Eating disorders afflict millions of people throughout the world, resulting in tremendous suffering for victims and families. Presently the prevalence of eating disorders has skyrocketed, becoming an epidemic in the United States of America, affecting all walks of life especially for women (Boen, 2006). Anorexia Nervosa and Related Eating Disorders Inc. (ANRED) reports that approximately 10 million U.S. females suffer from anorexia nervosa. National Eating Disorder Association reports that 4 in 10 newly identified cases of Anorexia are females ranging in age from 15 to 19 years old. Research suggests that currently 10 % of males have eating disorders, such as anorexia nervosa and bulimia nervosa, and the rate is increasing (Boen, 2006). Two million women age 19 to 39 and one million teenagers are affected by symptoms of anorexia or bulimia (Iowa State University, 1994). The chief reason for this high rate of occurrence of eating disorders is social pressure on men and women in the western society, that is, the western society encourages women to be thinner than average and puts strain on men to be more muscular than average (Lips, 1993; as cited in Shiraev & Levy, 2004; Pope et al., 2000; as cited in Nolen-Hoeksema, 2004). College students are especially vulnerable to the disturbances in eating patterns. This (college student population) is also the group who is most conscious of their body image. According to Vohs, Heaterton, & Herrin (2001; as cited in James & Pritchard, 2005) more college student freshmen reported figure dissatisfaction compared to high school seniors. Consistently the research also shows that the most at risk for group for developing eating disorders is Caucasian, female college students (Kinzl et al., 1988; Zuckerman et al., 1986, as cited in James & Pritchard, 2005). Eating disorders patients often starve (in the case of anorexia) or binge (in the case of bulimia) to battle or satisfy their inner hunger (Apostolides, 1998). Inner hunger is defined as emotional emptiness that remains in an eating disorder patient even after the patient feels physically satiated. Patients with eating disorders often times starve for attention, love, self-worth, value, happiness, respect, talent, beauty, acceptance, and self-esteem (Hardman, Berrett, & Richards, 2003). Eating disorder patients often find it easier to feed their inner hunger with food or suppress it by starving themselves, than searching for the real cause of this hunger. Many people substitute food for love and make an effort to make themselves feel better with food. According to the article Understanding Abuse: Eating Disorders published in the Iowa State University paper, “Food is an easy and quick source of comfort. It’s always there, tastes good and doesn’t talk back. Used in excess, food also can temporarily deaden painful feelings. Of course, eating a lot of food will not satisfy the inner hunger for self acceptance and love” (Iowa State University, 1994, p. 1). The quest to the etiology of inner hunger sometimes results in taking a person to his or her heart. Spirituality is one of many venues that a person can take to look for the meaning of this deep down inner hunger within him or herself. Reconnection with spirituality diminishes the likelihood of the risks of acquiring eating disorders (Costin, 2002). Many Americans are now becoming involved in spiritual practices. According to Newsweek’s 1994 report, three organizations polled Americans in 1994 and 1995. The results of the polls indicated that 58% of Americans feel a need for the spiritual growth. One-third of Americans surveyed reported experiencing some sort of spiritual or mystical experience. According to an American Bible Society project (1995), one of the leading priorities of Americans is to lead a moral life and maintain spiritual well-being (as cited in Young & Fuller, 1996). There growing evidence in literature of the influence that spirituality plays in human development, functioning, and healing. This evidence is also becoming more widely acknowledged in medical and psychological professions (Benson, 1996; Borysenko & Borysenko, 1994; Dossey, 1993; Richards & Bergin, 1997; Shafranske, 1996; Worthington, Kurusu, McCullough, & Sanders, 1996, as cited in Richards et al., 1997). According to Richards et al. (1997), a fairly small number of studies that have been done in the area of spirituality and eating disorders and their results supports the notion that spiritual influences may be significant in both the cause and treatment of eating disorders (these studies are discussed later in the paper). The current study will examine the interconnections between spiritual well-being and the risk to developing eating disorders.

DEFINING EATING DISORDERS
The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) classifies eating disorders into three categories: anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified. Research has suggested that both clinical and non-clinical disorders are on the rise (James, & Pritchard, 2005). Anorexia nervosa is a serious physical and mental disorder in which people do not maintain a body weight that is normal for their weight and height. The American Psychological Association (2000) states that anorexia nervosa is diagnosed when a person’s weight fall at least 15% below the minimum healthy weight for his or her age and height (as cited in Nolen-Hoeksema, 2004). Bulimia Nervosa is defined by uncontrolled binge eating, followed by purging, fasting, and excessive exercising in order to prevent weight gain (Nolen-Hoeksema, 2004). Eating disorders currently exist on a continuum and are no longer dichotomized into anorexia and bulimia, as they were in the past. The psychological risk factors that are usually linked with eating disorders are: Figure (Body Image) dissatisfaction, low self-esteem, general life dissatisfaction and loneliness, depression, perceived and actual stress and feeling of inadequacy or lack of control in life (Brouwers, 1988; Hagan, Tomaka, & Moss, 2000; Mayhew & Edelmann, 1989; Polivy & Herman, 2002; Cash & Deagle, 1997; Cooley & Torey, 2001; Morrison et al., 2003; as cited in James & Pritchard, 2005). James and Pritchard (2005) conducted a study with 185 college students ranging from 17 to 30 years in age to examine the relationship between disordered eating, class year, perceived stress, figure dissatisfaction, and self concept. They evaluated whether these factors predicted disordered eating among college students. Females made up the larger part of the sample of this study (n = 125) than did male (n = 60). Also, Caucasian comprises of the largest portion of the sample than students from other ethnicities (n =170). A cross-sectional design was used to compare students from each class (e.g., freshmen, sophomore, junior, and senior) on measures of disordered eating, body esteem, self-concept, and stress. The EAT 26 Questionnaire, Body Esteem Questionnaire, the Inventory of College Students Recent Life Experiences, and Self-Concept Clarity Inventory were used for their reliability and validity. Results showed that higher perceived stress scores were moderately correlated with higher disordered eating scores (r = .29, p < .01). A moderately negative correlation was found between lower self-concept ratings and higher disordered eating ratings (r = -.37, p < .01). Body image was also negatively correlated with disordered eating (r = -.40, p < .01). These results support that high stress, low-self esteem, and body image dissatisfaction are related to eating disorders.Various findings in research (Ellison & Smith, 1991; as cited in Phillips, 1998; Richards et al., 1997) point out that distress and low self-esteem, feelings of shame and unworthiness, are related to lack of spiritual well-being and illness. Also, a general consensus in the literature (e.g., Jerslid, 2001; Smith, Hardman, Richards, & Fisher, 2003, Newmark, 2002; Richards et al., 1997) is that lack of spiritual well-being is positively related to the high risk of disordered eating.

DEFINING SPIRITUALITY
Spirituality, on a broader basis, is defined as looking for the message and intention that a human life conveys. Opatz (1986) defined spiritual wellness as the willingness to seek meaning and purpose in human existence, to question everything, and to appreciate the intangibles which cannot be explained or understood readily. A spiritually well person seeks harmony between that which lies within the individual and the force that come from outside the individual. (p. 61; as cited in Young & Fuller, 1996) Research has suggested that spirituality and well-being are often times found in a direct relationship with each other. In other words, those who are more spiritual report having higher well-being. According to Ellison and Smith (1991) a lack of well being is translated as illness and distress (as cited in Phillips, 1998). Ellison in 1983 debated a need of a fourth (spiritual) dimension of well-being in addition to already existing physical, social, and psychological dimensions of well-being (as cited in Phillips, 1998). He stated that spiritual well-being (SWB) is enhanced when a person is spiritually healthy, that is the person is aware of his or her life’s goals, believe that there could be many possible out-comes to the plan for his or her life, feels emotionally and physically happy, feels a stronger connection with God, look for God’s support, strength, and guidance. Moberg (1979) and Moberg and Brusek (1978) state that the theory of SWB is bi-directional (intersecting) in nature and has two key components to it, religious and existential (as cited in Paloutzian & Ellison, 1991). The first component of the theory is the religious well-being (RWB). This dimension defines how a person perceives his or her relationship with God. The second component of the theory is known as existential well-being (EWB). This component deals with life purpose, meaning, and satisfaction. These two dimensions, RWB and EWB, are considered to make up the construct of SWB (Paloutzian & Ellison, 1991).

SPIRITUALITY IN RELATION WITH EATING DISORDERS
Apostolides (1998) writes in the excerpt published from her book, Inner Hunger: A Young Woman’s Struggle Through Anorexia and Bulimia:My body became the battleground where I played out my emotions. Look at you, Marianne. Look at that gut. Disgusting. It blobs like a cottage cheese. I was naked in front of the mirror. Look at those arms. My thighs used to be that big! Disgusting! Marianne…Do some push-up; Marianne, get your arms small again. This is disgusting! I looked in the mirror and saw flabby arms, fatty hips, rounded belly. I saw myself piece by piece. I didn’t see the connections. I didn’t see a form composed of curves and straight edges, of soft tissue and strong muscles. I didn’t see me. My body image reflected my self-image: I hated my body because I hated myself, I doubted my body because I doubted myself, I was angry at my body because I was angry at myself. Hate doubt, and anger. That’s what I saw when I looked in the mirror. (p. 2 -3)Jerslid (2001) notes that voicing of pain, power, anger, and self-care are common themes that quite often come up both in the worlds of spirituality and eating disorders. Eating disorder patients often want to voice their pain through engaging in unhealthy eating behavior. A spiritual person voices of his or her pain by communicating to a higher power. Eating disorder patients often feel lack of control or power. A spiritually healthy person feels in control by having the faith that he or she be supported. Eating disorder patients often feel angry and either turn it inward (i.e., stay silent about it) or let it out by engaging in some form of eating disorder. A spiritual person lets out his anger by talking it through and finding reasons behind his or her anger. Eating disorder patients often feel negligent toward their bodies and do not engage in self-care. A spiritual person is aware of his or her purpose in life and thus engages in self-care. Emmett (1985) describes addiction to exercise and weight control (in eating disorder patients) as small “g” gods and argues that in the absence of a spiritual purpose, the spiritual vacuum (inside an eating disorder patient) is filled by constant exercising and dieting rituals (as cited in Jerslid, 2001)Newmark (2001), a spiritual counselor, states that every individual suffering from an eating disorder feels sequestered (i.e., being cut-off) being cut-off, and experiences, usually unconsciously, the emotions of inadequacy and loneliness. These individuals are famishing not only for food but for any source of meaningful nourishment, such as affection, community, family, creativity or spirituality. She goes on to say that although it has been documented through empirical evidence that spiritual influences positively change the course of healing, eating disorder treatment programs often neglect the role of spirituality in the therapeutic process. She noted that for those of her clients possessing a strong faith, she was able to assist them in drawing on their spirituality as a means to help heal their disordered eating. She points out: “No matter how severe the symptoms of an eating disorder, somewhere in every human being is a whole self, wise and ultimately knowing how to heal. Spirituality offers a path for eating disorder patients to be exactly who they are, sufficient as is” (p. 76).Smith, Hardman, Richards, and Fischer (2003) looked into the relationship of religion and spirituality with eating disorders. They noted that even though there is not much literature available on the role of spiritual influences in recovering from eating disorders, there appears to be preliminary evidence that a relationship between the two may be present. Hsu, Crisp, and Callender (1992) did a study in which 16 patients with eating disorders were interviewed to acquire knowledge into the experience and recovery from eating disorders. One of the patients self-reported that her faith in God and prayer had assisted her in her recovery process. The investigators of this study admitted that they did not ask about the role of religious or spiritual influences in recovery and therefore, were not sure if spirituality was significant in the therapeutic process of the other patients as well (as cited in Smith, Hardman, Richards, & Fischer, 2003).Garrett (1996) did a study to explore the association of spirituality with the recovery process. This study involved 32 people suffering from anorexia nervosa. Her findings indicated that spirituality played a role in recovery and healing (as cited in Smith, Hardman, Richards, & Fischer, 2003). Mitchell et al. (1990) carried out a qualitative study of patients who had recovered from bulimia nervosa. They reported that a large number of patients mentioned that their recovery process was enhanced by the spiritual factors such as faith, prayer, or religious counseling (as cited in Smith, Hardman, Richards, & Fischer, 2003). Hall and Cohn (1992) conducted a study in which 366 women and 6 men who had bulimia nervosa in the past were surveyed. The investigators found that the spiritual factors played a significant role in the therapeutic process of these people (as cited in Richards et al., 1997). Rorty, Yager, and Rossotto (1993) conducted a study in which a group of 40 women in the recovery process from bulimia nervosa was interviewed. Most of these women (25% to 40%) indicated their involvement in the spirituality focused self-help organization of Overeaters Anonymous or had sought help from other forms of spiritual guidance. The researchers pointed out that a spiritual focus for some people may be conducive to their therapeutic process (as cited in Richards et al., 1997). Williams-Biddulph (1996) administered measures of spiritual well-being, depression, and self-regard to two groups of women who were going through the treatment of bulimia. Her findings indicated that there was a significant positive relationship between spiritual well-being and healthier psychological adjustment. However, due to the limitation of the study that the psychological measures were administered only one time, this study did not provide any insight into the relationship between growth in spiritual well-being and treatment outcomes (as cited in Smith, Hardman, Richards, & Fischer, 2003). According to Smith et al. (2003) the research to date has suggested that some patients with eating disorders believe that spirituality has facilitated their recovery process. They believe that even though the research has provided evidence in the direction that spirituality maybe conducive to healing and recovery of the patients with eating disorders, there are many unanswered questions that need to be empirically investigated.Smith et al. (2003) in their study investigated: a) whether intrinsic religiousness at admission predicts the treatment outcomes among women who receive in-patient treatment for eating disorders, b) does religious affiliation at admission could be a predictor of therapeutic outcomes for women who receive in-patient treatment for eating disorders, and c) whether improvements in one’s spiritual well-being during the eating disorder treatment are linked with reductions in eating disorder symptoms and better psychological functioning. The experimental setting that was used for the purposes of this study was The Center for Change, an in-patient care facility for women with eating disorders. This establishment uses a theistic spiritual emphasis, which the staff believes facilitates in fighting the hurdles associated with eating disorders and overcoming them. Patients take part in a bi-weekly, 12 step group. Patients are also supported to investigate their own spiritual beliefs and to draw upon them to help in their therapeutic process. A group of 251 women, ranging from 15 to 24 years in age, participated in this study. A large number of participants were single Caucasian and belong to Latter-Day Saints. There were also married and divorced participants from other racial groups and religious dominations and some specified themselves as not belonging to any religious group but having spiritual beliefs. Majority of the participant (35%) suffered from anorexia nervosa, 27% suffered with bulimia nervosa, and 29% with eating disorder not otherwise specified. Participants’ age of onset for eating disorder symptoms range from 7 to 38 years of age. Eighty-five of the participants reported suffering from childhood sexual abuse. The participants completed pre-treatment and post-treatment measures. The measures that were used included the Eating Attitude Test (EAT), Body Shape Questionnaire (BSQ), Therapist Outcome Evaluation Scale (OQ-45), and the religious well-being sub-scale of the Spiritual Well-Being (SWBS). The data were analyzed by computing correlations between the eating disorder and psychological outcome variables and predictor variables. The multiple regression analysis revealed that neither intrinsic religious devoutness nor religious affiliation were significantly associated with reductions in symptoms measured by EAT, BSQ, and OQ-45. However, improvements in spiritual well-being were significantly correlated with gains in psychological health, improvements in eating attitudes (EAT gain), improvements in body image (BSQ gain). Therapist improvement ratings were the only outcome variable that was not significantly correlated with improvements in spiritual well-being. Smith et al. (2003) emphasized, “Women who grew in spiritual well-being during treatment tended to develop healthier attitudes toward eating, their impression of their body image improved, their psychological symptoms declined, and they reported less conflict in their interpersonal relationships and improved social role performance” (p. 24). They suggested that experimental studies are needed to find out if a causal relationship exists between spiritual well-being and the various dimensions of therapeutic outcome of eating disorders.

COMMON SPIRITUAL ISSUES OF EATING DISORDER PATIENT
Richards et al. (1997) reports that in their clinical work they had come across at least seven common spiritual issues that patients of eating disorders often try to battle with. The first among them is the negative image of God, the perception that God makes judgment, is unforgiving and punishing. The second spiritual issue that eating disorders patients often struggle with is the feeling of spiritual unworthiness and shame, that is the patient believe that God consider him or her as unworthy and a useless person. The patient harbors a feeling of shame; their self-esteem is low and thus they are resistant to ask of God’s help. The author goes on to say that “ Many eating disorders patients attempt to compensate for their feelings of unworthiness through perfectionism, relentlessly striving to meet impossibly high standards-physically, morally, religiously, academically, and so forth” (p.265). The third spiritual issue that eating disorder patient has is the fear of abandonment by God, that is the patient has difficulty in trusting God’s love and feels abandoned by God. The fourth spiritual issue that eating disorder patients has is guilt and shame about sexuality, that is these patients are often time sexually abused as children and adolescents and are taught to fulfill their need of love through sexual activity. These people often grow up to be sexually promiscuous; this is especially true in the case of bulimia nervosa. If a person is religious, the guilt of being sexually promiscuous is enhanced and he or she feels agitated. The fifth spiritual issue that bothers eating disorder patients is reduced capacity to love and serve; these patients try to avoid love, such as God’s love and love of others. The sixth spiritual issue that eating disorders patients has is difficulty surrendering and having faith; they try to control their life by controlling the food they eat and in doing this they become so extreme that they refuse to have faith in higher power. They feel that only they could control their lives. The seventh spiritual issue that often disturbs eating disorders patients is dishonesty and deception; they are very secretive about their eating habits and go through emotions of shame over deceiving others about their eating disorders. They feel that God is not pleased with them because they are deceiving others.Hardman, Berrett, and Richards (2003) describes in their research as to how struggle with deep spiritual conflicts can become a major hindrance to the recovery of women with eating disorders. They had clinical experience with more than 350 women at Center for Change, an inpatient eating disorder treatment facility, for 7 years and observed that women with eating disorders may hold ten false beliefs that could become a hurdle for them in connecting with their spirituality. The researchers investigated how eating disorders (anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified) may affect spirituality and how spiritual influences can facilitate recovery. The researchers indicate that the first belief that women suffering from eating disorder might hold is that the eating disorder will provide them with a sense of control. They are afraid to give up on their illusion of control long enough to believe that someone outside of them can care for them, accept them, or love them. The researchers perceive this a major obstacle in connecting with the higher power. The second false belief usually held by the sufferer is that through their eating disorder they can express their pain, suffering, and feelings of unacceptability. The researchers believe that this pain could be communicated in their prayers. The third false belief is that the eating disorder will make these women unique and different from others. Hardman, Berrett, and Richards (2003) perceive this pursuit of being exceptional as a hindrance to reaching out for love, kindness, forgiveness, or support. The researchers observed that these women stopped praying because they believed that they are undeserving of a relationship with God. The fourth false belief is that the eating disorder will become the evidence for the sufferers for being unworthy. They feel that they are worthy of punishment and if God and others are not going to penalize them, they should punish themselves. The fifth false belief is that the eating disorder will result in making the sufferers perfect. They feel that the disorder will compensate for their drawbacks and failures. This pursuit for perfection results in “all or nothing” approach, which the researchers believe, result in leaving spirituality and compassion out of the self-improvement pursuits. The sixth false belief is that the eating disorder will get rid of anxiety and stress, and results in comfort and safety. The authors noted that many of their clients, especially those with bulimia nervosa found binging and purging as a way of releasing their tension. The researchers believe that this temporary comfort keeps the sufferers away from seeking more profound and greater comfort that can come from spirituality. The seventh false belief is that the eating disorder will give the patients as sense of recognition and identity. They are fearful that by letting go of eating disorders, they lose their sense of self. Hardman, Berrett, and Richards (2003) believe that with this false belief they feel spiritually hopeless. The eighth false belief is that the eating disorder will make up for the past problems, be it trauma, abuse or personal mistakes. The researchers believe that these patients often neglect God as a source of comfort or forgiveness. The ninth false belief is that the eating disorder will somehow able them to justify for the absence of an enriched and full life. By holding this belief the sufferers experience a sense of powerlessness, feeling that God did not instantly save them from eating disorder. The tenth false belief is that the eating disorder will provide them with other’s approval. Hardman, Berrett, and Richards (2003) noted, “Despite the challenges, we have found that spiritual discussions and interventions can greatly help women with eating disorders reconnect with themselves, with others, and with their God in healing and life-changing ways” (p. 74). The researchers indicated that empirical evidence has shown that praying is positively associated with the therapeutic process. In summary, the above mentioned research indicates that the spirituality plays an important role in the treatment and recovery of eating disorders. An eating disorder patient’s spiritual well-being, that is being able to talk about spiritual issues, participate in prayer and meditation is likely to assist that patient in developing a healthy outlook to his or her body image, enhances a patients psychological and mental well-being, and helps in promoting healthy eating habits. Eating disorder patients suffering from spiritual issues often find it hard to recover from their eating disorders. When the spiritual issues are resolved the road to recovery is often easy and less painful. Spirituality of an eating disorder patient gives that patient a power to fight eating disorder and is conducive to the therapeutic process of the patient.

CURRENT STUDY
The various purposes of this study are: a) to address the prevalence of eating disorders in college students; b) to expand on the definition of spiritual well-being; c) to examine the relationship between spiritual well-being and eating disorders, to assess whether the lack of spiritual well-being predicts a high risk of acquiring eating disorders among college students; and d) to investigate the interconnections between spiritual well-being and body image, to find out whether figure dissatisfaction is higher among college students who have a lower spiritual well-being.Based on the above mentioned research, it is hypothesized that a) college students who rank low on the Spiritual Well-Being Scale (SWBS) are at risk of developing eating disorders; b) college students who score low on the SWBS are dissatisfied with their body image or have low figure satisfaction; and c) female college students are more at risk of developing eating disorders than males.

Table 1
Regression analyses of lack of spiritual well-being as predictor of eating disorders among college students (N = 52)
Variable	B	SE â	âPredictor (scores on SWBS)	7.96	3.66	.50*Note. R2 = .25,* p < .05.