Tuesday, July 31, 2012

Nike: Just Do It!

Eating disorders are often so hard to understand for those who have not had one. Parents, friends and family often find themselves becoming so frustrated with their loved one who has an eating disorder because they can't understand why their loved one won't "just do it." They find themselves saying things like, "Come on, just eat!" or "If you wanted to get better, you'd do it." And, granted, some people with eating disorders don't want to get better at that moment, so maybe they really are not trying very hard, but at the same time, really, who chooses to have an eating disorder? And I think that is such a hard concept to work through when you are not the one struggling with this disorder. On the outside, it looks like a choice, it looks like something that could "easily" be changed by "just eating." So, what I try to help family and friends understand is that there is pretty much nothing rational about an eating disorder; thus, applying rational thought processes to the disorder just doesn't work very well. Oh, how tempting it is to rationalize with someone with an eating disorder, thinking, "if I can just get him/her to see the truth, she'll change!" But it is not that simple....

Eating disorders are (brace yourself for psychobabble) what is called ego-syntonic. What this means, basically, is that the ED helps the person in some way. Depression is usually ego-dystonic. People don't really want to have it, and when someone with depression comes into my office, they want me to help them get rid of it. EDs (and substance abuse, and self-harm), on the other hand, are "helping" the person. They help the person manage their emotions when they are so scared to face them straight on. They give the person an identity when he/she might feel invisible instead. They serve many, many purposes, which vary from person to person.

So, unfortunately, someone with an ED comes into my office partly wanting me to help them get rid of their disorder, and partly wanting to keep it so they feel safe. Many have what is called the "anorexic wish:" Please help me get over this disorder without gaining any weight. They don't want to have the disorder anymore, but they are terrified of weight gain, and honestly, they are terrified of life without the ED.

So, hopefully, now it makes more sense how the "just do it" approach doesn't work as well as we might hope. We can all relate to having emotions override rational thought, and how we act in those situations. So, for those with EDs, their fear overrides almost all rational thought on the subject. So, keep talking to your loved one rationally, but don't expect it to dramatically change their actions right then. It takes a lot to override fear. Early in treatment, "just do it" doesn't work.

Though my patients would tell you I have been known, much later in treatment, to threaten that they must wear Nike clothes all the time to remind them that there does indeed come a time when, in recovery, you have to "just do it." But that is another post.

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