. If religion or spirituality is an important part of your life, it may also play an important role in your recovery and continued wellness.



1Akrawi, D., Bartrop, R., Surgenor, L., Shanmugam, S., Potter, U., & Touyz, S. (2017). The relationship between spiritual, religious, and personal beliefs and disordered eating psychopathology. Translational Developmental Psychiatry.

2Lavender, J. M., Jardin, B. F., & Anderson, D. A. (2009). Bulimic symptoms in undergraduate men and women: Contributions of mindfulness and thought suppression. Eating Behaviors, 10, 228. doi:10.1016/j.eatbeh.2009.07.002

3Dimeff, L., & Linehan, M.M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13. doi: 10.1007/s10597-013-9679-2