Friday, June 02, 2006

Holding onto an Eating Disorder

One of the things that separates eating disorders from other diagnostic categories is their relative allure--while depression, anxiety, and psychosis, for example, are typically painful, intolerable states, driving people into treatment rather willingly, many who have eating problems are reluctant to seek help. If a friend had entered a depressive episode, I'd have no problem discussing it with her, recommending treatment, etc. It's a little bit different with an eating disorder. I'd probably dance around the topic (yes, this has happened several times before, particularly during my college days, when I first became exposed to the ubiquity of eating disorders), fear that the conversation might jeopardize our friendship, and proceed with calculated caution.

Eating disorders (and, by this, I mean, the clincal conditions of anorexia and bulimia, as well as the omnipresent sub-clinical manifestations of food/weight fixation. . . which, may also meet criteria for other diagnoses, such as Eating Disorder Not Otherwise Specified and Body Dysmorphic Disorder), in this way, look more like alcoholism and substance abuse, than other mental illnesses. Efforts at confrontation are often dismissed or met with failure.

So, why would a woman be so consumed with holding onto her eating disorder? Surely, having an eating problem is not a comfortable way of being in the world. (For just how uncomfortable anorexia can be, read Marya Hornbacher's, Wasted. The author, through her personal memoir, rips every little last ounce of glamour from an eating disorder and hangs it out to dry.)

What comes to mind is the psychological distinction between ego-syntonic versus ego-dystonic conditions. An ego-syntonic disorder is viewed as somehow acceptable and compatible with one's overall self-concept. Ego-dystonic conditions, on the other hand, are behavioral constellations that are inconsistent with your general views about yourself.

Despite the intense pain, secrecy, and obessive quality associated with an eating problem, it's basically ego-syntonic, consistent with a self-image that is negative, punishing, and often quite empty. While treating the eating problem on its own likely will not be met with success, addressing self-esteem concerns may allow a woman to arrive at a place where her eating disorder becomes obsolete.


Shaunta said...

I know for me, as painful as being severely overweight is...the thought of losing the weight can be even more painful. I'm only now starting to look at why. Part of it has to do with hiding. No one really sees you when you weigh 300 pounds. I think that they look at me and see what they could become if they aren't careful...and they just don't want to see that. Being fat is a built in excuse to not do some difficult things. "I will when I lose some weight..." rolls so easily off the tongue.

PalmTreeChick said...

Did you read my post again, drstacey?? ;) Feel free to take and use any of my material. I may start charging ya though. Ha, oh wait, you're supposed to charge me! ;)

Seriously, I can't imagine NOT having to give any thought to what I'm going to eat, how many calories I burn, what will happen to me if I take a day off from the gym (which rarely happens). I guess after 14 years this all becomes imbedded in you and becomes a part of you. Not a good part, but a (big) part (no pun intended), no less.

I can't imagine the freedom I would have, and how much time I would have if I wasn't obsessing so much.

(I love your blog!)

drstaceyny said...

PTC--I actually haven't seen yours, yet--guess we're just psychologically aligned right now!

All this stuff definitely becomes part of your identity. It is helpful to TRY to imagine a life without it.

What would you be thinking/talking about? I know I and Haley-O are curious! : )

Shaunta--people have lots of reasons for not wanting to lose weight--hiding is a big one. We're all pretty ambivalent about attention (sometimes, especially, male attention). And, you're right that having a permanent goal like this sets up a future fantasy world that's oh-so-perfect, if only we can lose the weight. Despite how seemingly difficult it is to lose weight, it's a pretty simple formula, at least, theoretically.

stephanie said...

I hope so. For me it's also a control thing. When I feel like my life is spiraling out of control, if I have control over my weight I somehow feel better. But when I lose control of that, I totally freak out.

PalmTreeChick said...

Maybe that post will come later today. I don't really know what I would think or talk about. I guess I'd be pretty boring.

allisonsky said...

Hi Dr. Stacey,

One of my closest friend's from 8th grade developed a serious eating disorder (bullimia) while we were roomates in college. I knew her whole history of having a verbally abusive Barbie Doll for a mother. I remember sleeping over her house in 9th grade while her mom told me " with those zits and flat chest how are you going to ever have a boyfriend." That was nothing compared to the fat, freckle face, comments she landed on her daughter day in and day out. Unfortutely for my friend her mother was beautiful and she looked like her father...... Anyway, she got skinnier and skinnier during our 2 years living together. She also stole my credit card and went on a shopping spree. With the help of major intensive counseling she has been a recovering Bullimic for 5 years and has a 3 year old daughter. Luckily for her she became part of a study 5 years ago taking a certain medicine (don't know the name) and going to support groups, and one on one counsling. She is still constantly being monitored by family, friends, and a counselor and hopefully will stay healthy. At one point she was 80 pounds, and growing up always "chubby". Now she is 5'1 and 105 pounds and looks great.... Her's was clearly a case of horrible verbal abuse from her Barbie Doll mother..........

Haley-O said...

I think one of the reasons people hold onto eating disorders is because they simply can't help it. In other words, I believe eating disorders are a "manageable" form of(or really a facade for)anxiety. Just as people with gross anxiety disorder can't get free of the anxiety, so anorexic people (for example) can't lose their obsessive thoughts about food (aka their anxiety in general).

I went from being weight obsessed to a form of post-partum depression during my pregnancy. I suffered from uncontrollable anxiety for which I had to seek major treatment. It was awful. Anyway, one of the things that became very clear to me when I had the anxiety disorder was that the old weight obsession seemed absolutely insignificant compared to what I was now going through. It was nothing compared to the anxiety and obsessions about *real things*--that, also, by the way, were far from "real". Weight/eating obsessions are just a cover-up...the brain's way of suppressing larger, deeper fears anxieties (about the unknown, about having no control--which is the reality of our human condition...we have no control! Controling our food gives us a sense that we have control. It's a farce and a coverup.)

drstaceyny said...

Allisonsky--yeah, I think it's pretty clear what happened in this case (I can't believe she actually targeted you, as well!) I'm glad your friend got help.

Haley--you're exactly right. You and Stefanie both hit on the hallmark of anxiety disorders and weight obsessions--a cover-up for larger, scarier concerns (that you may be consciously aware of. . . or not). Acceptance of the fact that we have no control seems to be a very Zen-like approach to this fate. It sounds like you went through a really rough time, and I'm glad to see that you seem to be on the other side of it.

drstaceyny said...
This comment has been removed by a blog administrator.
PalmTreeChick said...

Don't forget the numerous praises people get for losing weight. "Oh, you look great! Have you lost weight?" That's my personal favorite because you're like "was a porker before?"

Even if you don't believe it when people tell you you've lost weight, it still makes you feel good.

Lately people keep telling me I look thinner but I have lost NO weight, so I really don't know what they are looking at. I understand that body composition changes if you alter your workouts or what not, but come on people...I think I would know if I lost weight!

Yes, eds become such a part of your life that you don't know how to change your behaviors. The idea of being/eating "normal" is something you can't fathom.

Haley-O said...

Yes, it was a really rough time--understatement, par excellence, as that is! It was utterly horrifying. Amazing what hormones (+environment +genetics...) can do to you. I am on the "other side of it," but I will continue with my therapy, so I'm prepared for the next pregnancy, and so that I stay on top of it. It was a good experience (as horrifying as it was) because it gave me so much insight into the way my mind works, and into anxiety, obsessions, life, etc.. :) I call it my "initiation into motherhood" because I'll be a better mommy for it!

Anonymous said...

I just randomly found this blog by searching google for "reasons people hold onto fat." I have heard many times before that there is often a deeper reason that people hold onto their weight than just lack of exercise and a healthy diet. I wanted to research this, because I cannot think of a reason that I am holding onto this weight. I have tried to lose the weight time and time again. I overeat constantly. It is not what I eat; it's how much. Also, I exercise pretty regularly. In college ( a few years ago), I could run farther and longer than all of my skinny friends. But still yet, I have a weight problem.

Anyway, it was helpful to read some of the comments. I had never really thought of the eating as a way to control my anxiety, but that makes perfect sense. I am anxious quite a bit.

Also, the thought about "I'll do it when I lose some weight" was very enlightening. I also say this to myself quite a bit and always hated that I was missing out on things because of my weight, but I never thought of this statement as an excuse. I always thought of it as a result/ consequence of my extra pounds, if that makes sense. It seems like doing the things would be so fun and liberating, but maybe deep down, I'm scared to so them.

I'm going to try to come back to this blog sometime. Thanks for all the comments and best wishes to all of you as you seek to lose weight or recover from other eating disorders.