Hopelessness as the Engine of an Eating Disorder

There is a distinct and important difference between depression and hopelessness in the experience of having an eating disorder.

Depression is a host of symptoms including low mood, decreased energy and motivation, lethargy, poor or too much sleep and sometimes thoughts of wanting to die. It is a disorder that comprises an entire experience of physical and psychological symptoms that consume daily life.

Hopelessness can be part of a larger depressive episode but often signifies something different in the context of an eating disorder. It is an intellectual understanding of one’s own life and, at its most intense, feels like an absolute truth.

Hopelessness represents the inability to see a future in one’s life. This thought makes it seem like nothing in life will change and that the current experience is the only experience. This sense of life and the world is how it is now and how it will be forever.

People often describe hopelessness as drowning in the misery of the moment with no escape. When combined with the reality of an eating disorder, hopelessness can make the eating disorder symptoms appear to be the only way out even if it is only temporary. The behaviors take up time and emotional energy that provide a respite from the relentless, hopeless feeling. The end result of the eating disorder behavioral cycle is to feel even more hopeless and unable to see any route to change one’s life.

From this perspective, hopelessness can be the engine of an eating disorder. If it is impossible to see any change in the future and if it feels like this misery is going to be what life entails, there is no reason to avoid the eating disorder symptoms. These behaviors almost always reinforce this sense of depression and low mood combined with hopelessness.

This vicious cycle can be the centerpiece that keeps an eating disorder alive. More importantly, the hopelessness can pervade every relationship in one’s life, including any clinical and therapeutic relationships. At some point, clinicians can start to feel as hopeless as the patient.

The key change for the person and clinician to consider is to question the hopelessness directly. If left to dominate, the hopelessness will derail treatment and someone’s life.

But there is no factual foundation to the hopelessness. There are always new ways to approach a problem, the hopeless thoughts or an eating disorder. How one feels never lasts forever. Given the new possibility of a direction for recovery can often be enough to break the hopeless cycle and start a new path.

Self-Loathing in an Eating Disorder

A common core belief at the heart of an eating disorder is self-loathing. It feels like a deep, unshakable fact. That person feels like there is something wrong at their core. It’s an old thought they typically have believed for a long time and not one that even feels very logical. It just feels true.

Interestingly, someone can feel trapped by a sense of self-loathing and simultaneously be able to recognize positive traits about themselves. They may see they are competent, kind or caring. They may recognize an innate ability to be a good friend or employee. However, recognizing these qualities doesn’t seem to make a dent in the core negative belief.

Often when someone has a deep sense of themselves, it isn’t based on true events from their past. The belief seems to precede any sense of identity or of the true essence of that person. It’s a belief that feels grounded in their basic self-image. Rather than the belief stemming from events in someone’s life, generally facts of one’s life are twisted to reflect the core self-loathing.

This is the place where the eating disorder becomes relevant. Once the eating disorder starts, the behaviors reinforce the core belief that there is something wrong with the person and justifies the self-loathing. Even though the self-loathing always precedes the eating disorder, the eating disorder morphs into the overall explanation and justification of the self-loathing.

It then becomes easy to see why this cycle becomes difficult to break. If the self-loathing encourages the eating disorder and the eating behaviors strengthen the self-loathing, it feels like there is no escape.

Treatment needs to aggressively question the self-loathing. The therapy can bring to light the nonsensical logic behind the self-loathing and help that person see that this core belief is not rooted in reality.

The harder part of treatment is that the self-loathing needs to be replaced by love. This doesn’t mean a false belief in self-love. It means the experiment of being lovable, of accepting a profound sense of being loved even when that core of doubt and fear is exposed.

It’s remarkable how letting that love land can help someone find their way out of the vicious cycle of an eating disorder and self-loathing. As I have written many times in this blog, love is the true antidote to an eating disorder.