The Obsession: Reflections on the Tyranny of Slenderness

A struggling will, an insecure feeling, and despair may manifest themselves in problems with the care and feeding of the body but are fundamentally a problem with the care and feeding of the soul. In her aptly titled book The Obsession: Reflections on the Tyranny of Slenderness , Kim Chernin has written, "The body holds meaning . . . when we probe beneath the surface of our obsession with weight, we will find that a woman obsessed with her body is also obsessed with the limitations of her emotional life. Through her concern with her body she is expressing a serious concern about the state of her soul."

What are the emotional limitations commonly seen in individuals with eating disorders? What is the state of their souls?

COMMON STATES OF BEING FOR THE EATING DISORDERED INDIVIDUAL

• Low self-esteem

• Diminished self-worth

• Belief in the thinness myth

• Need for distraction

• Dichotomous (black or white) thinking

• Feelings of emptiness

• Quest for perfection

• Desire to be special/unique

• Need to be in control

• Need for power

• Desire for respect and admiration

• Difficulty expressing feelings

• Need for escape or a safe place to go

• Lack of coping skills

• Lack of trust in self and others

• Terrified of not measuring up

The scope of this book does not allow a detailed analysis of every possible reason or theory that could explain the development of an eating disorder. What the reader will find is this author's overview explanation, which involves the discussion of common underlying issues observed in patients. Additional information on the development and treatment of eating disorders from varying theoretical viewpoints can be found in chapter 9 on treatment philosophies.

Eating disorder symptoms serve some kind of purpose that goes beyond weight loss, food as comfort, or an addiction, and beyond a need to be special or in control. Eating disorder symptoms can be seen as behavioral manifestations of a disordered self, and through understanding and working with this disordered self the purpose or meaning of the behavioral symptoms can be discovered.

In trying to understand the meaning of someone's behavior, it is helpful to think of the behavior as serving a function or "doing a job." Once the function is discovered, it becomes easier to understand why it is so difficult to give it up and, furthermore, how to replace it. When exploring deep within the psyche of eating disordered individuals, one can find explanations for a whole series of adaptive functions serving as substitutes for the missing functions that should have been, but weren't, supplied in childhood.

Paradoxically, then, an eating disorder, for all of the problems it creates, is an effort to cope, communicate, defend against, and even solve other problems. For some, starving may be in part an attempt to establish a sense of power, worth, strength and containment, and specialness because of inadequate mirroring responses, such as praise, from caregivers.

Bingeing may be used to express comfort or to numb pain, due to a developmental deficit in the ability to self-soothe. Purging may serve as an acceptable physiological and psychological release of anger or anxiety if the expression of one's feelings in childhood was ignored or led to ridicule or abuse. Eating disorder symptoms are paradoxical, in that they can be used as an expression of and defense against feelings and needs. The symptoms of eating disorders can be seen as a repression or punishment of the self, or as a way of asserting the self, which has found no other way out.

Here are some examples of how these behaviors fill emotional needs:

• An expression of and defense against early childhood needs and feelings. It's too scary to need anything, I try not to even need food.

• Self-destructive and self-affirming attitudes. I will be the thinnest girl at my school, even if it kills me.

• An assertion of self and a punishment of self. I insist on eating whatever and whenever I want, even though being fat is making me miserable . . . I deserve it.

• Used as cohesive functions, psychologically holding the person together. If I don't purge I'm anxious and distracted. After I purge I can calm down and get things done.

The development of an eating disorder can begin early in life when childhood needs and mental states are not properly responded to by caregivers and thus get disowned, repressed, and shunted off into a separate part of a person's psyche. The child develops deficits in his or her capacities for self-cohesion and self-esteem regulation. At some point in time, the individual learns to create a system whereby disordered eating patterns, rather than people, are used to meet needs because previous attempts with caregivers have brought about disappointment, frustration, or even abuse.