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.