So National Eating Disorder Awareness Week is ending, where do we go from here? In some ways it seems like we have only scratched the surface. That makes sense, given that eating disorders are complex and multi-determined, involving biopsychosocial factors. I have discussed some of the social contributors. In this post I want to explore psychological issues.
Eating disorders aren’t really about food. Or appearance. Or eating/not eating. While therapy for eating disorders involves addressing those issues, it also involves looking beneath the surface to understand their meaning for the individual. I think of eating disorder symptoms and behaviors as a metaphor, as a disguised form of communication about that person’s inner world and pain.
Eating disorder behavior begins in an effort to serve a function. The behavior may be seen as an often unconscious attempt to address any of the following:
- a way to gain control when the individual cannot control anything else
- a form of numbing, dissociation
- an expression of hatred, blame of one’s body for the abuse it has endured
- an attempt to alter one’s body in an effort to feel safe from future abuse
- an attempt to self-soothe
- an expression of rage
- an attempt to make one’s pain/real self seen
- an attempt to be invisible
Over time, eating disorders become self-perpetuating, so it may seem that it is all about the food, or body size, or symptoms. But that is not where it began and that is not the road out.
Some time ago I made reference to an article by Joanna Poppink, LMFT that discusses one common underlying theme for those with eating disorders: boundary violations. This certainly fits in my practice, where many of those who present with eating disorders have also experienced some form of childhood trauma involving boundary violations. What I really appreciate about this article is that it addresses the violations of emotional abuse, not just sexual and physical:
However, there are other kinds of boundary violations, and these are less dramatic, less discussed, more prevalent, and just as devastating to a persons psyche. When, in the name of caretaking, people in authority take over a young person’s life, it constitutes boundary invasion.
When others deny her privacy, read her diary, borrow or take her things without permission, or use their ideas or goals or personalities to overwhelm her efforts in school or sports, that is a violation of her boundaries.
When others disregard or disdain her choices or deny her any control over her personal life, clothes, food, friends, and activities, they are invading her boundaries.
An invasion of boundaries also takes place when, in the name of caretaking, people give her no responsibilities of her own and attach no consequences to her actions.
…These boundary invasions are not loving acts, nor are they “spoiling” a child through overindulgence. Quite the contrary, they are acts of neglect. The child’s taste, mind, capacity to learn, and ability to grow and function as an independent agent in the world remain unacknowledged.
When others, even well-meaning others, ignore her identity as a unique, developing, and competent individual and flood her with their personal agendas, she feels as if a steamroller had flattened out her psyche.
Eating disorder recovery is not just about resolving symptoms, it is about developing an authentic self. It is about having the space to be seen and heard, to develop boundaries that protect but do not limit and to learn how to assert them.
I encourage clients to get curious about what their symptoms mean for them, to use impulses to restrict, binge or purge as opportunities to stop an reflect on what else is going on. What feelings, sensations, unspoken truths, unmet needs are present? This is the stuff eating disorder therapy can help you get in touch with.