Who’s Talking, You or Your Eating Disorder?

| Brianna Hicks, LCMHC

Eating disorders (EDs) can be difficult mental illnesses to treat, and come with a lot of internalized shame. This is often related to the inner conflict that accompanies eating disorders that can be different from other mental illnesses. Most mental illnesses are egodystonic, meaning that they cause thoughts and behaviors that are outside, and sometimes even contradictory to a person’s identity. For example, generally speaking, a person who is depressed does not want to stay depressed because their depression gets in the way of their life. It can keep them from making meaning in their lives, and can move them farther from valued living. 

By contrast, eating disorders are egosyntonic, and people who have eating disorders identify themselves with their eating disorder and want to (to some level) keep it. This is where conflict can present itself. Eating disorders, like most mental illnesses, serve a function. Eating disorder behaviors are often used to provide comfort or a sense of control– engaging in a binge to cope with intense emotions, restricting to feel in control of something, or purging to “cleanse” wrongdoings. Using these behaviors helps those with EDs cope with life’s challenges, and feel better.  Additionally, our society is quite body centric, and so when a person loses weight, they are likely to be praised for it. This creates positive reinforcement for a person to want to continue to use ED behaviors, and keeps them entrenched in their eating disorder. 

So, what if you decide that you don’t want to keep your ED anymore? A major treatment intervention for eating disorders comes from the tenets of Family Based Treatment (FBT) (otherwise known as The Maudsley Method) developed in the late 80s to treat anorexia. FBT focuses on externalizing the eating disorder from you. Learning that the eating disorder is driving your thoughts, feelings, and behaviors helps to reduce judgment and criticism, both of yourself and from others towards you. No one chooses to have an eating disorder, and focusing on the eating disorder having the power and making choices for you, rather than with you, helps to move forward. 

Externalizing the eating disorder can mean a variety of different things. For most, this means beginning to refer to eating disorder thoughts as separate from yourself. This can seem strange at first, and most will say that their eating disorder sounds like them– which it likely does. A way to tell if your ED is talking or if you are is to identify values. Are you engaging in valued actions when you are falling in line with your eating disorder? If you value honesty and family, but lied to your loved one about restricting a meal, were you living in line with your values? Were you in control at the moment or was it your eating disorder? Values can act as a helpful compass for identifying the difference between your thoughts and your eating disorder’s thoughts. To practice this, you would say “My eating disorder told me to lie to my loved one” rather than “I lied to my loved one.” This small change reduces inner shame and judgement. In externalizing the eating disorder, we may also opt to name it. Ed, Ana, Mia, are often common names that are used to further externalize and personify the eating disorder and to create more separation between you and it. 

In sessions, I will frequently ask who is in the room when we’re talking about your eating disorder in an effort to help you identify whether you’re in the driver’s seat, or it is.  If we can tell your eating disorder is running the show, we can then begin to shift focus away from it, and move towards living a full life again– one without the eating disorder.

Today's the day to make a change.