I am a bit surprised, looking back at the titles of past posts, that it seems I have not written on this before. After all, it is one of the biggest things faced by those in treatment/recovery from an eating disorder, and it is one of the things that can be really hard for family and friends to understand.
You always hear "self-esteem" as a mental health buzzword, right? But, where does it come from? What is it exactly? I sure don't have the exact answer to those questions, but I do know where part of it comes from, or at least I know where *I* think it comes from. In my opinion, self-esteem is closely linked to our identity, who we see ourselves as being. And that is something that develops over time. Think of teenagers and how prevalent cliques are in high school; why are they such a big deal at that time of life? Well, according to Erickson, the goal of adolescence is identity development. So we see adolescents putting themselves into groups, trying on different identities, and eventually (we hope) picking a path forward based on who they see themselves as being.
And, as I explain to parents frequently, it is really unfortunate that this is a prime time for development of an eating disorder, and the impact of that timing is that the eating disorder can become an identity. This is why you will never hear me say the term "anorexic" or "bulimic," as I will not label someone as their disorder.
Healthier identities will center around perhaps academic/work success, or athletic, musical or artistic success, or maybe will come from religious or political (used broadly here) views. But even those identities can become problematic. If one becomes overly invested in any one part of his/her life, it can then be traumatizing when that identity is lost, just as it can be, illogical as it seems, traumatizing to give up the eating disorder identity. So, think of someone fully committed to their job, or perhaps an athlete whose life consists of training, competing, performing, etc. When that is taken away, whether due to age or injury, it can leave a sense of emptiness and despair as the individual tries to figure out who they are without the career/sport/eating disorder. Anxiety and depression are not uncommon.
So, then what? A lot of the work I do is around finding out what else makes up a person's identity. If you have had an ED for years, unfortunately, it likely makes up the majority of your identity. So it is pretty intensive work to figure out what else will define you moving forward. But it is such important work. As the ED behaviors decrease, that hole must be filled with other things that are meaningful. You might look at what hobbies you used to have that got lost due to the eating disorder. Or, if you are an athlete or consumed by your profession, you might look back at what other things you used to do that you enjoyed; things that got pushed out by the high demand. For some, they cannot identify anything, and that's where the real work begins; the trying out of new hobbies, of new interests, trusting that eventually you will find something just as meaningful.
I can even say I went through this process to a certain extent. I used to work A LOT. My identity centered around being a therapist. And, even now, I can say I would absolutely be traumatized if that identity were to be taken away. My plan years ago was to eventually open my own treatment center, and do lots of training of new providers, while treating lots of patients. When I picked up the first hobby, running, I just did both. I worked a ton of hours, and ran a lot of miles, and nothing really changed. Now, I'd say that's because I wanted to run a marathon, but being a runner was not my identity. Then, horses came along, and the running was dropped pretty quickly, as I had met my running goals. Now, being an equestrian and an eating disorder therapist are pretty equivalent; both mean the world to me, and losing either would lead to significant suffering. But, at least I am more balanced now. I no longer want to open a treatment center as I know I would no longer have time to ride, and to do what I want to do with riding, I have to ride quite a bit (and drive quite a bit, LOL!). So that idea has easily fallen to the wayside. I'm completely content doing the work I do while also taking significant time to drive to and ride at the barn a lot. In fact, I have now started to look at how to combine my passions (beyond doing equine assisted therapy), which is what led me to go back to my therapy beginnings. I went off to grad school in Colorado and wanted to work with the US Figure Skating program; that eventually became unrealistic as I was 3 hours from the training center, and I walked away from the idea of working with athletes specifically. But, now I'm starting to reconsider how I could use my experience in treating eating disorders, and helping people change their sense of identity, to help athletes reaching the end of their careers. Do I ever expect that to be a big part of my work? No. But, it is something that has been, and would be, enjoyable to do.
Changing identity is certainly possible, but it is far from easy. As carers, it is important to understand, as illogical as it might be, how hard it is to abandon the ED identity if it has gotten to the point to where all your loved one thinks he/she is is an eating disorder (and the associated labels). I KNOW it doesn't necessarily make sense, but it is real nevertheless. Sometimes parents get confused why I am talking to their child about their hobbies, when it seems like I should be talking about ED behaviors. In the end, I do both, all for the purpose of achieving true, lasting recovery.
