In recent posts, I reflected on some of the larger social forces that have both led to the incidence of eating disorders in recent decades and impacted how these disorders are diagnosed and treated. Reckoning with the meaning of eating disorders in our society is essential, yet clinicians still need to address the symptoms of an eating disorder when someone comes to treatment for help.
First steps include assessment of the severity of the symptoms and education about hunger/fullness, metabolism and the need for energy and nutrition for overall health. Initial sessions then can focus on the means to change disorder eating patterns. No matter the larger picture, individual treatment needs to start in the same place.
However initial treatment stabilizes eating for many people, this step does not have to mean “full recovery,” the overarching promise of many programs that an eating disorder can disappear for everyone (and if it doesn’t then it’s your fault). Instead, stable eating means that someone eats enough and with enough variety to be healthy enough to move forward with their lives.
Often, treatment at this point searches for an underlying cause for the eating disorder thus implying that something external and concrete caused the problem . That is not commonly the case. The search is fruitless and not directed at the central issue.
Recent posts point out another possibility for the eating disorder in the first place. Eating behaviors or weight may instead be a means of expression, a way to say something powerful that otherwise won’t be heard. The message hidden behind the eating disorder often come from a source of emotional pain but may also be a way for others around them to understand the nature of their circumstances and the limitations they feel to move forward in their lives.
Examples can include family dynamics that scapegoat the child in the family to feel responsible for everyone’s ills or dynamics that necessitate the child care for a parent unable to take on their personal responsibility. Another possibility is a child forced to grapple with the wrath of a parent aimed at them which limits the child’s ability to focus on their own growth and development. A third may be a family with a disabled child and the sibling with an eating disorder has no room to be themselves.
There are myriad examples of scenarios where the child, much more often a daughter, finds themselves without a voice, bearing family responsibility and with an eating disorder as the only way for others to see their emotional and personal struggles.
Treatment at this point focuses on finding one’s own voice and thoughts and the means to identify, experience and express their internal world to chart a path towards living a full life. The broader social forces are at play in these individual instances, but the treatment is aimed at the person’s specific situation and finding ways for her to not feel so trapped by personal pressures. Understanding the larger implications may be helpful in the moment and helps educate the therapist to know how to proceed focusing on life change and not just food and weight.
Toggling between the larger causes of eating disorders and the individual’s need to get better is the primary experience for any eating disorder clinician. These illnesses aren’t just about food and weight, nor are they just about the social causes. They are about the combination of nuanced clinical care and understanding the root cause of eating disorders in our society.