Unlike most psychiatric illnesses, and most medical ones too, eating disorders are ego syntonic, a psychological term which means that the central thoughts of the disorder feel right and good, something crucial to one's ego. Based on my recent posts about the harsh thoughts associated with eating disorders, this idea may seem contradictory, but the negativity of the thoughts only become clear once someone starts recovery. Before that, as long as the person obeys the thoughts, the disorder makes a confusing and scary world very calm and peaceful, even as the illness destroys any chance at living a full life.
It's hard for most people to understand how an illness can feel good, and therein lies much of the public confusion about eating disorders.
The evidence abounds for this inherent trait of eating disorders: websites extolling the virtues and successes of having an eating disorder, the misguided envy of many adolescents of their peers with anorexia or bulimia, and the tenacious grip the person maintains on her eating disorder as a lifeline to safety. And that is just to name a few.
Unfortunately, the nomenclature for eating disorders largely ignores this critical component of this group of illnesses. The list of symptoms focuses on restricting food, binging and purging with only a minimal reference to the powerful attachment to the illness and the lack of insight into the severity of one's impairment.
Focusing on the eating symptoms themselves remains mystifying and intriguing to laypeople. The urge to resist eating and use compensatory behaviors to avoid digesting food masquerades either as a successful diet choice or completely perplexing behavior to people ignorant about these illnesses. The vast majority of available knowledge omits the intense connection between the ill and her disease, thus ignoring the central reason people cling desperately to their illness and the resulting difficulty of recovery.
So the struggle between the afflicted person and her family and friends stays focused on the food. The struggle between external pressures to eat cannot directly compete with the powerful personal connection to the illness. Any successful intervention has to challenge this connection and reveal the lies that sustain it, not just convince the person to eat dinner.
The calm and peace that comes with feeling together and close to the illness stems from a web of lies. The eating disorder limits personal life significantly. Although some people can enjoy some success, especially in the academic or professional arena, the end result is a severely limited existence. The opportunity for close relationships, personal connections and the full range of human emotions doesn't exist. The urge to engage in the eating disorder symptoms and retreat from life dominates daily life.
The thought process that keeps someone attached to this existence repeats the same messages over and over: relationships are not reliable; people always disappoint you; you have figured out how to stay skinny and that's most important; nothing will ever work out for you; you're not worthwhile enough to anybody; no one really cares; I (the eating disorder) will protect you.
These thoughts feel absolutely true which makes the need to stay close to the eating disorder even more important. The way to challenge these lies is not to implore someone to eat. That only fuels the eating disorder further. An effective approach is to challenge the lies again and again, to point out that the lies themselves keep someone so sick.
The next post will explain how someone escapes the ego syntonic experience of an eating disorder in recovery and how family and friends can support the process.
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