Thinking About Eating Disorders

Allow me to tell you the story of a friend of mine.

A young teenage girl we know recently suffered through the death of her mother and consequently had to be faced with being raised by her father in whom she was petrified of. Did I mention she was to be in charge of raising her 6 younger brothers and sisters.

She was always thin, but now weighs 90 pounds. She doesn’t think she has a problem and her father doesn’t think she has a problem. There are many questions in this situation, the major one being does she have an eating disorder. If she does have an eating disorder, what type is it….anorexia, bulimia?

It’s clear she needs help, others have tried, however her father prevents any intervention. The question becomes, what is causing the eating disorder? That’s why I assembled this collection of articles and ebooks on eating disorders. Hopefully, you…the reader, might see yourself or someone you care about in the articles to come. Perhaps you might see that you are experiencing the symptoms discussed for anorexia or bulimia. Maybe you binge eat.

In a society that is increasingly placing standards of beauty upon the youths of our population, people are at more of a risk than ever when it comes to developing an eating disorder. The celebrities in television and the media display stick-thin figures which can create a high standard of beauty that can lead to many problems with an individual’s self esteem. When coupled with the fact that an obesity epidemic is overtaking much of the modern world, it’s important to have a full understanding of the eating disorders which are prevalent in society today in order to be able to catch the warning signs when an individual you know is afflicted.

This truly is a life and death discussion. Admitting you might have an eating disorder of some type is the first step in finding a solution to your problem. I pray that you might listen to the voice inside your head as you read the following material.

Eating Disorders and Personality Disorders

Patients suffering from eating disorders binge on food and sometimes are both Anorectic and Bulimic. This is an impulsive behaviour as defined by the DSM (particularly in the case of BPD and to a lesser extent of Cluster B disorders in general). Some patients adopt these disorders as their way of self mutilating. We may be witnessing a convergence of two criteria: self-mutilation and an impulsive (rather, compulsive or ritualistic) behaviour.

The key to improving the mental state of patients with dual diagnosis (a personality disorder plus an eating disorder) lies in concentrating upon their eating and sleeping disorders. In my view, these disorders are a blessing in disguise.

It is very rarely, even in the lives of normal human beings, that they are faced with a veritable, identifiable enemy. By controlling their eating disorders, patients can assert control over their lives. This is bound
to reduce their depression (even eliminate it altogether as a constant feature of their mental life). This is bound to ameliorate other facets of their personality disorders. Here is the chain: controlling eating disorders=controlling my life=I am worthy, I have self-confidence, self esteem and self-worth=I
have a challenge, an interest, an enemy to subjugate=I am strong=I can socialize=I feel better (I am a success) etc.

When a patient has a personality disorder and an eating disorder, I see no point in concentrating at first on anything but his eating disorder. Personality Disorders are intricate and intractable. They are rarely cured (though certain aspects, like OCD, can be dealt with using medication). It calls for the enormous, persistent and continuous investment of resources of every kind by every one involved. This is not realistic. Also this is not a realistic threat. If a personality disorder is cured but the eating disorders are
aggravated, the patient might die (though mentally healthy) ...

An eating disorder is both a signal of distress (I wish to die, I feel so bad, somebody help me) and a message: "I think I lost control. I am very afraid of losing control. I will control my food intake and out-take. This way I control at least ONE aspect of my life".

This is where we can and should begin to help the patient. Help him to regain control. The family or other supporting figures must think what they can do to make the patient feel that he is in control, that he
manages things his own way, that he is contributing, has his own schedules, his own agenda, possesses both authority and responsibility.

BY FAR the most important element in such a patient's mental abnormalcy is his eating disorders. He is usually right in emphasizing them over his personality disorders. They indicate the strong combined activity of an underlying sense of lack of personal autonomy and an underlying sense of lack of self control. The patient feels inordinately, paralyzingly helpless and ineffective. His eating disorders are an effort to exert and reassert mastery over his own life. At this stage, he is unable to differentiate his own
feelings and needs from those of others. His cognitive and perceptual distortions (for instance, regarding body image) only increase his feeling of personal ineffectiveness and his need to exercise even more self
control (of his diet, the only thing left).

The patient does not trust himself AT ALL, not in the slightest. He is his worst enemy, a mortal enemy and he knows it. Therefore, any efforts to collaborate with HIM against his disorder - will be perceived by him as collaboration with his worst enemy against his only mode of controlling his life to some extent.

The patient views the world in terms of black and white, of absolutes. So, he cannot let go even to a very small degree. He is HORRIFIED - constantly. This is why he finds it impossible to form relationships: he mistrusts (himself and by extension others), he does not want to become an adult, he does not enjoy sex or love (which both entail a modicum of a loss of control). All this leads to a chronic absence of self esteem. These patients like only their disorder. Their eating disorder is their only successful feat in life. Otherwise they are ashamed of themselves and disgusted by their shortcomings (expressed through shame and disgust directed at their bodies).

There is a chance to cure the patient of his eating disorders (though the duality of eating disorder plus the existence of a PD is not favourable prognosticator of recovery). This - and ONLY this - must be done at the first stage. The patient's family or closest should consider therapy AND support groups (the equivalent of Alcoholics Anonymous or a 12 step program for eating disorders). Recovery prognosis is good after 2 years of treatment and support. The family must be heavily involved in the therapeutic process. Family dynamics usually contribute to the development of such disorders.

Medication+ cognitive or behavioral therapy+psychodynamic therapy+family therapy ought to do it.

The change in the patient IF the treatment of his eating disorders is successful is VERY MARKED. His major depression disappears together with his sleeping disorders. He becomes socially active again and goes on with the business of living. His personality disorder might make it difficult for him - but, in isolation, without the exacerbating circumstances of his other disorders - he finds it much easier to cope
with.

Patients with eating disorders may be in mortal danger. Their behaviour is ruining their bodies relentlessly and inexorably. They might attempt suicide. They might do drugs. It is only a question of time. Our goal is to buy them time. The older they get, the more experience they accumulate, the more their body chemistry changes with age - the better their prognosis.

Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He is a columnist for Central Europe Review, United Press International (UPI) and eBookWeb and the editor of mental health and Central East Europe categories in The Open Directory, Suite101 and searcheurope.com.

Visit Sam's Web site at http://samvak.tripod.com

Written by: Sam Vaknin