My first job as a clinician was at an inpatient eating disorders program in Northern California. It was a terrific program and I learned a lot in the three or so years I was there.

Something I noticed early on was a tendency for clients to seem sort of "zoned out" or "not present" or "disconnected." If I asked a client about his/her experience, she would describe herself as not present or in a fog, a state she depicted as "pleasant" or "safe" or "comforting" but also "strange," "unsettling," and/or "lonely."

After awhile I became convinced that becoming disconnected or not present might be a central feature of eating disorders- that perhaps a main purpose of the food and exercise behaviors was in fact to induce this disconnection from one's self, in order to minimize or eliminate emotions.

When I was getting my doctorate I investigated this hypothesis by studying whether the bingeing and purging in bulimia directly affected someone's experience of being "present."

What I found (though it was a very small study) seemed to suggest that the people involved in the study were using (unconsciously) the binge/purge behavior to make themselves less connected to their emotional experience.

So, if this is true, how does it help us? It helps us a lot I think. For instance, I primarily work with eating disorders as "disconnecting" phenomena. Consequently, the job of myself and my client is to figure out why she needs to be disconnected from herself (from her emotions) and what we need to do to allow her to remain more present or connected to what she feels.

One of the big problems with the disconnection that seems to come with ED behaviors is that it isn't selective or sophisticated about how and when it disconnects someone from herself (think about it- if you are walking around in a kind of fog, you might not feel emotions you don't want to feel, but you also won't feel things you might want to feel or experience things you might want to experience). In addition, the sufferer can feel disconnected from other people (or animals, or nature, or the world at large). Her overall experience is often that she's quite alone and isolated.

If in therapy, over time, we can get her to tolerate staying connected to herself, she feels more alive, more a part of the world and a part of relationships that are important to her. It's a little like training for a marathon or other endurance event- she has to gradually build up her endurance for feeling her emotions. We have to be thoughtful and careful about pacing ourselves, so she doesn't become overwhelmed by the process and so she gains confidence that she's strong enough to experience her feelings.

Comments

[katie]

Once again, I think you get it completely right, Johanna. This comment and the previous two related to treatment of long-term ED's are very consistent w/my own experience as someone who had anorexia as an adolosent, which then evolved soand still live w/ me to some extent (sometimes more, sometimes less) in my forty's.

The disconnection theme is exactly what I have recently discovered is a key to my disorder in one of those "aha" moments.

Keep up the terrific blogging!

[aflo]

this is so right. though people know me as such a sociable and outgoing person inside i just feel so alone. makes sense

[aflo]

this is so right. though people know me as such a sociable and outgoing person inside i just feel so alone. makes sense

[aflo]

this is so right. though people know me as such a sociable and outgoing person inside i just feel so alone. makes sense