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Anorexia: My friends tell me I have an eating disorder but I don’t think so…..

March 5, 2010

Dear Reader,

If the above title resonates with you, then you’ve come to the right place.  It is difficult to be in the position of being confronted by friends and family about your eating and weight.  It can bring up many contradictory feelings.  On the one hand, you feel that others care about you and that’s why they’re concerned.   On the other hand you think everyone else is crazy, because if they could only see straight they’d be able to tell that you are NOT skinny.  You may also wish to keep your eating habits a secret, and you feel violated by their over concern.

Many of you might argue that everyone has an eating disorder.  You see your friends drinking a diet snapple or diet coke, they’re all dieting, watching their carb intake, reading about the latest diet fad.  You think you’re no different than anybody else.  But secretly maybe you might admit that the topic is a sensitive one for you, and maybe you wonder if food has taken too central a role in your life.  Maybe you think about food more than anything else in your life?  You plan all your meals in advance, as well as when you’ll exercise next, and you’ve become adept at counting calories, how much you take in and how much you’ve burnt.  You feel good when you’re in control of your caloric intake, and terrible when you’re not.  Does this sound familiar?

As a psychologist who specializes in eating disorders, I find it most challenging to appeal to women who are in the beginning stages of anorexia nervosa, those that don’t think they have a problem because they do not see themselves as too thin.  Here’s why.  Often, when in the beginning anorexic phases, some people actually feel high on life.  This term has aptly and simply been dubbed “the anorexic high”.  These young girls, women, or men are feeling great because they feel as though they are in absolute control of their appetite and  body weight.  In some cases, they might feel that they’ve improved their look.  Maybe they’ve even gotten positive feedback from parents or peers when they initially started to lose weight.  This anorexic high, in combination with the compliments can be so utterly confusing. Why would they seek help if all is seemingly going well?

There are many reasons why therapy is actually a smart move, despite this high.  First of all, the earlier you catch an eating disorder the easier it will be to beat it.  Then, it is important to understand that the anorexic high is just as it sounds: it’s like a drug high.  It is based on something that has a negative underbelly.  Like with a drug high, it is hard to sustain and there is withdrawal.  No one can maintain absolute control all of the time!  Here is a basic reality about controlling you food intake and weight:  even though some people control their caloric intake over a period of years, many of them eventually slip into “out of control” bingeing at times.  At some point, their bodies may become so malnourished it’s as if their body is begging  to eat- and then a binge occurs.  They then feel horrible about bingeing.  In fact we know that if you starve any human for a while, when you allow them to eat they will binge!  (see more on the Starvation Study in my next post).  It’s usually after a sustained period of bingeing, and attempts at compensating for the bingeing (through exercise, or vomiting, or laxative use, or fasting) that people eventually show up for therapy.  For instance, many of the women who come in with a diagnosis of bulimia had at one point met the criteria for a diagnosis of anorexia!  They find  the bingeing purging rituals more uncomfortable than the controlled restriction so they come to therapy in order to stop bingeing.  And they wince when they learn that the secret to stopping to binge is to stop to restrict!

There are many topics that come up in therapy that can be uncomfortable and contradict a world view that values control over the appetites.  But, your therapist is not just there to contradict your world view.  A good therapist will want to understand how you came to your world view, and why you started to engage in your specific eating patterns.  One thing I learned from my clients is that there is always a very good reason why a person has adopted certain beliefs and habits.  It’s almost always the best possible solution to surviving in their world.  And in fact their eating pattern and their beliefs actually worked for them, and were a viable way to survive and feel better in certain situations!  That’s why it is so hard to give up an eating disorder.    So, to then begin to rework daily eating habits, and beliefs will take some time, patience,  curiosity, and good therapy.

In conclusion, if your friends and family are concerned, it might be worthwhile to visit with an eating disorder specialist in your area to get an objective point of view.  Even if you don’t meet criteria for an eating disorder, you might discuss the pros and cons of starting a course of therapy with a professional.

Best of Luck,

Anat

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