Monday, September 24, 2012


A topic I have been talking to people about quite a bit recently is that of ambivalence. Outpatient eating disorder treatment is an interesting animal. Most everyone who walks through my doors is wanting treatment; it is only the occasional adolescent that is brought in against his/her will. However, in spite of this, many patients present as very ambivalent. They come in for treatment, and of course pay for it, but they don't necessarily follow what we recommend. So, from the total rational perspective, they are wasting their money, right?

But that's the tricky thing with eating disorders. As I tell patients, the "psychobabble" word is ego-syntonic. I think I have mentioned this before. But, in short, eating disorders serve a number of functions for the patient, so whereas on some level they want to get rid of their eating disorder, on another level, they really don't want to.

So, it is interesting to figure out how to challenge the ambivalence and point it out, without being somewhat offensive, perhaps. Fortunately, because the majority of patients we treat are motivated on some level for treatment, simply identifying the ambivalence is sufficient to break through it.

We can all talk endlessly, probably, about why one should not have an eating disorder. I think the more important question is this.....why is it "good" to have an ED? How does it "help" you?

Also, thanks to you who are still reading. It's been a rough couple weeks. I'll try to get more on track with posting, however. I still would love topic suggestions; sometimes my brain just can't come up with enough ideas!


  1. Here is what I have learned about how my ED helped me. I didn't have to have a voice. My ED could speak for me (though albeit not very effectively). I didn't have to tell people I was hurting, I could show them with my ED. There were certain responsibilities I didn't need to take on because I was "the sick one." I could use my ED to numb out to other things in life. If I didn't want to face something, I could spend countless hours focusing on food, counting calories, exercising, purging, etc. rather than fixing the problems in life. In a cruel way I was able to use my ED to get back at people I was angry with. I hate to admit it, but the ED was also a quick and easy way for me to drop pounds when I felt like I needed to lose weight for a special occasion (yes, I realize how horrible that sounds, but in my mind that reason was a way that the ED "helped" me).

    As for topic suggestions, one thing that has always bothered me is this sort of eating disorder hierarchy within people who are sick. I have always felt like those who have ED's and occasionally some professionals act as though having anorexia is somehow worse (or in an eating disordered person's mind more desirable or honored) than having bulimia. I have felt at times as though people think that those with anorexia are sicker and more fragile than those having bulimia- therefore creating this twisted competition for those who are suffering. Am I making sense or am I creating something that doesn't really exist? I am curious to know if you see this as a professional. For example when I first went into treatment 10+ years ago I was technically diagnosed as anorexia purge type because I was underweight but also binged and purged. It seemed like in treatment patients were mortified of telling people they binged and purged, but talking about restricting was almost glorified. I have even heard girls recently acting repulsed because someone accidentally assumed they were bulimic when they actually struggled with anorexia. It was like bulimia was this shameful disease and anorexia was something to be proud of. It made me mad because I don't know how these people can't see that no matter the diagnosis or how the eating disorder manifests itself we all struggle with a lot of the same things on the inside.

  2. Krista,

    Wow, it looks like you have learned/admitted A LOT about how your ED functioned for you. I am very impressed! I think the reasons you describe fit a lot of people with EDs, and these things are not necessarily well understood by providers. I think what is most frustrating for everyone involved is that the ED is, as you suggest, not a very good voice. I think the people in one's life don't really "translate" very well what the ED is communicating, so they get angry, when the person with the ED just wants someone to understand how terrible he/she feels.

    I definitely see all the time the comparison you are identifying. I will be happy to write a post on my thoughts about that topic.

  3. hey, i'd like to hear you talk a bit more about why/how the patient's family should be involved, and how it can be helpful.