PHOTO: Moreno Matković
Text: Alejandra Misiolek
An Eating Disorder is a complicated relationship with food that affects a daily function of a person who suffers from it. It is related to not accepting the body and with low self-esteem.
An ED can become an obsession that occupies a lot of mental space, uses up a lot of energy, can lead to serious somatic problems and even death. However, Eating Disorders are very difficult to treat due to a very high dropout rate and low collaboration of the patients. Why? Because the relationship with eating is ambivalent and people with EDs at the same time want and don´t want to give up on these patterns. This ambivalence causes that they come to therapy and leave therapy very often.
How can we understand this ambivalence?
At some point in their lives, they found out that eating or eating and purging/restricting can become a way of regulating their emotions, sel-esteem and their limits.
How does it work?
When you feel emotions that are overwhelming, either because they are strong emotions, have accumulated or because they trigger other emotions that are underneath, and you are not sure how to regulate them (become mindful of them and down-regulate them by processing them and finding solutions or being able to sustain them), you may have learned to use food to obtain a quick relief or distraction. Unfortunately, its effects are very short-term and in a long run you may start feeling guilty or ashamed because of bingeing on food. That may trigger a vicious cycle of using food again to relief the feeling of guilt and shame for having used food previously and may lead to a compensation – purging or restricting. These, on the other hand, create a caloric deficit (physiological response) and feeling of privation (psychological response) that may lead to a tendency to overeat again. This pattern becomes automatic, and it happens before we think. Therefore, to change it, we need to become more mindful of our emotions. And here comes the first obstacle – if you want to stop using food for emotion regulation, what do you use then? It may become scary to suddenly be overwhelmed by emotions you have been trying to numb out for such a long time.
On the other hand, there is self-esteem and identity that have been build around the ED mechanisms. Self-esteem in a person with an eating disorder is strictly related to how much they eat and much they weigh and cab be “easily” regulated by eating less, exercising more, weighing less, etc. Giving up on this can leave a person with ED without an “easy” way of feeling good about themselves. There is a completely new and scary world to be discovered to find self-worth in other things, too.
If we think about the identity, when a person has had an ED for many years and especially if it started in adolescence (which is the most frequent onset age), the core of their identity is build on some convictions and way of perceiving themselves and interests that are related to food and body. Giving up on making the eating center of their mental space can be scary as well. They can ask themselves: who am I without my ED? Will people still love me if I give up on that? Will I still relate to the same friends? Will my partner perceive me differently? All that can become overwhelming.
Moreover, deciding on eating, on what we eat, how much we eat and refusing to eat, is a way of deciding on some limits when other personal limits are not respected or when we have a strong need of finding a refuge somewhere inside of us when there is no safe space in the world around us.
For all those reasons, giving up on an eating disorder can be very scary. Ambivalence is totally comprehensible and requires acceptance to help patients with ED first deal with it before we expect from them that they change their eating. Otherwise, we wouldn´t be respecting their limits.