Breathing between the waves



Most of us only drown some of the time…gasping for breath between life’s waves. Symptoms of anorexia and bulimia are what happen when you are drowning in overwhelm. Having to swim harder and harder to keep up with the strong current and waves crashing over your head. Sometimes you come up for air and sometimes you’re under water. The illness comes in waves.

If eating disorders are about an internalization of the thin ideal, a perfectionistic personality style and dispositional need for control, then why do the symptoms of Bulimia and Anorexia change depending on what is going on in one’s life and environment? Most people think if a person has an eating disorder, they always have it–the symptoms are the same across the timeline. However, that is hardly the case in my experience. Most of the clients I work with report symptoms change all the time. Some weeks it is better and some weeks it is worse. When I ask how this could be so, they usually give me a perplexed look and say they don’t know. But my intent isn’t to stump them, I want to make them think about their illness differently. Perhaps the eating disorder isn’t so much about wanting to be perfectly thin and in control all the time as it is about one’s footing in the social system.

When we graph the symptom severity, we can see that things usually worsen when there are social issues and interpersonal dynamics creating strain. Of course, most eating disorders theorists propose that the symptoms are a reaction to stress, so more stress would mean worse symptoms. I agree that stress worsens the symptoms, but I don’t believe the symptoms are one’s attempt to cope with stress so much as the stress one endures reduces his ability to care for himself in a healthy way. And not all stress is created equal. Some stress will worsen the eating disorder (fighting with mom because she feels you are choosing your new fiance over her) and some stress will not worsen the eating disorder (my car broke down and I had to pay a tow truck and wrangle with the dealer over my car’s warranty).

In other words, indiscriminate stress doesn’t worsen symptoms, what worsens symptoms is the strain and overwhelm one feels when the perceived needs/demands of the social system and one’s proscribed roles outweigh one’s ability to fulfill those roles. Eating disorders are not perfectionism and control or a stress reaction, they are a disease of exhaustion. The only cure is to navigate in one’s social world in a way that is less exhausting. The exhaustion comes in waves, and so do eating disorders.

Bullying and eating disorders–the REAL connection

Female student being bullied by other group of students

What is the connection between bullying and eating disorders? Some that jump to mind are: when someone experiences the stress and devaluation of a bullying encounter, they are more likely to escalate their symptoms as a coping mechanism. Loss of self-worth can make symptoms escalate. Kids who are bullied often feel lonely and unsupported, leaving them more vulnerable to having eating problems and body image issues. Particularly if the bullying involves weight and shape-related comments and teasing, this could make and eating disorder flare up.

However, this column is not to explore the already explored aspects of eating disorders and bullying. Instead I want to focus on some often unrecognized dynamics between being bullied and being afflicted with eating pathology. Too often, I see clients who are suffering from Bulimia or Anorexia, and they often describe being bullied in school. In my perspective, bullying worsens when the victim of the abuse acts in protection of the abuser, which is in alignment with how people with eating disorders often interact with their social worlds. There is a general tendency for someone with an eating disorder to be more likely to protect and accommodate others over themselves, and this is the interaction that reinforces bullying exchanges.

The other day I met with Alice, she was telling me about how the kids at school tease her. With tears in her eyes she relates this heartbreaking scene. “They call me a whale, they say I’m dumb and I should just go away. It really hurts my feelings.”

“No one should ever say those kinds of things to you. That is awful of them. What do you usually do when they say those things?”

“I laugh, I pretend it doesn’t matter, I just play it off like it’s no big deal.”

“So they won’t have to feel embarrassed or on the spot for being cruel to you?”

“Yeah, I figure if they see me cry or if I get mad at them or call them out on it, they will just do it more and have even more of a reason to target me.”

“So you kind of throw yourself under the bus so you can protect them and not make them look bad, in the hopes that they will ease up on you, but it seems to just make the bullying worse?”

“Yeah, and my eating disorder gets bad after that.”

As it would, and here’s why. We believe everything we do. So when you put your needs secondary to the protection of some aggressive and disrespectful jerk, you are sending yourself the message that your needs and feelings don’t matter as much as the other person’s convenience that you are not calling attention to their awful behavior. This lowers your self-worth, which makes the self-deprivation and self-punishment pattern of an eating disorder worse. The other bad news is, others believe everything you do as well. When you protect their honor and let them save face by acting like they didn’t say anything offensive, it sends them the message that their comfort matters more than your feelings, and they become even less likely to respect you or consider your feelings in the future. This sets off a self-perpetuating cycle that leads to increased symptom severity by means of reduced self-worth and triggering interactions.

Bullying involves some complex internal and social dynamics, and if we are to protect our kids with eating disorders from having triggering encounters, we must teach them to think critically and act with intentionality in every interaction. The more they can understand these dynamics, the more they can protect themselves and stop protecting those who would harm them.