Threats and Punishment in Eating Disorder Recovery

One of the reasons this blog focuses on compassion as a core value of treatment is that threats and punishment comprise such a large part of the attitude of clinicians and families towards eating disorders. 

Shame is a central part of an eating disorder, and punishment is an underlying manifestation of almost all eating disorder thoughts. These two values are truly the engine that drives most eating disorders. Using those attitudes to approach these illnesses only strengthens their hold on the person who is suffering. 

The general public struggles to understand all psychiatric illnesses, but eating disorders may be the least understood. Still glorified as a successful diet and as a source of envy, most people are hard-pressed to see the torment patients endure. 

When the symptoms finally come out in the open and the medical or social repercussions become clear, family and friend responses are very often punitive. Threats quickly rise to the surface, and the underlying message is that an eating disorder is not an illness but a willful choice of behavior meant to ask for attention or cause trouble. It's extremely rare for the first question about the eating disorder to be, "What is wrong? How can I help you?" Yet this is the only question that might really avert the severe illness that often ensues. 

The public opinion of an eating disorder as a successful diet or an adolescent rite of passage only explains part of this general attitude. The other part is that eating disordered thoughts and behaviors just make no sense to most people. As explained in a recent post, once eating behaviors are ingrained, they become very automatic. Someone with relatively normal eating patterns will find disordered behavior completely confusing and almost unthinkable. Hence the most common initial suggestion of a parent with a newly diagnosed child with anorexia: just have a milkshake! This sentiment only makes the sick person feel more alone and more scared. 

Similarly, it appears to be almost universal to think that anger and threats will somehow snap the person out of an eating disorder even though those reactions only alienate and isolate the person further. Kindness and compassion are the way most people would approach a loved one in pain and suffering. That's no different with someone who has an eating disorder.