Common Denominators of Eating Disorders
"The importance one gives to food masks what is underneath;
I am interested in understanding what is expressed on the surface yet felt beneath”
Whether people know it or not, there is always a reason in having an eating disorder, an intention that serves as the foundation for it all. Eating disorders often develop as a subconscious way of self-medicating, a coping mechanism that may help hinder feeling or working through present and/or past pain that one does not have ability or emotional awareness to effectively process yet. It is through an established therapeutic relationship we could discover what’s underneath the eating disorder, and expand, through modeling, the window of tolerance. Therefore, the individual can gain more capacity to feel and process the uncomfortable feelings, and ultimately HEAL.
Common Denominators of Eating Disorders:
Shame / Low Self Esteem (grandiosity): Shame often begins to develop at a young age, usually in childhood or adolescence; it can be a feeling related to shame about oneself or a family of origin. For example, families who were, in their view, not good enough, not caring enough, (i.e. a neglectful mother or a father who pressured for achievements and was emotionally and/or physically abusive). An individual on the receiving end of this behaviour very often tries to repress or avoid the feeling of shame due to the painful nature and inability to properly advocate for him/herself.
Abandonment & Loneliness: A person may develop an extreme relationship to eating, whether in excess/binge or restraint; this may root from past/present traumas such as having pour attachment styles, unhealthy/toxic relationships in life, unresolved trauma, and more. For example, an individual may have grown up in a family with a narcissist parent that emotionally abandoned them; an individual growing up in such an environment often feels a black hole in themselves, leading to the sensation or desire to fill it with something. Often times, the emotional response of fulfillment is another form of coping, and/or another form of avoiding healthily processing the actual issue at hand. Coping by eating and drinking can be misdirected desire, the need is for something different.
Alexithymia: Alexithymia is when an individual has difficulty identifying and expressing their emotions. Often, they are out of touch with their feelings and do not have the emotional vocabulary or cognitive awareness to be able to connect and name their internal processing/experiences.
Case Conceptualization
An individual comes from a family where feelings were not empathized, recognized, dealt with, responded to, which creates an anxious attachment pattern where the client feels a lack of support and develops feelings of distrust and uneasiness towards those that surround her.
What do we do about it?
Initially, one would need to explore what stresses & upsets them, both emotionally and somatically. From a clinician's perspective, it is important to be an active therapist, to engage constantly with the client instead of passively waiting and listening; an interactive and nonjudgmental approach is essential. For example. if a client realizes they have the desire to binge, it is important to unpack what the specific emotional events are that are causing anxiety where one uses food to deal with it. Explaining it to the client that an eating disorder is a coping mechanism, and that food is not the actual issue can be both cathartic and enlightening. Therefore, instead of personally judging oneself, one can become interested and curious to explore their relationship with food, and the actual underlying reasons that cause them to form that dynamic.
As a psychotherapist it is crucial to develop trust, to build the relationship before we take any step further. Freud said “the action of therapy is the cure of the soul through LOVE”, which illustrates the power of the relationship.
Various Beneficial Therapeutic [or Parenting] Approaches
Exploring Childhood/History and Attachment History
Getting curious about what your client/child is repressing or hiding can be explored after the therapeutic relationship has been established / parent- child relationship has been repaired enough. An essential aspect of creating a safe space and relationship dynamic between the client and therapist / parent and child can eventually lead to the expanse of a window of tolerance while building resiliency; one can model and teach conscious breathing, and various of other nervous system regulation to do so. For example, a specific kind of play therapy called Synergetic Play Therapy offers a variety of tools, as well as Daniel Siegel's approach, which is describes teenagers as individuals who learn faster by abbreviation, emphasizing the way to support them is by having awareness of ourselves, with no judgment and trying to understand their approach.
- Build Emotional Awareness - We can teach it through modeling by; naming our own sensations in the body (neurologically, we are connected with the brain stem, reptilian brain, which is developed during the period of 0-18 months), naming our feelings (limbic brain, developed 18-36) or describe mental faculty (cortex based, above 36 months). Its important to know where trauma exists developmentally and where the repair needs to happen. As we help the client to talk about feelings & help them to tolerate them, they will process of an old pain/trauma that one does not yet have capacity to do alone. In addition, their nervous system learn the art of processing discomfortable feelings on its own (Nervous System Regulation), resulting in decreased reaction for outside stimuli, effective impulss control, better focus and behavioural change.
- Nervous System Regulation: we practice body and emotional awareness ourselves, regulating ourselves in a session or as a parent, building Emotional Awareness
- Somatic Experiencing: draws from many different disciplines to address the physiology of stress and trauma. It essentially helps individuals learn to pay attention to what is happening inside, and helps one connect to their physical selves, while repairing the cognitive and emotional components tied to their somatic state.
- Setting Boundaries: as therapist we need to explore if at present the client is in relationships that are abusive and not supportive and help them to bring awareness to it. As a parent we need to take responsibility for where we have been off, make amends and apologize
- Self Love: we need to teach our clients to develop patience and compassion for themselves (through modeling this behaviour) and their bodies. To explain that their body has more meaning beyond aesthetic validation, we need to teach them to connect to how it feels from the inside, and bring awareness to judgmental voices that often place a big role in eating disorders. Along with this, it is important to eventually learn to trust oneself and others, and eventually feel safe in reaching out for support, along with developing healthy coping styles/techniques they can use to regulate themselves. A book recommended that captures this whole process is Eating with the Light of the Moon, by Anita Johnston. It is a read for a parent as well as a teenager.
A Collective Effort
When working with teenagers, it is important to include and work along with their parents/caretakers. While working with parents, it is really important to explain the entire process of therapy and have the treatment goals established. An expectation should be out lined at the beginning, making them feel included and transparent in the process. This not only make them a part of the process, it gives them the appropriate tools they can practice with their child while developing a healthier and sustainable relationship that supports the clinical treatment. Teaching patience, compassion, and ultimately understanding the internal processing can lead to a decrease of judgment and criticism.
Very often females (and males!) have had their true selves suffocated or hidden, which then develops an insatiable hunger inside to reveal themselves. Sometimes the physical hunger is just a cover up, a longing for authentic expression. So what are WE really hungry for?
The biggest gift we can offer to others is when we transform ourselves...