While anorexia often begins as a battle of self-control between the desire to eat and the desire to lose weight, it eventually becomes a complex disease that is much more about control and self-esteem than about food and dieting.

The anorexic may come to develop her identity through her thinness and relish the special attention she gets for it. The special feelings of uniqueness can perpetuate her patterns of behavior and reinforce her controlling relationship with food. In other words, this behavior and attitude make her feel in control and seemingly good about herself. When she experiences the anorexia symptoms as a positive thing, we say that her symptoms are egosyntonic.

The physical and emotional price of this behavior can be very high. Physical problems can range from stomach pain, diarrhea, bloating, and constipation, to the very dangerous electrolyte imbalance, teeth chipping, osteoporosis, and cardiac arrest. Because the anorexic often has to rationalize and sometimes hide her behavior, anxiety and depression are common. Her focus is less on herself and more on others’ perception of her, always thinking ahead and anticipating other people’s criticisms.

Successful treatment of anorexia requires that the patient’s symptoms become egodystonic enough for the patient to become motivated to do something about them. In other words, rather than seeing herself as victorious in achieving and maintaining weight loss, she must experience her symptoms as enough of an interference in her quality of life in order for her to become a willing and active participant in her treatment. There are many factors that influence her experience, but this shift from seeing her symptoms as egosyntonic to seeing them as egodystonic is the single most crucial determining factor in whether or not treatment can be successful. Success for her must be redefined as not being achieved through dieting, a target weight or a clothing size, but by feeling good about herself, who she is, and an inner sense of integrity.

Research findings seem to suggest that it might be possible to recover from this disease without therapeutic intervention, by possibly experiencing a profound epiphany or a terrible loss, by gaining ego strength or through positive relationships, but such instances are very rare. While medical, psychiatric and nutritional interventions address many of the physical symptoms of the anorexic patient and are of vital importance, they do not address the primary cause of this disorder, which most clinicians agree is rooted in family dysfunction, and, therefore, psychotherapy is an essential part of the recovery process.

In the nearly two decades of working with this population myself, I have yet to see anyone get better, let alone recover, from any of the above occurrences and without therapeutic intervention. I have seen many anorexic patients experience huge losses, and a good deal of them have had very tight-knit, positive relationships. It was within the therapeutic relationship that they experienced epiphanies which helped them recover and process their losses. When family members could come in and understand how they can modify their relationships with the patients in a way that would be helpful to them, the recovery process rapidly gained momentum.

I often get calls from understandably worried moms or dads, saying their daughter is anorexic, very underweight, and still losing, not eating, and they are scared to death. They say they want to bring her in, and my first question to them is, “Does she want to come in? Does she believe she has a problem?” Fortunately, more and more of the time, the answer is in the affirmative these days. But I will still run across someone who has no desire to change or even talk about it, and in those cases, I have to make suggestions to the parents for helping themselves deal with this very challenging time. I can also teach them some ways to relate to their daughter that may eventually get her to turn around.

This information is provided for informational and educational purposes only. For more information or help with these and related issues, please download one of my free reports or call my office at 805-375-5860 so we can discuss how we might work together to achieve your therapeutic goals as quickly and effectively as possible.

Linda K. Laffey, Licensed Marriage and Family Therapist, Encino and Westlake Village, California

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