Where Does "I Feel Fat" Come From?

Dear Readers,

For those of you who have helped or are helping a loved one battle an eating disorder, one of the most puzzling aspects of these diseases can be the absolute conviction of your loved one that she or he is fat, when in fact they are starving to death, or even on the thin healthy side.

There are so many other behaviors associated with eating disorders that are equally inexplicable: Why does your child feel happier and safer the more his bones stick out, the more he courts cardiac or cerebral damage? Why does she crave the ritual of stuffing herself with junk food until she feels sick and passes out? How can she continue starving and purging when she knows eventually her bones will crumble like bread sticks and her teeth will rot and fall out?

Two eating disorder specialists, Johanna Marie McShane, Ph.D., a psychotherapist, and Tony Paulson, Ph.D., a social worker, have written a book designed to explain these mystery, and in general take you inside the eating-disordered person's head. It's called "Why She Feels Fat: Understanding your Loved One's Eating Disorder and How You Can Help," and it is published by, Gürze Books, the publisher of our book.

This is a great idea. As many of you know from reading our book, family based therapy is now considered the most effective way to treat adolescent eating disorders. Yet as much as parents want to help, often they are held back from being truly effective by their absolute bafflement at how their smart, responsible and loving child has seemingly lost all reason when it comes to food, exercise, shape and size.

McShane and Paulson act as psychological translators, explaining the complex web of emotions that lie beneath exclamations such as “I feel fat,” or “I feel chaotic and out of control.” Eating disorders, they explain can be many, many things: A way to feel secure; a way to make life feel predictable, a means of communicating emotions. They can impart a calming sense of “being in control” for the child who feels his life is entirely out of control. And, as we saw with Dr. David Herzog’s book (see my April 20 post), eating disorders can be a way for the child to prove that she is “good enough,” even as she fears and believes that she isn’t.

Eating disorders, the authors explain, aren’t really about being thin (although the desire to be so, fed by our thin-obsessed culture, can be the launching pad for an eating disorder); they ultimately become a cherished coping mechanism.

After reading this book, I was struck anew by how similar an eating disorder is to a negative and destructive personal relationship. Your child’s world has shrunk to the point where this isolating relationship is all she has in the world. She clings to the relationship, having come to believe that without it, she is nothing.

You may have to fight the fight of your life to extract your child from this destructive relationship, but once you understand the anxieties and fears that lie below all the inexplicable food behaviors, you will have an easier time emphathizing with your child, and a better chance of winning the battle.

Good luck and take care,

Nancy

Comments

[vickyann]

I feel huge at the moment yet in reality I know I'm not; I don't complain about it because everyone tells me how small I am. I want to believe them with my heart, it will be interesting to read the book.

Vx

[Nancy]

Dear Vx,

Wow, you are really ahead of the game in just realizing that there is the way you feel (huge), and the objective reality of what you really look like (not huge).

According to Johanna Marie McShane and Tony Paulson, this distorted perception of your own body is more about some kind of psychological pain that you have (and maybe don't really realize or understand) than about your size.

I hope you do read their book, and try to reading as much as you can about eating disorders and body image, because the more you know, the better armed you will be to fight this feeling, to get to the bottom of what's causing it, and to resolve it. Imagine living a life where you see your body accurately and are happy with it!

Good caregivers -- doctors, therapists, nutritionists -- can of course be very helpful in helping you get to this point. If you find that you are starting to starve yourself, or your health is in danger, these caregivers are crucial.

Good luck and keep us posted,
Nancy

[vickyann]

I will read the book, I'm currently on a waiting list for ed treatment and I want to fight this false image I see.

[Nancy]

Dear Vx,

Please do read it and let us know what you think of the book. Your comments and experience could be very helpful to others.

Good luck with the eating disorders treatment -- it's the best thing you can do for yourself now.

Nancy

[Brittni]

I was in treatment for 5yrs. while going to college but when I graduated I had to move home leaving behind my treatment team. I would come home to a place I couldn't wait to leave 5yrs prior. My parents believe my ED is an attention-seeking behavior. My parents call me fat all the time. I'm 5foot and 95lbs. My treatment team figures I've been suffering from ED since I was around age 9. I'm 23. ED has really bad through jr. high and in senior high--then worse in college but now--I don't care what ED does. I want to disappear. I want to be less than 70lbs. I eat barely 600 calories and I about 75% come back up. Life just hurts too damn much. I have no support, my family doesn't care and I feel as if I'm going no where. I can't afford treatment nor does my parents believe I need treatment for something I'm making up to get attention. What I'm suppose to do?

Brittni

[Marcia Herrin]

Brittni, Please don't give up!

I suggest you consider exploring self-help options such as Jenni Schaefer's blog on this site http://www.eatingdisordersblogs.com/recovery/. Jenni's book Life Without Ed about her eating disorder recovery is really helpful.

Gürze Books http://www.gurze.com/ has a complete list of self-help books.

Explore online support. The best way to get started there is to go the somethingfishy website. This organization screens online resources and recommends the most helpful. http://www.something-fishy.org/online/options.php

Check out your town's community mental health resources. I know of many people who found the treatment they needed to get better there.

Hang in there, you are worth it.

Marcia
The Parent's Guide to Eating Disorders (Gürze Books, 2007)