Eating Disorder Therapy: Moving Beyond The Surface

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.

Kathleen Young, Psy.D.

This entry was posted in Eating Disorders, Emotional Abuse, Psychologist, Therapy, Trauma and tagged , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

5 Responses to Eating Disorder Therapy: Moving Beyond The Surface

  1. Dear Kathleen,

    We are in such agreement! You wrote, “Eating disorder recovery is not just about resolving symptoms, it is about developing an authentic self.”

    That’s the key, isn’t? Regardless of how an eating disorder came to be, our goal is to help, guide, shepherd and accompany a woman on her way to not finding but actually developing her authentic self. Then she discovers she is free and has the ability to create a life worth living.

    I appreciate your quoting my article. I’ve written many, but this is still the one that gets the most response. Letters and phone calls come in with women saying, “I read this and had to call you. I feel understood for the first time.”

    Yes, we need research, studies and some political changes to learn about how and why the growing spread of eating disorders. But that’s a different territory from working with a woman toward her personal recovery. That work is deep, as you say, below the surface, and it’s possible to achieve in therapy with a clinician who understands that the symptoms have meaning. They serve a function that a woman, once she develops her authentic self, can take over herself. That’s where the real freedom is.

    Do you agree? I hope many people find your eloquent article.

    warm regards,

    Joanna Poppink
    Los Angeles psychotherapist
    author: Healing Your Hungry Heart, 08/11 Conari Press

    • It is wonderful to have your input here Joanna. Your article really resonated for me the first time around and as I thought about summing up this week it came back into my mind. I really appreciate the way you bring to light the variety of types of boundary violations, especially those that are so hard to see and accept: the emotional. Thank you for your courage in speaking about things that may be hard for some to hear. We know there are others out there still struggling who need to know someone understands.

  2. Java Princess says:

    I really have appreciated all your posts this week on eating disorders! Eating disorders, like most things, seem to exist on a spectrum. I am a person of “normal weight” who has recently become aware of how I have used restrictive eating as a quick mode to dissociation and as a way to soothe myself. Being able to control what was going into my body when I felt most out of control in other ways was a defense mechanism. Last year I had a really stressful couple of months where my depression and anxiety were overwhelming. I used food control and restriction as a way to “take back” control of my body. Unfortunately (or maybe fortunately!) I developed severe hypoglycemia which made this old coping strategy unmanageable. With help from my Naturopath I was able to get myself back to good health and learn how to feed myself small amounts of the right food throughout the day. The surprising outcome was a huge decrease in my symptoms of depression and anxiety!

    I now realize I was on a cycle of food restriction=low blood sugar=increase in feelings of depression and anxiety=food restriction. This may not be something therapists think about when working with clients.

    • Thanks for your comment, Java Princess.

      Great insight into how you use eating behaviors. I really think the cycle you identified is so important! Food behaviors can definitely impact, for the worse, mood and even thinking. The very thing the person is using to make them feel better winds up making them feel so much worse!

  3. Pingback: Self-Injury and Trauma | Dr. Kathleen Young: Treating Trauma in Chicago

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s