HOPELINE #4

Eating Disorders Support.COM

located just outside of Seattle, Washington

The Hopeline

Volume 1, Number 4

Revised April 2004

In the last Hopeline, I mentioned that I wanted this issue to focus on the fears of leaving home and establishing intimate relationships. As I have been trying to collect my thoughts, I have come to realize the enormity of the task, so intend to stretch out the discussion over several issues. Before plunging in, I want to share with you four issues I believe each of you can begin to address as an individual on the road to recovery. I strongly believe that a mixture of family change and individual growth leads to a recovery with low likelihood of recurrence your eating disorder. Since it is sometimes difficult to involve your family in therapy right away and sometimes ever, I want to share with you some things that were helpful to me and challenge you to give them some thought. I call them The Four I's.

Information

Insight

Individuation

Intimacy

Information. I feel that it is very difficult to fight to get well when you do not understand from what it is you are trying to recover. By coming to a support group, talking to others, and reading (even if it is scary), you can begin to understand what an eating disorder really is. For example, until I read about the impact of family interaction on the development of my problem, I had no idea that some of my family and I would benefit from working together to help me to fully recover. Some therapists will jokingly say that eating disorder patients are the only people who know more about their disorder than they do. There is a tendency for people with eating disorders and their families to collect information about the disorders, particularly anorexia nervosa and bulimia. There is sometimes a concern expressed that people with eating disorders will use this information gathering process to find new behaviors to try in their efforts to lose weight. There is no doubt that sometimes that is the case, but I think it depends on the person's stage of recovery. When I was still in semi-denial that I had an eating disorder ( I outwardly denied it, but deep inside knew there was something wrong and that it most likely was an eating disorder), I read the book The Golden Cage by Hilde Bruch. I was fascinated by what she wrote. Part of me was interested in learning about the eating disorder and how to be thinner; however, another part of me was desperate to learn about how to get well. At that time, I was still somewhat enamored with losing weight and with my behaviors even though I wanted to stop them, I was not ready to use the information in that book to help me to recover, but I stored it away and later came back to it. I needed to understand that my problem was more than a food problem and reading this book opened the door for me to begin to do that. I am of the opinion that the majority of the work of recovery takes place in the mind of the person with the eating disorder when he/she is at home, alone, and away from therapy or a support group. After all, that is the same way the eating disorder starts for most people: in the mind of the person when he/she is at home, alone, and away from others. The information needed to do the work of recovery can come from many sources.

Insight. Information alone is not enough. Some people with eating disorders have so much information about their problem that they could write their own book!! What is lacking is insight, the personal application -- that "click" when a lightbulb goes on inside and you suddenly understand how something applies to you. These "clicks" are often life changing turning points. A counseling relationship with someone you trust is an excellent way of speeding up the insight process; a therapist can force you to deal with information you could avoid on your own. Yet, insight is not in of itself enough either. I had a wonderful supervisor for several years, Raymond Vath, MD, who often said, "Insight without behavior change is of limited value". How true!! If you have all the insight in the world, but cannot use it to change relationships or food or weight related behaviors, it is not going to help you to recover. However, behavior change without insight is of limited value, too! Behavior change without insight really increases the risk of relapse. In alcoholism, a person who has stopped drinking without insight is called a "dry drunk". Likewise, a person with an eating disorder could be called a "dry anorexic" or "dry bulimic" or "dry binge-eater" if he/she stops behavior without addressing the issues that underlie the behaviors.

Individuation. Individuation is the normal process in adolescent development in which a child begins to be able to view herself as separate from her parents and family in preparation for leaving home. Frequently, this process begins with things like changes in dress, hairstyle, political views, religious ideas, and preferred music that are different from mom and dad. Both teenagers and parents can typically recount many stories of the conflicts that arise over these issues. This is all part of the normal process of growth and development in a family. Another of my supervisors, Dr. Tom Roessler, once asked a father in a family therapy session I was observing, "Would you rather have a daughter who is sick (with an eating disorder) or one who is rebellious?" I found this to be an interesting and thought-provoking question. In his book, Psychosomatic Families, Salvador Minuchin writes, "Instead of focusing more and more on the extrafamilial world, the anorectic turns her expanded viewpoint back into focusing on her parents. She tries to help and change them. This overfocus and the parents' response strengthen the boundaries that keep the child overinvolved with the family." (p. 60). I'll talk more about this in another Hopeline, but in the meantime, try to think about or write down the ways you are different from each parent and think about how much freedom you feel to express those differences when with your family.

Intimacy. An intimate relationship is one in which you can honestly express your thoughts and feelings to another person in a climate of mutual trust and acceptance. Communication is direct, not manipulative or covert. Most people with eating disorders were not taught by their families to communicate honestly and directly. In fact, many learned or decided to be the peace maker and people pleaser in their family at the expense of expressing their own thoughts and feelings. Once the eating disorder begins, manipulation and deceit become the norm, however, occur most commonly around eating disorder behaviors (e.g. food is "sneaked", purging is hidden, binge eating often takes place after other people have gone to bed, subtle lies about food preferences occur).

For example, a person with anorexia nervosa would rarely say, " I am afraid of gaining weight, so I am not going to eat the dinner you made. I will pretend to eat it, but in reality will push it around on my plate and sneak some of it into my napkin so that it looks like I ate more than I really did. If you force me to eat it, I will just go into the bathroom and throw it up. If you do not let me into the bathroom, I will go into my room and vomit into a plastic bag!" This would be direct, assertive communication. Instead of speaking like this, the person would make excuses to not eat with the family, state that she does not like a particular food when she really does but is afraid of the calorie/fat content, or eat the food and then secretly throw it up later.

Another example is that of the person who is obese and a binge eater who eats a tiny amount and declines desserts when with family or friends, claiming to be on a diet. At the same time, he/she knows that he/she will overeat in secret later, having a special meal of his/her own making and/or stopping at a fast food place on the way home.

As I have been writing, a verse from the Bible has been running through my mind. I am often amazed at the universal application of the principles in that book, regardless of whether one believes in God or not. In the gospel of John, Jesus is quoted as saying, "And ye shall know the truth, and the truth shall make you free". It is my hope that you will begin to experience freedom as you understand more and more of the truth about yourself, your family, your eating disorder, and your life.

With hope,

Kim