Compassion in Treating Eating Disorders is Vital
Sometimes, the patient and therapist learn that food restriction is about a wish to become invisible. Sometimes eating very little means a person wants to be small. To cope with a history of trauma, they just don’t want to be noticed.
In trauma-informed therapy we talk about why that behavior makes sense. When we re-frame the behavior by asking why it’s there, we can empathize. It is not ‘craziness,’ but the person’s best attempt to soothe enormous fear or angst in a world where they feel unsafe.
It’s about finding meaning in the patient’s choice of coping. It doesn’t matter whether that choice is food restriction, binging, purging, overeating or other self-harming behavior. It’s a survival skill and the person is doing the best he or she can.
Seeing the reason or the meaning they make around why a person struggling with harmful behavior is so important. Witnessing a person’s pain opens a compassionate connection that is necessary for healing. Relationships that bring compassion to people with eating disorders have a vital role in recovery.
The Link Between Eating Disorders and Adverse Experiences
Experiences that cause trauma — especially when they occur in childhood — dramatically increase the risk that a person will struggle with emotional regulation. Trauma survivors strive mightily to look normal. They face enormous difficulty with hypoarousal or hyperarousal throughout life. Studies show that the earlier the trauma and the more types of traumatic childhood experiences, the higher the risk that addiction, eating disorders or self-harming behavior will occur.
In fact, the origin of the landmark Adverse Childhood Experiences (ACE) Study began in an obesity clinic. Dr. Vincent Fellatti noticed that more than half of his patients were dropping out of his weight loss program even though they were losing weight well. He wanted to know why, so he interviewed some of those who left.
What he found was a high incidence of sexual abuse among obese patients, which often occurred when they were children. After the abuse, their weight skyrocketed and remained high.
Some people with disordered eating behavior also have a history of trauma (physical or attachment trauma). They try to use their size for protection in some way. Others use food as a mechanism of self-soothing or something they have control over.
People with trauma use addictive behaviors (food, drugs, alcohol, gambling, sex, etc.) in desperation to resolve unresolvable emotional distress. People use food, substances or other self-harming behaviors to help them feel less bad, because otherwise, they feel too reactive or numb.
Desperate for a Sense of Control
How do eating disorders help people who struggle to function?
No matter what eating disorder or what self-regulation mechanism people use, people turn to them to get some sort of control over their emotions and their lives. Without other tools for self-soothing, or self-understanding, they don’t know what to do.
They’re feeling so out of control, or life feels so overwhelming, they turn to something else they can control. “Well, I can control what I put in my mouth.”
Restricting or binging with food brings some people down from hyperarousal. For others, it brings them up from a low.
The Longing to Feel Less Bad
The issue for those who use food is not usually just about appearance. I believe that anorexia or bulimia isn’t about wanting to look like the model in the magazine. It’s about wanting to feel like her (or how we imagine she feels). Restricting food or binging on food is not about trying to feel beautiful. It’s a mechanism to feel less badly. The behavior offers at least some measure of control over uncontrollable emotions.
To restrict food, binge or purge successfully, you must disconnect your awareness from your body. Whether you’re starving yourself or overeating, you must numb yourself to the signals and objections from the body to succeed.
The brain-body disconnect can give some measure of relief from symptoms such as anxiety or shame. But the problem then becomes dissociation from healthy signals too.
Helping Reframe Relationships in Recovery
Relationships that support recovery have deep roots in compassion. Healthy relationships in many forms are vital to recovery.
Loved ones may criticize disordered eating, but this usually backfires and makes the person hearing the criticism feel worse. Changing this dynamic involves careful re-education for loved ones and family members.
A huge sign of progress happens when someone recovering from an eating disorder can say something to friends and family about how they can help. Recovery happens in relationships where it’s safe to talk more about feelings than about food. Compassion helps parents who want to know how to talk with their teens about self-harm or substance abuse. Connection becomes possible when parents can show gentle curiosity and compassion for what is going on for their child.
We encourage everyone involved to bring an attitude of understanding, support and compassion to each other’s emotional life.
Finding trust in relationships helps ground people in recovery. For trauma survivors, these relationships are much harder to come by. People with eating disorders need the compassion of healthy relationships to find better ways to feel all right.
The Concept of ‘Health at Every Size’
I believe a person can be healthy at any size. Nobody has to be a size 2. As therapists, we can help people accept the body they have today. Walking the path of better self-care starts with the message: I accept you as-is.
The first step in recovery is to realize that every behavior has meaning. And if we can bring compassion to it, rather than judgment, we are more likely to help others find hope and healing personal connection.
- Healthy Relationships Matter More than We Think
- How to Talk With Your Adolescent About Their Drug or Alcohol Use
- Loving a Trauma Survivor: Understanding Childhood Trauma’s Impact On Relationships
- Trauma-Informed Care: Understanding the Many Challenges of Toxic Stress
- What Is Good Self-Care, and Why You Deserve It
Brickel, R. (2018). Compassion in Treating Eating Disorders is Vital. Psych Central. Retrieved on February 21, 2018, from https://pro.psychcentral.com/compassion-in-treating-eating-disorders-is-vital/