Can I excuse myself from fasting if I have an eating disorder?
Dear Fatima,
I am a 24 year old heterosexual single Muslim female. I have suffered from binge eating disorder since I was 15 years old. I don’t purge and I don’t take laxatives. My eating disorder therapist told me that fasting may not be the best for me because it’s not good for an eating disorder. Alhamdulillah, I’m healthy and have fasted ever since I reached puberty when I was 13 years old. What is the ruling on eating disorders and fasting during Ramadan please?
Thanks,
A sister in need
Assalamu ‘alaykum,
You raise a very important question and the most difficult part of the response is that there is no one right answer. Everybody’s body is different and everybody’s experience of an illness is different. There are some women for example who can fast easily while pregnant or nursing and others who struggle to do so.
The allowance in Islam for individuals to not fast is available for those who find that they are unable to fulfill the obligation, and it’s also a way for people to not push themselves into an unhealthy place. It’s also not necessarily an all or nothing decision. That means that if one day you are able to fast one day, and the next day you feel like your body isn’t up to it then the leniency is there for you.
I don’t know your situation, for example when did the behaviors of binge eating begin even though your diagnosis was at 15? What has your experience of Ramadan in the past been? What are the challenges that you are currently experiencing with eating? How long have you been seeking treatment for your eating disorder? Have you been fasting while receiving treatment before? How long have you been seeing the current therapist? How well have you discussed these issues with him or her? What are your fears related to Ramadan? What are your feelings about potentially not fasting? How would you make Ramadan meaningful to you if you were not able to fast? How would working on your binge eating get triggered during Ramadan? How would some of the underlying issues behind your binge eating get triggered during Ramadan (for example, you might see people who are difficult for you to be around because of the iftar parties etc.)? Are you taking medication? If so, how would the function of that medication be affected by fasting or dehydration?
All of these questions are important ones for you to work through with your therapist so that you can examine your strengths and the challenges you face and come up with a good plan for how you will approach Ramadan.
Many researchers in Middle Eastern countries have looked at fasting during Ramadan and health concerns such as diabetes and other chronic conditions. I would not be surprised if they’ve also done research about eating disorders and fasting. Perhaps reviewing that research with your therapist would help you better understand how other people’s bodies reacted to fasting while also struggling with an eating disorder. There might be protocols or other useful information that could inform the conversation between you and your therapist as you figure out the best plan for you.
May Allah (swt) give you a meaningful Ramadan regardless of whether you choose to fast this year.
Sincerely,
Your sister in Islam
“Fatima Z”
Note: Dear sister – we also posed your question to a number of Muslim health professionals. We have posted one clinical response below and the remaining responses in the comments section of this post (including their credentials when available, e.g. MD, MS, RDN, etc). Please note these are their personal and/or professional opinions and not necessarily endorsed by Stones to Bridges.
If you are looking for a religious scholarly response to consider alongside the health professionals responses by Fatima and the comments below, you may find it beneficial to submit a question on http://seekershub.org/ans-blog/.
InshaAllah, you will find “Fatima’s” response above, and the comments on this post beneficial in making your decision. May Allah guide you and bless you for your efforts in striving to determine what is best for your particular situation.
I work at an agency where we run an Intensive Outpatient Program for Eating Disorders. Based on my knowledge and working with individuals with ED, I would say yes, treatment does need to be individualized. However, based on the question posed by the 24 year old with Binge Eating Disorder, I would discourage her from fasting, as that perpetuates binge eating. It would be important and healthy for her to focus on developing healthy eating habits. Ramadan is an excellent time to work on ourselves, and our well-being. Remember, we do have a responsibility towards our physical well-being, as well as our psychological well-being. Additionally, Binge Eating Disorder is one that isn’t adequately treated typically, so I would encourage her to find a clinic (if she has not already) that specializes in eating disorder treatment, and get the support she needs to work towards healing.
Please also note, that ED have a very high mortality rate, and result in many medical complications, so I would urge you to be cautious when recommending treatment, and also continue to reach out to specialists in the ED field.
Sincerely,
NYS Licensed Psychologist
Anonymous
I work at an agency where we run an Intensive Outpatient Program for Eating Disorders. Based on my knowledge and working with individuals with ED, I would say yes, treatment does need to be individualized. However, based on the question posed by the 24 year old with Binge Eating Disorder, I would discourage her from fasting, as that perpetuates binge eating. It would be important and healthy for her to focus on developing healthy eating habits. Ramadan is an excellent time to work on ourselves, and our well-being. Remember, we do have a responsibility towards our physical well-being, as well as our psychological well-being. Additionally, Binge Eating Disorder is one that isn’t adequately treated typically, so I would encourage her to find a clinic (if she has not already) that specializes in eating disorder treatment, and get the support she needs to work towards healing.
Please also note, that ED have a very high mortality rate, and result in many medical complications, so I would urge you to be cautious when recommending treatment, and also continue to reach out to specialists in the ED field.
Sincerely,
Amina Mahmood, PhD
NYS Licensed Psychologist
Anonymous
Wa Alaikum Assalam,
Certainly the sister should do her best to decide whether she can fast or not by checking with her family and knowledgeable friends. However, eating disorder psychology is quite complex and fasting can be detrimental. If her therapist is recommending that fasting may be harmful then she should follow the treatment plan so she may become healthy and fast safely later in life once again insha’Allah. Most eating disorder therapists nowadays are familiar with the Muslim tradition of fasting and typically do not make these suggestions lightly.
Shamel
Shamel Abd-Allah, MD
Chief, Pediatric Critical Care Division
Anonymous
From a clinical perspective I believe fasting may be triggering, in that it requires restriction throughout the day and then having a moderate meal at night. However, most Muslims do tend to binge during the evening and before fajr, thus making it triggering. I believe if she has a solid plan in place, and if she has had a period of abstinence from binging than she could potentially fast. However, in the event that she is still struggling with urges and acts upon these urges, my primary recommendation would be for her not to fast. Is her family aware of her disorder in order to support her through this time? Is she attending support groups or any skills groups to help in this process, that may help with combatting urges?
-Masters in Counseling, specialize in EDS
Anonymous
Salaam everyone,
I agree with both previous responses. One of the beauties of fasting is that it is one of the most personal acts you can perform for Allah and therefore it is truly between you and Him, and I would hate for you to miss out of that if you were unable to fast. However, it is important to remember the reason why Allah has added such safeguards for those who are traveling, pregnant, have chronic illnesses such as diabetics, etc. Allah is not intending to make Islam more difficult on you, and He wants to ensure that we take care of ourselves as best as we can while performing our obligations as Muslims.
Does that mean you definitely should not fast…no I am not suggesting that. A person who is traveling will not be punished if they decide to skip a fast and make it up later, but another person may feel they can handle it and go ahead and fast while traveling. Allah will hopefully choose to reward both. Allah knows your true intentions, and by you even bringing up such a question shows you are torn in that you want to fast for Allah.
While I admit that there are many individual differences, it is very dangerous to state that the “medical community knows so little.” We do not know the severity of this eating disorder, and while she may be able to handle fasting and not resort to relapsing, she may have difficulty controlling her urges as well (and that does not make her a weak person in any way).
I wish I had a direct answer for the sister, as to whether she should fast despite her eating disorder or not, but it is just not that easy. Two years ago, during Ramadan, a brother passed out during Juma. He was diabetic and chose to fast and ended up needing to be hospitalized. Again the point is not to scare anyone, or to suggest he made a poor decision to fast at that time, but to remind everyone that EACH AND EVERY SITUATION needs to be looked separately. Some diabetics may have been able to handle it and some individuals need to forgo fasting.
I would even suggest maybe take some time to do istikharah. Ask Allah for guidance on this matter, and regardless ask Him for help in controlling your eating disorder and to help you overcome this trial. May Allah bless you and make this time easy for you. Also I apologize in advance if I have offended anyone by my message, as that was not my intention.
Fi Amaan Allah
– MD, Child & Adolescent Psychiatrist
Anonymous
Totally agree. If she has fasted since age of 13 without any problems she should continue to fast for obvious beneficial reasons. If fasting worsens her eating disorder than she should not fast. She is her own best judge, nobody else can make a decision for her.
– M.D.
Attending Physician & Nephrologist
Anonymous
If your physician says that fasting is not good for your health then you should not fast. If your physician thinks that you will heal after a given time, then you wait until you heal and fast the days you missed. Now, if your physician thinks that your ailment is chronic and currently there is no available treatment that will prevent the harm of fasting then you feed a poor person for every day u don’t fast or pay what is equivalent in currency. I highly recommend that you stick to the opinion of the physician treating you.
-PhD
acharan
I’m a Muslim female Licensed Professional Counselor (LPC) in the state of Texas.
Just like the previous message from the Psychiatrist, I’d like to reiterate the importance of this being an issue of an illness. Eating disorder (ED) is a disorder, a condition that requires treatment and attention. People with ED tend to be very secretive about it and can indulge in ways to mask it. ED is about restrictive and unhealthy eating behaviors. Fasting requires us to restrict our consumption between sunrise and sunset; unfortunately this can enable the young girl to continue those unhealthy eating patterns. ED treatmeant usually includes well planned and timed meals throughout the day- and this is a very important element of treatment.
ED can be very dangerous when left untreated.
Besides,as mentioned in previous emails, Allah SWT is Compassionate and Mericiful and one is not required to fast when he/she is sick. ED is a sickness, that requires close monitoring and treatment.
I hope this helps.
– MA, NCC, LPC, Licensed Professional Counselor
Anonymous
I am a Muslim woman psychiatrist
Eating disorder is an illness, it needs attention, psychotherapy and sometimes addition of some medication of its combined with Anxiety symptoms, depression or OCD
Sometimes, patients need hospitalization if there is Bulimia with frequent self induced vomiting
Which may cause chemical imbalance, dehydration or even heart attack in severe conditions
So the issue here is Treatment, Treatment , treatment
In Ramadan, if someone is Sick, they can feed an indigent
I.e. the person if unable to fast for medical reasons, he or she pay to a poor person what equals 30 meals for the 30 days of Ramadan
Many mosques do this service, they take money from the person who is unable to fast and give food on their behalf to poor people
But, if the condition is simple and not complicated and able to be in therapy, fasting may help healing the condition!
Because the person knows that at time of breaking the fast at sunset he or she can eat all they can eat
But again , it’s important to seek professional help ASAP
The person can do all other ways of worship like praying, Zikr, reading Quran or try to memorize some of it
I hope I have some answers to the question
-Nahed El- kholy, MD, Board Certified Psychiatrist
Anonymous
If you have been fasting without a problem for so many years, and you feel it doesn’t worsen your disorder, you may want to fast.
The benefit of fasting in terms of building self control are tremendous and should not be under estimated!
-MD
Anonymous
Assalaamu ‘alaikum,
In the original question, our young sister mentioned:
She states she has an eating disorder, specifically binge eating diagnosed at 15yo.
She states she has fasted since the age of 13.
Her therapist is concerned that fasting may not be good for her.
People who are ill are exempted, not necessarily prohibited, from fasting and are to make up the fasting when and how they are able from available options. There is according to the person’s judgement. In this case, I think it depends on our sister’s insight and judgment. Can she make that determination by herself? What has her experience with fasting been? What are her triggers? Does the therapist have all necessary information to make a specific recommendation to this specific client?
Wallahu a’lam.
May Allah help our sister. May He grant her and her family tremendous blessings this Ramadan.
Anonymous
I noticed that too. I am going to assume that something must have changed. However, I wonder what her state of health was like after each Ramadan. There’s really missing pieces to the puzzle. Although, she may have been doing it since the age of 13, was there an exacerbation of her condition. Giving the missing pieces, I would say that she shouldn’t put pressure on herself if she’s unable to fast. It’s okay.
In health,
Maliyka A.Muhammad, MA, MPH
http://www.maliykaishealth.com
Follow me on twitter @maliykaishealth
Anonymous
Salaam
The overall principle is below – if a physician deems fasting risky for their patient then it is fair for the patient to leave fasting and instead pay the fidaya.
I would frame it that if the medical advice is to avoid fasting out of fear of relapse or worsening of her eating disorder, then it is best for her to leave fasting until it is medically safe to do so, and to see the proper religious authority to discuss alternatives to fasting so she can still participate in the holy month. If she has any further questions, we can provide her with the contact of an Islamic scholar who is a particular physician so she can get a second opinion.
Q: Does a sick person have to fast?
A: A sick person is exempted from fasting altogether if there is genuine reason to believe that the current illness will intensify by fasting or that he will suffer another illness on result of fasting or that his recovery will be prolonged due to fasting.
Anonymous
ASA WRB
Only God and the affected person can judge their ability to fast. If you were able to fast in previous years, I will continue to fast. I skipped fasting when I was in my 20s because I took a diuretic for hypertension but later realized that I was able to fast without problems. Fasting is between you and God and it is a real test. I do not seek the advice of my physician regarding suitability of fssting for myself. Medical community knows so little and there are so many individual differences.
May Allah swt accept your service and piety.
Ma’Assalam
Anonymous
Walaikum salaam.
With binge eating disorder, in the absence of anorexia, purging and purging, I think the young lady should go ahead and make a strict meal plan for sahoor and iftaar, and since she’s fasted since she was 13 and would likely have feelings of guilt if she abstained, and try fasting.
If binging at iftaar becomes a problem, then perhaps the issue would need revisiting, with discussion turning to medications approved for binge eating disorder.
Salaam
– MD, Psychiatrist
Anonymous
From an Islamic perspective you do not fast when you’re sick. An eating disorder is a sickness. Unless she has her eating disorder under control and is sure that it’s never been a trigger for her, she shouldn’t do it. You don’t just have to fast from food. My Ummi can’t fast because of her diabetes. She engages in everything else except from abstaining from food. She’s also at the mosque cooking for those who did fast. Allah (swt) is kind. Don’t make things hard. He doesn’t yet we always do.
In health,
Maliyka A.Muhammad, MA, MPH
http://www.maliykaishealth.com
Follow me on twitter @maliykaishealth
Anonymous
As salaam walakum,
I have known Muslim folks with eating disorders and here is how I have counseled them:
1.) For those who have had a regular habit of fasting, Praise their effort and desire to continue this normal aspect of their life, despite their challenges.
Remember that low self esteem contributes to eating disorders and so it’s important to not say anything that may be viewed in the patient’s eyes as criticism.
Additionally, if the patient is strong in their faith we want the patient to feel that they can continue with their religious practices without sacrificing the progress they have made in overcoming their eating disorder.
2.) Review with the person that fasting is for those who are healthy and engage the person in a one on one conversation about how they feel regarding their overall health status, nutritional status, and if they check in with their medical physician for annual physicals.
3.) If the patient wishes to fast, advise them that in order to preserve their physical and mental health, and all of the good progress they have made, they should sit down and devise a healthy meal plan for their sahoor and Iftar meals. This will help them prepare their nutritional content as well as prevent binge eating and/or anorexia. I advise patients to include a good multivitamin and also plain yogurt into their daily regimen.
Side note ***new research has drawn a connection between eating disorders and underlying thyroid conditions. Or in some cases, the eating disorder is due to disrupting the healthy bacteria in the colon.
So, patients following up with their physician is important.
Anonymous
Excellent response. Especially when looking at not only endocrine related diseases but also considering the state of mind of the person.
– MS,RDN,LD
Registered Dietitian Nutritionist