Why She Feels Fat

Trust is a basic necessity. It is the foundation of stable, healthy relationships- with others and within ourselves. For myriad reasons, people who develop eating disorders feel they can't trust, themselves (their bodies, their thoughts and beliefs, their emotions, their needs and desires) and others.

I was talking to a mom today. She'd come to see me about her daughter who has suffered from an eating disorder for several years and hasn't been willing to seek help or even acknowledge she is ill. The mom said to me, "she's in so much denial. I don't know what to do, I don't know how to reach her, and I'm so frightened."

I was thinking about the teenager and her summer camp job. I was reminded of two things people with eating disorders have a lot of: fear and courage.

I was talking this week with a mother of a teenager who has struggled with anorexia for several years. The mother was remarking that she and her husband had, about a month ago, told their daughter that if she wanted to work this summer as a counselor at a camp (something the daughter very much wanted to do) she needed to gain weight (she was approximately 88% of ideal body weight- significantly healthier than she had been a year ago, but not yet at a weight she where she would be truly healthy). If she could not achieve this goal, the parents felt they could not allow her to accept the job, since they worried she wouldn't be healthy and strong enough.

Another aspect of eating disorders that is getting quite a bit of attention these days is "mid-life eating disorders." I'm very happy about this; in my practice I have often seen women (and some men too) who have had various types of eating disorders since adolescence or from when they were in their twenties.

In response to my post about EDNOS, Carrie commented about her own experience being diagnosed with EDNOS and encountering serious medical problems as a result of her eating disorder.

I've been meaning to say something about EDNOS, which suddenly many people who come to see me are asking about. Until recently this category of eating disorder was generally ignored or used as a kind of "garbage pail" diagnosis. However, the idea behind EDNOS is important and the diagnostic category actually quite relevant and useful.

We know the eating disorder is a powerful coping strategy. And from the tenacity of its symptoms we can see it has both a "strong work ethic" and takes its "job" of "protecting the sufferer from overwhelming emotional experiences" very seriously.

A new client said to me today, "I hate my eating disorder. I'd love nothing more than to get rid of it." I said, "Wow, that's too bad, I don't hate your disorder at all. Actually, I rather respect it." I thought the woman was going to get up and walk out of my office.

"Perfectionism" is thought of as a common characteristic of people who have or develop eating disorders. What I find interesting is that very often people who tend towards this characteristic don't think the term fits them.