In anorexia nervosa the main issue is a struggle for control, for a sense of identity, competence and effectiveness. Many of these people struggle for years to make themselves over, and to be perfect in the eyes of others. Concern with thinness is a late step in this development. The first outstanding symptom is a disturbance in the ability to see the body. The body is seen as much fatter than it is. There is an absence of concern, so the gruesome emaciation is defended as right. This is rigorously and defiantly defended as the only possible security against the dreaded fate of being fat.
The second characteristic is a disturbance in the accuracy of perception of stimuli arising from within the body. Eating patterns have two phases. 1. There is the absence or denial of desire for food and 2. Uncontrollable impulses to gorge oneself, usually without awareness of hunger, are followed by self induced vomiting. People identify with the non-eating phase and defend it as a realistic expression of their physiological need. In contrast, they experience overeating as submission to some compulsion to doing something they do not want to do. They are terrified by the loss of control during such eating binges.
A third characteristic is a paralyzing sense of ineffectiveness. They experience themselves as only acting in response to the demands of others and not as doing things because they want to. The indiscriminate negativism in response to other people is a cover up for an undifferentiated sense of helplessness and a generalized parallel fear that eating one bite will lead to all control being lost.
This often precedes the not eating. The not eating and the fear of being fat are resorted to when previous attempts at establishing a sense of control have failed. This need becomes urgent when the severe deficiency in autonomy comes into the person’s awareness as a sense of ineffectiveness. This sense of ineffectiveness is often precipitated by the challenging demands during the crisis of puberty and adolescence.
Evoking awareness of impulses, feelings and needs originating within, is the essential step in helping a person to develop a sense of competence. These are areas of functioning where he had been deprived of adequate early learning. Through the therapist’s alert, consistent, confirming or correcting responses to any self initiated behavior and expression, the person can become an active participant in the treatment process. Thus, she eventually become capable of living her life as a self directed, competent individual capable of enjoyment. The therapeutic focus is on the failure of self experience and on the defective tools and concepts for organizing and expressing one’s needs. This failure of self experience leads to dealing with others being experienced as bewildering.
Paying minute attention to the discrepancies in a person’s recall of his past is helpful. Focusing on the way she misperceived or misinterpreted current events and responded to them in inappropriate ways is beneficial. People will uncover the real or fantasized difficulties and emotional stresses which they had been completely unaware hiding behind expressions like “compulsive eating” or “food addiction”. Inability to identify bodily sensations correctly is a specific disability in eating disorders. There is a difficulty in accurately recognizing or perceiving other’s feeling tones accurately as well. This leads to a difficulty in recognizing the implications of his interactions with others. She suffers from an abiding sense of loneliness. He feels not respected by others, insulted or abused, though the realistic situation may not contain these elements. The anticipation or recall of real or imagined insults may lead to withdrawal from the actual situation and flight into an eating binge. The process of exploring and examining alternatives in such situations eventually lead the person to experiencing herself as utterly helpless in human relationships. Therefore, he feels a victim of powers that overwhelm him. Feeling more centered and experiencing a sense of personal agency comes from a greater awareness of ones feelings. A greater sense of personal agency is an essential foundation of the road to recovery.
Dr. Daniel Paul is a caring Los Angeles psychoanalyst and expert in Eating Disorders. Call today for an appointment if you’re dealing with eating disorders. 310-271-1858