The Grateful Paradox


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.