An Old Dress, A New Body

Beautiful slim girl wearing a gymnastic bodysuit covered with clouds of the flying white powder jumps dancing on a dark. Artistic conceptual and advertising black and white photo. Copy space

The following is a guest posting from an extraordinary young woman in recovery. 

Once upon a time I was a lot less confident. Once upon a time I didn’t trust myself or others. Once upon a time I was so lonely and scared. I wish I could say, “until one day everything changed,” or “then one magical evening”…. but it’s not like that. This isn’t the fairy tale of my dreams. This is real life. It’s fucking hard. It’s scary. It hurts. Things go wrong, plans fail, relationships fall apart, your biggest nightmare turned reality. But that’s the thing. This is reality. It’s real. It’s right in front of us. And we have to deal. So once upon a time…. I wasn’t the same as I am now. I was timid and scare and couldn’t speak the fuck up. In my darkest moments I wanted to die. I wanted to disappear. I wished I had never been born. But haven’t we all. Most of us have been there. Most of us know how hopelessness feels. Damn. What a life. That’s how it used to be. And here I am now. So much more happy. So much stronger. I have more passion and drive than I ever thought possible. I know who I am more than I ever have. That’s not to say I have it all figured out. That’s not to say I know every part of myself. I know I have many more doors to open within my soul that will lead me to many more adventures and realizations. I know there is a long winding path ahead of me. But, God, I’m so excited to walk it. Once upon a time…. this dress wouldn’t stay up, even with tape. It would slip and fall, every few minutes I had to pull it up. I didn’t eat very much then. Just like I didn’t trust people I didn’t trust food. I couldn’t, it just didn’t make sense in my mind that food could actually be a good thing for me. I knew I needed it. Wtf I ran fucking cross country for 5 years I KNEW that I needed to eat. I just…. didn’t trust it. I would eat, trust me I did…. I just, made rules for myself about what was okay and what wasn’t. I had very solid, blunt lines that I could NOT cross. Never. And if I did…. sheesh. Well, in my mind at the time that was just another reason not to trust myself. So this dress… it used to be so big on me. But today it fits perfectly. Today it hugs me and holds me and I feel so content in this body. This body I have built with love.

You Have a RIGHT to be Here

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“You are a child of the universe no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should.”  
-Desiderata by Max Ehrmann

I lean forward, resting my elbows on my knees. I look my client in the eye intently. She looks back uncomfortably. This is one of those situations where I am want her to be uncomfortable, because what I am about to say is, I know, as imperative for her to learn as it is outside of her norm to consider.

“Take space.”
“I’m sorry?” she says.
I stand up, spread my arms out, breathe in, lift my chin up and proclaim like a madwoman to the room “TAKE SPACE!!!”
Now she’s really uncomfortable. I sit down and resume the intense posturing of a Superbowl coach during halftime.
“The only thing I teach people to do in therapy is to take space. Make room for your needs in your life. Stop living as if your feelings are a liability, your wants are a burden, your boundaries are destructive, don’t live as if what you require for peace of mind is stressful for others, that to ask for nurturing is selfish. Placed in priority above your own well-being is an intense fear of appearing ungrateful, weak, self-centered, gluttonous or narcissistic. This is all based upon the habit of self-constriction, the idea somehow that the world doesn’t have enough space to accommodate your needs, or that for some unstated reason your existence demands that you suppress your desiderata.”

“SO! Remember when I said ‘You are what you need’? If you don’t make room for your needs in your life, then what does that do to the self?” I ask.

“It makes the self smaller.” She says.

“Genius! And if the self is smaller or weakened, then self-worth is what?”

“Weakened,” she answers.

“Brilliant! And if self-worth is weakened then what happens to self-care?” I ask.

“It’s reduced,” she replies.

“Prodigal! So what is an eating disorder?”

“It’s not taking care of myself because I don’t feel like I deserve to,” she says, looking down.

“Yeah…” I whisper.  “Hey. What do we need to do about that? Should I give you a lecture on why you should take care of yourself or is that just information you already know?”

“I already know it, I just can’t do it,” she says.

“OK. So instead should we work on helping you take space in the world? Building up your fulfillment of your needs by asking your world to nurture you? This might increase your ability to feel worthy of eating, worthy of taking care of yourself, worthy of taking action on all the healthy things that everyone says you should do for you?” I ask.

Smiling shyly, she nods.

“Where should we start?”

“Well, I could tell my dad that it feels good when he hugs me goodnight, I could take out my jewelry kit and start working on making some bracelets…just for me!” she adds, grinning. “I might even ask mom for help with the jewelry. I could ask my friend to stop teasing me about what I wear…is that taking space?” she asks.

“You got it!”

-P.S. last week I wrote about the poem “desiderata” as striking at the core of my system of Thermodynamic Psychology. I had never looked up the definition of “desiderata” though, until recently.

desiderata:  plural noun, singular desideratum:  things wanted or needed; the plural of desideratum

In that moment, I was overwhelmed with a feeling that, perhaps the universe really IS unfolding as it should….

In Pursuit of the Gentle Self

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Therapy does so many things that to try to sum it up in one sentence seems obtuse and myopic. And as often as we complexify (DEFINITELY a word) a discipline, perhaps all discrete pieces of truth circulate around a unified core axiom. I believe in psychology, we do not have that veracity pegged, so our systems so far seem to reflect  an expansion rather than a contraction of ideas. Yet, there is serenity to be found through the pursuit of parsimony, clarity is found in simplicity, and this is never more marked than in the formation of a new counseling relationship. In these early sessions, I must briefly, concisely convey how I treat mental illness and eating disorders so a shared vision of progress can be achieved. In the past I have struggled to fit  concepts that I could spend 10 hours explaining into a manageable, user-friendly brevity. In fact, often I feel like the ideas of Thermodynamic Psychology (ThP) are like the Death Star–I don’t need the whole thing at once, I need the Lego version!

But therapy is a deeply spiritual process, and what is spiritual is always infused with feeling. So instead of asking myself to lecture about my system in a linear logical way, I focus not on what Thermodynamic Psychology IS, but rather on what it FEELS LIKE. This approach not only cuts to the core of the system, but invites a more authentic and holistic unfolding of the counseling bond. To sum up the essence of ThP, my heart turns to the Desiderata by Max Ehrmann, and it is with these words I encapsulate my design.

“Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should.”

For this article, I will take only the first sentence and describe what it means to me.

Beyond a wholesome discipline…

Sometimes we need to do things that are for the maintenance of our achievement goals, things that are hard or boring, things that are somewhat aversive but in the long run create a value-rich life. For instance, I force myself to eat kale and salmon, go to bed at a reasonable time even though I want to stay up reading Jean-Paul Sartre (Stephen King), drink water even though I might want beer, exercise regularly and take my vitamins (even though the fish oil I take occasionally bursts in my mouth and I spend the next 6 hours gagging). Do healthy stuff. Also, I do things that get me closer to my goals. I have to finish my papers even when I am tired, go to work even though I would rather stay home and play Legos (I have 2 boys so that’s not weird), pay my taxes, take care of my business. I have to clean the house and the cat box, do laundry, cook (bleh) and keep my home homey, etc. even when I might not always feel like it. So a wholesome discipline means conscientiously endeavoring toward one’s achievements while tending to the needs of those around you. In other words, eat your broccoli and be NICE to your sister!

be gentle with yourself.

Amidst all the accomplishments and duties, the hustle-bustle and “to-do lists” of our day is the experiential self, and if we neglect this core element of existence, we suffer. Living gently means showing empathy inward and taking time/energy to engage in process-based experiences that are fun, relaxing, restful, peaceful, spiritual, and enjoyable. Giving yourself permission to nurture priorities that are “just for you” and not outcome-driven, not other-driven, while inviting others to see and respond to your needs in kind…this is being gentle with yourself.

I pride myself on having a firm grasp of the obvious, and in my view, people with eating disorders are not gentle enough with themselves. They drive toward an internalized “self-expendable” goal that toxically eclipses self-nurturing. Kind and empathic self-sustenance is lost, such that a person starts to resent himself for what he needs. Concern for the needs of the self are displaced by self-directed admonishment, beratement, and guilt, and eventually the requirements for rest and restoration start to be seen as a liability and weakness. Eating disorders are about self-deprivation and self-punishment, where monitoring and accountability that may in measured doses be healthy for one’s life runs rampant and overtake the ability to be inwardly gentle. A good therapist will need to hold this hopeful and gentle care for the client until she is ready to claim it as her own. Good therapy is always a journey of love.

The Grateful Paradox

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As some of you who are familiar with my work are aware, I believe eating disorders are caused when the needs of the self are unmet. These unmet needs arise when one’s system of need satisfaction breaks down, becomes imbalanced, or otherwise misoperates. In order to lend support to this theory, I would like to take a look at the role that gratitude plays in eating disorders.
Last year I read an article written by Vartaniant, et al. (2014) entitled “Early Adversity, Personal Resources, Body Dissatisfaction and Disordered Eating”. When participants with eating disorders completed the Gratitude Questionnaire, which measures the degree to which one is grateful for a variety of life’s aspects, there emerged a negative correlation between scores on the gratitude questionnaire and body image–as gratitude increased, body image worsened. This finding was unexpected, as the authors assumed that gratitude would decrease eating disorder severity and negative body image.
Gratitude is an emotion that one has in response to receiving help and nurturing (McCullough, et al., 2001). Therefore, it stands to reason that gratitude would be positively correlated with the amount of help one receives–the more others care for you, the more gratitude you feel (Komter, 2004). The fact that there was an inverse relationship between gratitude and body image might seem to fly in the face of my need-fulfillment theory. However, in psychology, paradoxes abound, and perhaps there is a more complex relationship between gratitude and social nurturing. I believe people with eating disorders may experience gratitude such that the feeling sometimes impairs their ability to receive nurturing from others.  If one believes that “others have already done so much for me, I ask for too much, I should be satisfied with what I have already received, etc.” they might hesitate to express unfulfilled needs or accept additional acts of caring from other people. Over time, gratitude might lead to a restricting of a person’s ability to solicit and receive nurturing from those in the immediate social circle–a habit that will lead to unmet self needs, thereby worsening eating disorder pathology. With regard to body image, I believe there is a mediating variable of guilt. Guilt, in my observation, causes body image issues to worsen. I believe the more grateful one is to others, the more likely he or she is to also experience guilty feelings in that relationship, particularly if there continue to be unmet needs experienced in the dyad.
It is important to understand how variables such as gratitude, guilt, entitlement, obligation, and accountability are unique in the minds and interactions of people with eating disorders. What is a positive, bond-building strength for some individuals could function as an impediment to social intimacy and need fulfillment in a person who is predisposed toward certain brain-based emotional and cognitive traits. We should primarily understand how feelings, beliefs, behavioral patterns and roles all impact the degree to which a person meets his or her psychological needs, because these unmet needs often lead to unmet physical needs, which is the embodiment of an eating disorder. So often in this field, things are not as they seem upon first glance and if we are to meaningfully join with those we serve we must look beyond the obvious and explore the hidden paradoxes.

Komter, A. E. (2004). Gratitude and Gift Exchange. The psychology of gratitude, 195.

McCullough, M. E., Kilpatrick, S. D., Emmons, R. A., & Larson, D. B. (2001). Is gratitude a moral affect?. Psychological bulletin, 127(2), 249.

Vartaniant, L.R., Smuth, J.M., Zawadzki, M.J., Heron, K.E. & Coleman, S.R.M. (2014). Early Adversity, Personal Resources, Body Dissatisfaction and Disordered Eating. International Journal of Eating Disorders, 47 (6), 620-629.

 

 

 

The Certainty Trap

Caught in Red Tape A man caught in red tape. The man & tape and the background are on separate labeled layers.

I’ve heard it said by top leaders in the field that “there are no surprises in caring for patients with eating disorders”. I see how saying such would inspire confidence and be reassuring for patients and families seeking treatment, and to be honest, it’s a lovely thought. The statement implies certainty and comprehensive knowledge of this disease. However, I can’t help but wonder, if there are truly no more surprises, if we’ve thoroughly solved this puzzle, wouldn’t we be seeing a success rate above 50%? Wouldn’t our etiological theories and methodologies inspire so much hope and resolve in sufferers that more than 50% would reach out for treatment in the first place? Most of the journal articles I read indicate that eating disorders are continuing to elude us clinically, which is why we have so few evidence-based treatments at our disposal.
Schiller says “knowledge is death”, which to me means the stance of “knowing” causes us to lose the ability to discover, be curious and it overall precludes understanding. Of course, as professionals we want to rely upon empirical fact and utilize what we have learned through our experience, but it seems important to also approach our work from an open-minded platform, rather than one of certainty. The stance of “knowing” is like a closed hand, holding tight to what is assured. We should not confuse that which we are unaware of with that which does not exist. Like babies without object permanence, if we can’t see it, we assume it isn’t there, and this mindset can hamper the development of better approaches. Closed hands cannot grasp new information or reach for a new opportunity for growth.
In my practice, the most essential element of success comes not from the material in my manuals or the data in my books, it comes from my desire to understand each of my clients for the unique person he or she is. The more I am curious and intent on discovering them, the more they are able to discover and recognize their own true selves, and ultimately this is what paves the path to recovery. In short, each and every person we treat has surprises and we should strive each day to be worthy of hearing them. To do otherwise misses a golden opportunity to help clients cultivate self-curiosity that is the gateway for self-care. Certainty can be a trap and the biggest trap of all is the one we don’t know we are in.

Family: The Vehicle of Nurturing

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What do I think causes eating disorders? In a word, unmet needs (Ok two words). Humans meet psychological needs through social exchanges, as we are first and foremost social creatures. Our minds become unwell when we are socially isolated because this isolation stops the flow of understanding and nurturing that feeds the mind. However, this flow can be blocked by a number of variables even when we are not isolated. For instance, certain biological predispositions can create affective and cognitive patterns that interrupt the smooth flowing of nurturing in a social system. In order to restore one’s psychological needs, we must a priori understand these potential blockages, imbalances and entropic dynamics that stop an individual from receiving what sustains healthy feelings and behaviors. When treating eating disorders, it is imperative that we help clients recognize variables that interrupt self-sustenance and self-understanding. In other words, what is getting in the way of their ability to be understood and taken care of by those they love?

Case Example: Stephanie

Stephanie was suffering from a longstanding and protracted Anorexia, that started in her early teen years. She had been through several stints of treatment but was unable to achieve a lasting recovery. At our retreat, we do an alignment exercise (involving lop sau #1 from Wing Chung). This shows ways that two individuals share space and make mutual adjustments in order to find balance between self and other. Stephanie was consistently dominant over her father, which indicates that she tends to approach this relationship from a rather inflexible and closed-minded perspective. Dad made adjustments as we instructed, which showed that he is probably willing to do in his relationship with Stephanie as well. This exercise helped Stephanie to see how she was shutting out a major source of nurturing in her life–that of her father. She had not been open enough to rely upon him for the care and help that she desperately needed. After this, Stephanie really challenged her view of her dad and was able to commit to letting him back in to her life, opening up the pathway for him to meet her needs. We also did the alignment exercise with her and her husband, and discovered that the couple tend to lock into a proverbial arm wrestling match, both wanting to dominate the other. We encouraged them to adopt a stance of mutual flexibility, mutual vulnerability, in order to open up the pathway of love and care. We helped Stephanie to move more of her focus and energy onto her marriage and off of other derailments. These adjustments allowed Stephanie to regain a healthy weight and her recovery is sustained.

Case Example: Alex

Alex was a boy of 13 who came to counseling at a very low weight. He was started on an outpatient protocol of nasogastric feeding by his PCP.  During our early sessions, I talked to him about his family, which he described as very healthy and overall really great. However, Alex was be very worried about mom, as mom has health concerns that caused her to be ill and in pain much of the time. Alex reacted to this condition by constricting his own needs, as he didn’t want to add to mom’s stress or contribute to draining her. I encouraged Alex to give more of a voice to his own feelings and reduce the tendency to withdraw from mom because he was preoccupied with adding to her stress. Alex’s dad struggles with untreated anxiety, and Alex responded to dad’ anxiety in a similar fashion–by withholding what he feels and what he needs because he was too preoccupied with dad’s anxiousness. Overall, Alex perceived his family as not really expressive of emotions, so because he didn’t want to be different or make them uncomfortable, he would suppress his own emotional expressions. I encouraged Alex to embrace the ways that he is different from his family and look at his emotionality as something that might inspire others to also share their own feelings. Additionally, I emphasized to him that what he feels is who he is, so to not share his feelings is to effectively disappear. Alex stopped disppearing, he started expressing himself, he gave himself permission to accept emotional and psychological care from those who loved him. He reports that his relationship with his dad and mom are closer than ever. He recovered a healthy weight within 4 months, he embraces wanting to be healthy and is now trying out for soccer and football.

Let me be very clear. Families are NOT to blame for eating disorders. Families ARE the most significant source of emotional and psychological nurturing in all of our lives. When families are blocked from giving the nurturing that sustains us, we become ill. These blocks can be caused by neurological predispositions in the individual with ED, they can be caused by situational stressors and changes in the lives of an already vulnerable individual, they can be caused by a variety of misalignments in relationships. My concern is that, in our drive to remove the blame from families (a very necessary thing), we may be running the risk of not considering enough how family dynamics impact everything the client experiences. It is well accepted that families are a huge strength in recovery, but as a change agent, the help that families can give extends so far beyond weight restoration. In order for weight restoration to be sustained, we must sustain the mind that ultimately helps the individual give “permission” to take care of himself physically, which requires a thorough understanding of all the dynamics of nurturing in a person’s life. Family is the primary vehicle of that nurturing.

Endophenotypes and Entropy: Exploring how Brain Biology Could Affect Family Dynamics

Domino stones

In my perspective, the mind’s job is to distribute energy toward meeting the needs of self and the needs of others. As we are social creatures, we are continuously exchanging attunement and behavioral nurturing inward and outward, back and forth, with other people. This exchange is what builds our social intimacy, our realization of fulfilling goals and is the foundation of our emotional/experiential sustenance. When our needs are left unmet because of a disturbance in this exchange and distribution of energy, pathology results. In this line of thinking, the goal of counseling and psychology should be to address any disturbances, imbalances and sources of wasted energy in the need-fulfillment system.
From a neurocognitive perspective, there are certain inborn predispositions that can cause a person to be prone to disturbances in the smooth flowing of energy toward needs. With regard to eating disorders, research has indicated that people with Anorexia tend to have poorer set-shifting (ability to change tasks)(Tchanturia, et al., 2012), poorer central coherence (ability to see bigger picture over detail) (Lopez, et al. 2008) and more difficulty establishing theory of mind (the ability to identify the mental states of others)(Oldershaw, et al. 15).
How might these predispositions affect an individual’s ability to effectively meet his or her needs in the social system? I suggest that if one has a tendency to misperceive the emotions, mental intent, needs and expectations of those around them, and they tend to perseverate in these inaccurate preoccupations, this could generate positive feedback loops that culminate in unmet needs of both self and others.
The mind must continuously distribute focus and energy toward the emerging and changing needs of self and others in order to ensure that these needs are adequately met. However, if a person is unable to adaptively move that energy where appropriate, when appropriate, due to low set-shifting and poor central coherence, and if that mode is based upon faulty assessment of need in the first place, that energy will be stuck in a wasted space, leaving the other areas of need in deficit. The less these needs are fulfilled and the more the individual is preoccupied with these misinterpretations, the more energy is drained out to entropy. Entropy is most destructive to our psychological and behavioral health. Wasted energy means needs cannot be sufficiently fulfilled because we all have a finite amount of energy and focus with which we can devote toward the fulfillment of the needs of self and others.
In conclusion, there are endophenotypes that predispose a person toward the generation of entropy in the environmental field. That environment is most marked in the family because family is the primary direction most of us devote our energy to. However, these entropic exchanges are not limited to family–they extend to every social network in the person’s life (you take your endophenotypes everywhere you go).
If an individual is not able to “change the channel” on where they put their focus and effort, and if that focus and effort is directed toward an inaccurate target, then the real target of other people’s needs cannot be met and the needs of self will be neglected. This cycle further adds to the internalization of emotional strain from the social group, which feeds back into the preoccupation, further driving the cycle of entropy. In essence, I believe the brain makes us prone to social exchanges that are entropic, this entropy causes us to lose energy, lost energy leads to unmet needs of self, which lead to pathologies like depression, anxiety disorders, and eating disorders.

References

Lopez, C., Tchanturia, K., Stahl, D., Both, R., Holliday, J. & Treasure, J. (2008). An Examination of the Concept of Central Coherence in Women with Anorexia Nervosa. International Journal of Eating Disorders, 41, 143-152.

Oldershaw, A., Hambrook, D., Stahl, D., Tchanturia, K, Treasure, J. & Schmidt, U. (2011). The Socio-Emotional Processing Stream in Anorexia Nervosa. Neuroscience Biobehavioral Review, 35, 970-988.

Tchanturia, K., Davies, H., Roberts, M., Harrison, A., Nakazato, M. & Schmidt, U. et al. (2012). Poor Cognitive Flexibility in Eating Disorders: Examining the Evidence Using the Wisconsin Card Sorting Task. PLOS One, 7 e28331.

Anything Different is Good

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In the most recent issue of the International Journal of Eating Disorders, a study by Chen, et al. compared standard Dialectical Behavior Therapy with a DBT that focuses on issues of over-control of emotions. This concept reiterates work done by co-author Lynch, et al. (2013), who noted that the issue with eating disorders may less related to an excess of overwhelming emotions and affective impulsivity (as is the target of traditional DBT), but rather stems from the other end of the emotional sensitivity spectrum–that of over-control and numbing of emotions. Particularly with the restricting type of Anorexia, clinicians are seeing problems with over-control of emotions, rigidity and lack of openness. The authors see this as connected to an over-sensitive biological threat reaction and a blunted reward receptivity. So RO-DBT focuses on connecting communication with rewarding close social bonds, decreasing the behaviors of over-control of emotions, increasing behaviors that are expressive of emotions. The authors believe that dietary restrictions are a variety of over-control that has been reinforced. Findings indicated that DBT that focuses on increasing social/emotional flexibility and expression yields improved outcomes.
I am always happy to see signs that the “business as usual” approach to eating pathology is being challenged in any small way. I differ from the authors of these studies in my interpretation of what eating restriction means–to them it is simply a variety of over-control, but I see the restriction of food as the inevitable self-punishing and self-depriving outcomes of unmet self needs. To me, over-control and uder-expression of emotions impairs an individual’s ability to identify internal needs and communicate those needs to others. If needs go unrecognized by self and by others, there will inevitably be a corresponding deficit in the fulfillment of those needs. Lack of need fulfillment creates eating pathology (among other mental illness symptoms). In the Chen and Lynch studies, the targeting of over-control resulted in improvement of eating pathology. I see this as due to an improved ability for their subjects to identify and fulfill internalized needs, as well as solicit and accept nurturing from others. When one’s self-needs are met, the eating disorder reduces correspondingly.
I applaud researchers who are thinking outside of the box and looking beyond our extant stale and inefficient approaches to eating disorders. Going against the dominant paradigms in this field takes courage and preserverence. However, the call for a better understanding and treatment of eating disorders is nearly deafening. Just pick up almost any peer-reviewed research journal on eating disorders and peruse the articles therein. They almost all start by declaring that eating disorders are famously hard to treat, our methodologies are not evidence-based nor all that effective, and generally we are losing the war against eating pathology. Sadly, there is a real dearth of articles offer much new in the way of creative and original ideas on how to better approach these illnesses.

Emotional over-control is just one spoke of the ED puzzle, but like Bill Murray says in Groundhog Day

“Something is different. Anything different is good.”

Lynch, T.R., Gray, K.L, Hempel, R.J., Titley, M., Chen, E.Y. & Heather, A.O. (2013) Radically open-dialectical behavior therapy for adult anorexia nervosa: Feasibility and outcomes from an inpatient program. BMC Psychiatry, 13, 293-309.

Chen, E.Y., Segal, K., Weissman, J., Zeffiro, T.A., Gallop, R., Linehan, M.M., Bohus, M. & Lynch, T.R. (2014) Adapting dialectical behavior therapy for outpatient adult anorexia nervosa–a pilot study. International Journal of Eating Disorders, 48 (1) 123-132.

Eating disorders and the absent emotion

 

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In my experience, the repression of feelings is closely tied with the manifestation of eating disorders. This is one of many articles that will explore the underpinnings of emotional numbing, and will hopefully shed some light on how we can lessen the effects of this phenomenon. First, it is helpful to clarify how eating disorders are worsened by the muting of emotions, as this connection might not be very obvious at first light. Emotions are the horsepower with which we pursue our needs–they make us pay attention and propel us to take action. They also make others pay attention and take action toward us. As internal needs arise, an emotion generally follows it, which drives the individual to seek out fulfillment of that need. Further, when we have strong feelings, we generally express those feelings through nonverbal or vegetative means, we verbalize those feelings, we cry, we laugh, emotions change how we interact with our environment. Anger might drastically alter the way that you interact with inanimate objects (ever slam a door, throw something, punch a wall?) As we are able to bring attention and advertise our feelings and therefore our needs, we are able to get those needs met much more quickly and efficiently than if emotion was not expressed or experienced. Further, we are designed to not only be affected by our own feelings, but also be affected by the feelings of those around us. Fortunately, this generates a reciprocal flow of effort and concern between self and others, which better positions us to meet needs.

                Eating disorders, along with most other mental and mood illnesses, are caused by unmet psychological needs. If emotions are flattened, the individual becomes impaired in his ability to meet those needs and this flattening also limits the ability of those around him to understand and respond to his needs. This cycle generates pathology in the form of eating problems and body image disturbance. There are various reasons why people develop habits of self-suppression. Sometimes I see clients who are very good at describing how everyone else in the room feels, but completely unable to pin down any personal feelings. The client will sit in my office describing mom’s emotions to a T, but she will look to mom for answers any time I ask the client about her own feelings. Sometimes clients are told that they don’t feel what they feel because the family sees the sentiment as disrespectful, inaccurate, illogical, ungrateful or inconvenient. Well-meaning families can have habits of repressing a child’s emotional world without even really being aware of it. I often tell my clients that they are allowed to feel any way they want, no matter what–that it is not wrong to feel something that is different from how others want them to feel. It amazes me how what seems like such a “no brainer” thing to say is actually quite a profound concept that they seem to have never considered before. I sense the uplifting and unburdening effect of this permission, and when the client truly internalizes this truth, the eating problems and body image distortion usually improve drastically. My business partner, Sifu Joseph Simonet is fond of saying “what I think is what I know, but what I feel is who I am”. If feelings are lost, the self is lost and eating disorders are the outcome of a disappearing self.

What pulls the trigger?

Gun shaped man hand

Eating disorders can often wax and wane throughout a person’s life course. Most clinicians and theorists attribute this vacillation to ‘stress’ but they fail to specify the types of stress that actually trigger the disease. In the world of someone with an eating disorder, not all stress is created equal. I once asked a group of women with eating disorder if their car getting a flat tire would trigger symptoms of eating pathology to worsen. The response was a resounding ‘no’. However, earlier in the group many mentioned that ‘stress’ worsened their urges to purge and restrict. I reflected back to them that getting a flat tire is very stressful, as would be enduring a hurricane, having one’s cat die, having one’s wallet stolen, etc., yet none of these events could be imagined by the group as triggering their eating pathologies. However, when I mentioned the type of stress such as mom and dad getting in an argument and the client getting pulled into the middle, your mother telling you she is very embarrassed by you because you didn’t make the cheer squad, or being told by your husband that you are not a good mother, these ‘stressors’ were endorsed as being very triggering of eating disorder. I feel this is important, because the type of stressor that triggers symptoms speaks highly to the social and psychological origins of those symptoms. I am frustrated that most people believe that skinny models and dieting ads are ‘triggering’. Granted, a lot of people with eating pathology would endorse that these issues are triggering, but I believe this is due to a superficial understanding of what really causes eating disorders. Skinny models and dieting ads may make urges to restrict and body image concerns more salient for a short time, but it is the self-system and feedback about roles and place in the family that actually changes one’s self-worth, triggers feelings of failure, which triggers urges to self-punish and self-neglect. Most individuals are exposed to images of emaciated models and actresses, and may even experience a desire to be thinner, but eating disorders are NOT a desire to be thinner. Eating disorders are patterns of self-deprivation and self-punishment that result from a crisis of self and a severe imbalance of energy in the social system. I believe targeting the media as a cause for eating disorders is the same as believing cold weather causes the flu. Yes cold weather can worsen a flu if an individual is carrying the virus, but it is the virus itself that causes the illness of the flu, not cold weather. Yes there is an association, but I think in the field of eating disorders, we have mistaken correlation with causation.