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.