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.

2 thoughts on “Anything Different is Good”

  1. Hi, I like a lot of what you write. I differ in that I am more nuts and bolts when it comes to an eating disorder. I have many clients who are really sick and tired of having to try to identify their unmet needs. Their unmet need might just be blood glucose/nutrition. When they are well nourished they often stop being so pitiful, they can reset on their own, they become more rational with respect to themselves and others. So I say start with nutrition first!

    1. I like that approach because it gives clients a concrete path during a time of confusion. One way that I help my clients attune to their unmet needs is to simply set aside 1 hour of unstructured time each day. Once the “clear a path” for attunement, it’s amazing what they start to realize about themselves. Interestingly, one’s awareness of one’s needs is a form of energy in itself. If a person has fallen into a habit of self-neglect, they also don’t drive focus inward so it becomes impossible for them to say what the needs of the self even ARE, let alone starting to try to meet those needs. In order to avoid the frustration that is inherent in this process, I remind my clients that their awareness of their own needs only will happen when they actually drive energy toward the self, and starting with simply making space for it helps them to not want to punch me in the face when I tell them to “start meeting their needs” when they don’t even know what those needs are. Thanks for the discussion and sorry for the late reply!
      -Brett

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