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,