For a technical breakdown of eating disorders, including statistics and symptoms please visit www.nationaleatingdisorders.org/
I would like to outline for you a brief version to conceptualize eating disorders as a life strategy and my approach to treatment.
At the heart of all eating disorders is the common link of one’s ability to regulate. Therefore, eating disorders are better understood by seeing them as a general life strategy, rather than, focusing on what it is that one is doing with food, and/or, their body. I see the individual, embroiled in an eating disorder, as a primitive attempt to communicate their needs, and an illumination of their particular difficulty with regulation. The particular symptoms, i.e. anorexia vs. bulimia are not arbitrary and offer more specific information, about where and how, the difficulty with regulation is experienced for each individual. The specific symptoms also offer insight, into the early life of the individual and their developmental history.
I think of the human growth and development process metaphorically, like the constructing of a house. It begins by creating a foundation and then additional floors are added on top of the foundation. Next, more interesting aesthetics are applied to finish the house. The aesthetics are modified from time to time. However, the foundation is generally not modified unless, there is a specific need that arises.
The origins of eating disorders, I believe are rooted in the early foundation of an individual’s life. This is largely because, the very first way we begin to relate to the world around us, beginning on our first day of life, is through the feeding process. We cry out for food and someone responds either timely and appropriately or not. It is our first expression of need, in which, we begin to lay the foundation of how we interpret ourselves, in relation to others. Furthermore, we do it multiple times per day, on every day thereafter.
This is why I employ a psychodynamic approach to the treatment of eating disorders. I believe treating the symptom is ineffective, if it does not accompany a thorough understanding of the context where the symptom developed. Rather, I think it necessary to view the symptom, as an indicator of what the individual has concluded about their need. It is merely a constructed response to manage oneself within that context. Psychotherapy is somewhat of an excavation process during which, the individual can develop new strategies from the perspective of a far more mature individual. This is in contrast to their infant self who first had to cope without these developed skills. More importantly, psychotherapy is also a place to practice these acquired skills.
I never think of the symptom as accidental, meaning there is specific information contained in the symptoms of anorexia versus bulimia. The symptom strategy that, any person has gravitated towards (although usually not consciously), offers specific information about their strategy for regulation. This is usually not done with only food, but with other commodities, as well.
For example, they may wear only a few garments, or be very frugal with money. They often feel they are taking up too much space in the world. The symptoms are telling me that this individual feels they have an appetite for any commodity that is too ravenous. They fear that if they start, they won’t be able to stop and therefore, it is better to not start. Be minimal.
Therapy for someone with this profile involves understanding how they have concluded that their are too ravenous. It also requires helping the individual develop an accurate sense of what their needs are, in the here and now. They will also need help in developing trust within themselves and to allow their needs to be adequately rather than only minimally met. This leads to the acquisition and practicing of strategies other than restricting.
An individual with symptoms predominantly of bulimia has the same dilemma, but they have learned to manage their inability to regulate, by using an “undo” button. When these individuals are faced with the fear of needing too much, they don’t avoid through restriction. Rather, they allow themselves to get, and then undo the damage as if it never occurred. Again, this is seen not only with food in their lives, but other commodities as well. One of the most obvious is money. They may overspend in a shopping spree and then either return everything, or never wear their purchases.
Like with the case of anorexia, the patient with bulimia is best served by understanding the symptom in a more global way, rather than, focusing strictly on one’s eating patterns. Simply modifying eating behaviors does not address the underlying origins ,or the angst about how one’s needs are met.
Eating disorders are, I believe one of the most interesting forms of psychotherapy, because the symptom provides such a rich metaphoric language, for understanding the inner world of the individual. That said, however, eating disorders are one of the most dangerous maladies experiences can experience and why treatment requires a high level of expertise.
