Your Role by Tony Paulson

Emotions and Eating Disorders

Eating disorders are biopsychosocial. That means these disorders have biological, psychological and social causes. We are learning more about the biological causes which have contributed to more effective treatment plans and I hope as our knowledge of the biology of eating disorders continues to grow we will be more sophisticated in our approach to treating these disorders.

However, I would like to discuss the psychology of eating disorders and what families can do to help their loved ones address some of the psychological contributors to eating disorders. When people with eating disorder who have recovered have been asked what they got out of their eating disorders they cite several things including: identity, care, way of communicating difficulties, and a way of avoiding "negative" emotions. The reasons we feel a need to avoid emotions is what I would like to touch on today,

We as a society have a mindset that emotions are something to avoid. Why? I strongly believe that we were created to be emotional beings. Emotions are something that no one can avoid and exist not as a burden but as a resource. Emotions are what give life its color or richness. Without emotions life would be bland and superficial.

People with eating disorder often feel overwhelmed by emotions and as a result view emotions as potential threats to their well being. Consequently, they do whatever it takes to try and avoid emotions. Eating disorder behaviors are very effective ways of altering emotions and emotional awareness. Thus, the eating disorder becomes more important or more valuable because it becomes a resource to help patients avoid or minimize their emotions. Many patients have commented to me that the one thing they like most about their eating disorders is their ability to alter their emotions through the behavior.

If patients do not feel a need to avoid their emotions, I wonder if that would change the importance of the eating disorder. It certainly would eliminate a benefit most patients assign to the disorders.

As a support person, helping someone with an eating disorder, how do you intervene with respect to the role of emotions in the maintenance of the disorder? Encourage emotional expression and normalize it. Its OK to be emotional and emotions can be a resource and not a threat. We were created as emotional beings so why not accept that and begin to work with the resources we were given.

Accountability

I just got done talking to a patient who is about to advance from treatment and her words of advice was to tell as many people about your eating disorder as possible. For her the accountability piece was very important. When she started venturing down the eating disorder path she needed to have someone there reminder her why she didn't want to do that.

Stages of Recovery

I often have families ask how their loved on is going to get better. Unfortunately, there is not just one answer for everyone. Eating disorders are complicated as is recovery. What might work for one person doesn't for the next. One moment it seems like you're on the right track only to experience a set back. With that said, what should families expect in treatment?

In my opinion, the very first step in treatment is to stop the progression of the eating disorder. In others words, prevent the behaviors from happening. This is an important first step because eating disorder behavior causes chemical changes in a person's brain which can cause the person to "crave" eating disorder behavior. In essence, the brain likes the chemical changes that occur and wants it to continue. This leads to patients experiencing strong compulsive urges to engage in the eating disorder behavior. For these patients the eating disorder is not about a fear  of gaining weight or losing control over their eating. Instead, it is a biological compulsion that is only satisfied by engaging in the behavior.

Unfortunately, we don't have a quick fix for this. There are some medications that can help decrease the intensity of the urges but overall nothing to make them go away. However, we know that with consistent feedback the brain will change. Thus, the first step in recovery is to give the brain feedback that the eating disorder behavior is not something that we want to continue. When a patient tries to stop his or her behavior the brain reacts strongly because its not getting the chemicals it wants. Thus, the patient experience intense urges to engage in eating disorder behavior. If the patient is able to refrain from giving into these urges the brain gets feedback that it needs to change. Unfortunately, it takes a lot of feedback before the brain actually begins to change.

So the obvious questions is how does someone stop or alter the behavior?  Most patients will not engage in their behaviors in front of others- so be there when your loved one is most likely to engage. In addition, offer loving support as he/she struggles not go give into the compulsion. Reassure him/her that everything will be OK and that you will be by his/her side throughout the entire process.

More to come...