November Membership Meeting Write-Up — Kirstin Carl, MS, LMFT

Decoding the Message Behind Eating Disorder Urges

by Sherry Fleming, LMFT

Eating disorders are the most deadly of all psychiatric illnesses. At least 1 in 5 people who have eating disorders die. This statistic is a low, conservative number because death certificates do not usually list eating disorders as the cause of death.

No genes have been identified for eating disorders. Temperament contributes to eating disorders. People with eating disorders tend to be perfectionistic, people-pleasing, highly sensitive, intuitive, empathic, and have difficulty with change.

Full recovery is possible, but it does require deep, hard work. For people with eating disorders, their primary attachment figure is their eating disorder. Eating disorders occur when the person experiences something that the brain finds intolerable. Eating disorders are all about avoiding the intolerable emotions. The eating disorder urge is not the real issue. The real issue is something that is happening underneath, set off by a trigger.

Although they are less likely to come forward, men can have eating disorders. One hundred percent of a person with an eating disorder believes that he or she is fat. He or she is not playing a game. As therapists, we have the role of helping people figure out what the real trigger is, breaking it down into every single, minute detail. People with eating disorders have high levels of self-judgment. Just identifying the trigger does not mean that the eating disorder is now going to go away. Then we have to deal with that trigger. The trauma is still there.

Having clients do eating disorder healthy self-dialogues is one intervention. What that means is that people who have eating disorders feel like they have a part of themselves, a voice, that tells them what to do. It’s nothing like schizophrenia; rather, it is a part of self. It has its own agenda, and it tends to be very mean. We want them to start dialoguing between their “healthy soul self” and that eating disorder aspect of self. A lot of times, they won’t know what that is. They won’t be able to identify who their healthy soul self is. Ultimately, the dialogues will get to what’s really going on underneath in any given moment. We are helping them to let go of judgments about eating disorder behaviors and urges.

Another intervention is empowering clients to journal before, during, and after an eating disorder behavior. We are trying to get them to break the cycle; to change the ritual, and to put something else in there. If we can get them do any form of journaling: to draw a picture, or get two words down-to get something down on paper either before, during, or after using a behavior, then we are successfully utilizing this intervention.

Some people have true restrictive anorexia. Those people tend to have very early, infant attachment trauma. Most people with anorexia do enjoy food; they have just learned to restrict themselves. There is a select subgroup of people with restrictive anorexia who do not like food. Those people will not tend to swing to the other side of overeating. The other subgroup of people often do swing to the other side, because they do find food comforting. So there is a lot of work around their guilt and their shame about losing control and giving in. Anybody who has an eating disorder wants to have anorexia. No one wants to have bulimia or binge eating disorder, because those are seen as “weak.” So the approach to working with people who swing between undereating and overeating is the same; providing education and helping them to figure out what’s really going on in any given moment when an urge comes up to do a behavior.

You know you are recovered when it doesn’t occur to you to use eating disorder behaviors anymore. Technically, it’s when you no longer meet the criteria in the DSM. Sherry looks at it more like it when it doesn’t even occur to you to restrict, exercise, binge, or purge; when it doesn’t cross your mind, and it doesn’t even make sense to do that; when there is a cognitive dissonance in using those kinds of behaviors. And then being able to see through different comments that people make about body image is another sign of recovery. Recovered people have a better relationship with body image and with food than most men and women have.

Resources for families and loved ones include ANAD (Anorexia Nervosa and Associated Disorders) groups; they have a list of resources on their website. Resources for professionals include VFED (Valley Federation of Eating Disorders) meetings, which also have a list of resources on their website. Another resource is NEDA (National Eating Disorder Association), which additionally has a lot of resources on their website. Helpful books include the “Eating Disorder Sourcebook,” and “Life Without Ed.” When she recommends “Life Without Ed,” she also lets the people know that it looks at the eating disorder from more of a narrative perspective; the eating disorder is not outside of the person. It gives a really good sense of what it’s like to live with an eating disorder.

If anybody needs any support or help with eating disorder cases, Sherry encourages people to reach out to her. Her website is sherryflemingmft.com.

Kirstin Carl, M.S., LMFT, has a private practice in Encino, specializing in trauma, faith-based therapy, and adolescents. Practicing for over 10 years, she is passionate about her work. Currently seeking certification in Emotionally Focused Couples Therapy, as well as participating in training on Voice Dialogue Therapy, she remains strongly committed to her development. You can reach her through her website kcarlmft.com, or at 818.593.9047.