IMAGE: Sharon McCutch
Text: Alejandra Misiolek Marín
Anorexia nervosa is an eating disorder (ED), but what is there behind this behavior?
Anorexia nervosa is characterized by a threatening fear of gaining weight and often with extreme thinness. But behind this symptom there is an important disturbance of the self-concept. Anorexia is primarily a disorder of the self, identity and emotional regulation.
The person* with anorexia has been the typical “good girl” who has spent her life trying to please her parents. She hasn´t had conditions to be able to develop her identity because she never felt like a person separated from her parents but as if he belonged to them or as if she were their extension. This lack of psychological autonomy is what leads to seeking limits.
Anorexia usually appears in the adolescence which is the stage of shame. Shame is related to the need to dare to be yourself and suffer a possible rejection. But what do I do if don’t even know who I am?
Here the body appears. The body is in our culture many times used as an object to define itself or to seek external validation. The person suffering from anorexia has not felt unconditional validation (they only felt loved or valued for being “good” or for fulfilling what was expected of them in the family) and therefore, they have a great need to receive it. Consequently, she discovers that she can receive it through thinness (highly valued in our culture) and through demonstrating willpower, discipline and perfection (other highly awarded values today).
In addition to being an object of external valuation, the body helps us to set physical limits, when it is inconceivable to set psychological limits. Deciding what I eat, if I eat and how much I eat; these things are from the few things I can decide on. It is a way to set limits and begin to create a feeling of identity based on the body. It is a salvation and a way to resolve a more important conflict, although health professionals see it as a problem.
Finally, how do I regulate my emotions, which tend to be very intense in adolescence, if I don’t know myself? Emotional regulation is closely related to the ability to be connected with oneself, with self-awareness, with mentalization, self-reflection and self-esteem. Exactly what goes wrong most in eating disorders. Well again, I use my body to regulate what I feel. Anorexics regulate their emotions by feeling them in the body and by making bodily decisions. Hunger and thinness, for them, are feelings, the need for validation translates into how they see themselves (see psychic equivalence as a mentalization failure). All this leads to a greater disconnection with oneself and alexithymia (inability to feel and become aware of emotions). A vicious circle is formed, in which I know less and less how to process emotional states with my mind and more and more I need my body to help me. Dependence on the body causes anorexics to be unable to leave the symptom that health personal wants so much to remove.
We know that the symptom (not eating and extreme thinness) hurts them, but we cannot make them change it if we do not first help them to build their identity, to learn to set limits in another way, to validate them and help them feel more self confident and without providing them with tools to regulate their emotional states. At the end of this whole process, the patient with anorexia should come to the conclusion by herself: I am going to eat more because I do not want to do this harm to myself. I do not deserve it.
*In this post I will use the feminine form referring to both women and men.