Blog: The Hidden Truth About Eating Disorders

The Hidden Truth About Eating Disorders
National Eating Disorders Awareness Week Is February 21-27, 2016
Eating disorder patients often use their bodies to express what their minds cannot.  One challenge of treatment is to decode this hidden communication, as in this example:
“I was lonely so I ate cookies.” said Jayne, 29, a single woman who struggled with bulimia.  “I couldn’t stop until I was literally in pain.  Then I got rid of it.” She sighed.  “I told myself, you are so gross.”
“I was lonely so I ate cookies”
As early as 1900, Sigmund Freud suggested that food symbolizes mother (and mothering) when he wrote, “love and hunger… meet at the woman’s breast”. 
Our initial experiences of feeding include being cradled in a parent’s arms and receiving nurturance as well as nourishment. Food thus functions as a representation of people.  
People may be unreliable, unavailable and unpredictable, but food is consistently reliable and available, making relationships with food appear safer than with people.
Jayne, who was starving for love and connection, ate cookies to alleviate an empty, painful loneliness.  Her core problem was not cookies, but alienation and mistrust.
“I couldn’t stop until I was literally in pain”
Many individuals fear that having needs make them needy, weak and unlovable.  They wish for more companionship, understanding, connection, money, friends, yet simultaneously feel guilty or ashamed of their desires.   
Some consciously disavow needs but unconsciously express them through food.  Jayne, who lacked fulfilling relationships with others, filled up on food as a substitute.   
Conversely, restricting may be understood as denial of desire.  Anorectics turn away from both food and people, as if declaring complete indifference to any needs.
When emotional pain is unbearable, painful emotions may be converted into physical sensations.  By eating until she was in physical discomfort, Jayne exchanged the hurt of loneliness for the pain of a stomach ache.   
“Then I got rid of it”
Although Jayne asserted that she only purged to prevent weight gain, it became clear that something else was being communicated by her behavior.
Jayne grew up with a busy, single mother and a stern grandmother who labeled her as oversensitive and showed undisguised contempt for Jayne’s chubbiness.  As a child, Jayne yearned for close, loving attachments but was humiliated by her inability to get the affection she craved, eventually turning against her wish for love.  
She unconsciously enacted this dilemma by eating food, which represented all that she longed for, and then got rid of those longings by purging. Research shows that for many who struggle with bulimia, such wishes are symbolically first owned and then disowned with food.
“You are so gross”
I noted Jayne’s use of second-person (“you”) when she talked to herself.  
“Who’s talking?”  I asked. 
Recalling her grandmother’s disapproving attitude towards her body, Jayne recognized she had unknowingly adopted the same contemptuous stance towards herself.   
The relational dynamic between Jayne and her grandmother had turned into an internal dialogue between parts of herself. 
Regarding these identifications, one goal in psychoanalytic treatment is for patients to relinquish negative identifications and take in the nurturing presence of the analyst.
When Jayne incorporated my accepting and loving view of her, she stopped being dismissive and self-critical. Later, she shared the following experience:
“I was lonely the other night,” she said.  “I thought about calling my friend and at first I was afraid of bothering her.  But then I thought about what you’d tell me and I told myself, ‘Just call.”  We ended up talking for an hour.”
By understanding how the past influences the present, people with eating disorders deconstruct their relationship to themselves (and to food) and cultivate new ways of nourishing their bodies and minds. 
In Jayne’s case, she was able to articulate hopes and fears in words, instead of enacting them with food.  She challenged assumptions about relationships and learned to enjoy meaningful friendships. 
When relationships represent a safe haven, rather than a threat, eating disorder patients turn to people for nurturance, instead of enacting conflicts with food. 

Nina Savelle-Rocklin, Psy.D. is a Los Angeles-based psychoanalyst and recognized expert in weight, food and body image issues.  Her book on the psychoanalytic perspective on eating disorders will be published by Rowman & Littlefield later this year.