Are eating disorders attempts at self-care?
I'll preface this really quickly with a couple of things. Firstly, I want to acknowledge that this post comes from an 'aha' moment after listening to a seminar recorded last November by Anna Lavis (of Goldsmiths) at the University of Oxford on the topic of subjective lived experiences of anorexia as a form of self-care. If you'd like to listen to it, you can find it here. But this is what inspired this post.
I also want to acknowledge how uncomfortable this may sound or feel to speak about eating disorders as a form of perceived self-care given the undeniable suffering and pain that eating disorders bring to sufferers lives. However, I think this is a very important topic to discuss in the context of treatment and recovery because it enables us to develop a deeper understanding of what might keep people entangled with these dangerous diseases for so long.
Almost all of the people that I've worked with have a deep understanding of how their eating disorders are hurting them physically, emotionally, and socially. That's ultimately what brings them to therapy. Whilst continued psychoeducation about the latter is a part of the therapeutic work, perhaps the biggest piece is unpicking the uncomfortable subjective realities of why they feel that they 'need' the eating disorder, or as I prefer to say, what they 'get' from it. Unpicking this in order to create meaning and devise treatment action is a delicate, uncomfortable, but necessary process in therapy which often proves to be incredibly fruitful. There are many symbolic meanings of why people might feel that they 'need' an eating disorder, and I'll outline a few of them.
For some, the eating disorder gives them a sense of power and control which is beneficial when they are feeling afraid of the unknown or when they feel like life is out of control. This can also be framed as protection from the world, a way of trying to keep themselves safe, and it's done through food, exercise, and trying to control bodily appearance.
Sometimes it's more to do with coping with their experience of emotions. I've found that most of my clients are empathic or could be considered 'highly sensitive". This means that they feel their emotions in big ways and they also easily absorb other people's emotions and take them on as though they were their own. This, understandably, can be totally overwhelming and makes social situations challenging and stressful. To almost numb this out, food (either a lack of or overabundance), extreme focus on appearance, overexercising, and a preoccupation with being 'healthy' can function as a distraction, or a way of coping, with emotions / an attempt to emotionally regulate.
Occasionally the eating disorder functions as a way of communicating to the world - of being seen or heard. And I don't mean that it's a form of attention-seeking. Rather, the eating disorder and what it does to the body can be a way of trying to communicate vulnerability to others; to feel accepted and ok ( aka to combat shame, which is "I'm sorry for being me and for being so wrong ); to take back power; to feel protected and strong; or even to feel invisible in order to avoid shame or criticism.
Whilst these are all potential symbolic meanings of the function of the eating disorder, I've had clients explicitly communicate that the eating disorder is the one thing that they feel they do for themselves --- in other words, they tell me that it's a perceived form of self-care. Some have told me that bingeing and purging is a form of stress relief, or that it's something they do in the evenings to avoid feelings of boredom or loneliness. Others have voiced how they truly enjoy the numbness, stillness, and silence they experience when they are restricting, overexercising, or bingeing. They tell me how it offers them solstice from the chaos they perceive within themselves and out in the world. They tell me how it gives them comfort and safety. And as much as I'm a psychotherapist that works with symbolic meanings, I also feel that it's incredibly important to listen to what my clients are explicitly telling me and to find a way of working with it.
Uncovering what sufferers "get" from the eating disorder is necessary for appreciating what keeps them stuck in it despite their understanding of the despair and harm it brings to their lives. And the thing is, that when someone is struggling with an eating disorder they are living with the meanest and most spiteful bully you could ever imagine inside of their head. This internal bully constantly tells them they're not good enough; it tries to pre-empt rejection and criticism by constantly criticising and rejecting them; it preoccupies them with a quest for perfection and tells them that happiness and self-confidence will be theirs once it is achieved. And as horrible as that bully sounds, and is, it represents safety and offers a particular sense of self to hold on to.
Within this context, it is also easy to see how scary it can be for someone to consider letting go of an eating disorder. If it offers them comfort, a way of communicating, a way of coping and feeling as though they're taking care of themselves, a form of protection and a sense of self, then understandably the thought of letting go of those things can feel terrifying. But working with this is key, I think, to uncovering what needs to be done in order for sufferers to feel safe enough to let go of the eating disorder.
And that looks different for everyone. It can involve anything from building internal and external boundaries; learning different coping skills; dismantling social support networks and building new ones where they can feel more seen and heard; restructuring their lives ( finding a more satisfying job, for example, or leaving destructive relationships ); learning new forms of self-care ; building self-compassion and a kinder relationship with self; connecting to creativity; or learning more about emotions, how to identify them, and how to manage them.
All in all, the most efficient way -- that I've found -- to figure out what that looks like for each individual is to work with their own subjective meanings to uncover and address what it is that they might 'get' from the eating disorder. From there, we can make a plan tailored to their individual needs so that they can let go of the eating disorder once and for all x