Why is Eating Disorder Treatment an Existential Experience?

After the stabilization of food, attention to meal planning and work on identifying hunger and fullness cues, eating disorder treatment is an existential process at its core.

Eating behaviors are largely unconscious and automatic. Similar to other animals, the human drive to eat and survive is necessary for our species. The conscious ability we have to decide what to eat, when to eat and how to eat pales in comparison to our fundamental need to eat to live. When given the choice between any philosophy about eating and food as survival, the human instinct to persist always wins.

Regulating eating patterns enables us to feed our bodies appropriately. Within reasonable guidelines, our bodies don’t care too much how we eat but don’t like to be subjected to insufficient eating over long periods of time.

What makes eating disorders so intractable is really not about the food. Instead people with eating disorders develop all psychological, behavioral and emotional aspects of their lives around the rules of disordered eating. Disentangling this web feels like tearing apart the soul, an unenviable task for anyone.

Eating symptoms start at a young age and fill the need to learn coping skills in the formative stages of life. At a time when identity is vague, emotions are strong and the need for an anchor overpowering, food and body can become an incredibly stabilizing force.

People often turn to food to manage all kinds of emotions from frustration to sadness to joy. For many, food is an automatic way to experience and tolerate emotion and experience. Eating behaviors obviate the need to look for other ways to cope.

Body shape and eating behaviors are powerful means to create identity. Our world values public food restriction and thinner bodies as true achievements and as signs of moral superiority. In this regard, some eating disorders provide an immediate identity that is very grounding.

In a much more painful context, people who spend years of their young life in treatment can develop an identity as a scapegoat and identified patient in the family. The personal recognition of attention by being sick can create identity that is painful and limiting, but equally powerful.

These are a few examples of how an eating disorder can affect psychological development. The effects on body and eating patterns are profound and the creation of a framework to understand and oneself very straightforward.

Then, after the focus on food, therapy needs to recognize how strong the psychological hold of an eating disorder is and create a path to learn an entirely new way of being. In therapy one can work on finding new coping mechanisms for daily living, experience emotions in different ways and explore a deeper sense of identity outside of food and body.

These are not simple tasks. Learning so many ways to function in the world demands a willingness to remake and rework our fundamental sense of ourselves and to open up difficult and often frightening vulnerabilities.

No other mental illness necessitates therapy on such a profound level to get well. Recovery is so hard because one needs to truly break down the self built on eating disorder beliefs and find new ways to exist in the world. The result of this work is very powerful and meaningful. The path is hard.