Eating Disorders and Death
Eating disorders have the highest mortality rate of all mental illnesses. Those suffering from this condition often lose themselves to it long before they lose their lives. Like all addicts they become a slave to the rules and needs of what it is they are addicted to, mechanically passing through the days. Registering no distinction from one week to the next. All that once held meaning and fervor now lost to the elusive blur one’s grip on reality becomes.
When addiction consumes one’s life, in this case disordered eating, the individual loses the light in their eyes, spring in their step and pulse in their passion. Most of all the person loses the hope of ever being free of the parasite disordered eating is.
Those suffering from disordered eating are known to be prone to suicide. This can be due to subsequent depression; physical depletion, change in chemistry, mental confusion and the overall misery and chronic exhaustion anorexia, bulimia and binge eating create over time.
The underlying vulnerable emotional and psychological predisposition that initially renders one susceptible to disordered eating is likely to further contribute to suicidal tendencies. Furthermore, severe malnutrition and the mental and physical assaults disordered eating inflicts on the sufferer are known to result in death by sudden heart attack, multiple organ failure, dehydration, electrolyte imbalance, etc.
It is, at the most basic level, a bundle of deadly contradictions: a desire for power that strips you of all power. A gesture of strength that divests you of all strength… It is an attempt to find an identity, but ultimately it strips you of any sense of yourself, save the sorry identity of “sick.”
Marya Hornbacher. Wasted: a memoir of anorexia and bulimia. 1998.
Inner Life of the Disordered Eater
Dr Anita Johnson promotes a holistic approach to overcoming disordered eating. She acknowledges that food and the body are literal issues to be addressed in addition to confronting and engaging with the underlying meaning and significance of dysregulated eating, which is always specific to the individual. She insists attention to the sufferer’s internal world is essential if lasting recovery is to be an option.
To investigate the underlying function of disordered eating facilitates a confrontation with an incredibly fragile and vulnerable emotional reality and sense of self that is starving. That is, the excessive nature of the hunger or deprivation in disordered eating is not literally about food. Rather it is a physical expression, ‘picturing out‘ or externalisation of one’s unmet internal needs such as love, acceptance and connection. Psychoanalyst, Stephen Grosz says in his bestselling book, The Examined Life: How We Find and Lose Ourselves (2013):
When we cannot find a way of telling our story, our story tells us – we dream these stories, we develop symptoms, or we find ourselves acting in ways we don’t understand.
The dysfunctional relationship with food and the body played out through anorexia, bulimia or binge eating are symptoms of the emotional and psychological hungers needing to be known and satisfied. So too are the accompanying negative core beliefs, I am bad, unworthy and unlovable. This can be done through working with the sufferer’s tenuous sense of self and emotional dysregulation. For until one’s internal needs are met, the person suffering from disordered eating will automatically depend on such maladaptive behaviour in order to survive the overwhelming lack in their life.
To stress the importance of understanding this point I repeat, the person with disordered eating unconsciously uses this self-harming behaviour to protect and distract against fear, confusion and loneliness.
To someone prone to addiction these emotions are experienced as larger than they are. Due to not having developed a sufficient internal capacity to contain, process, constructively express and overcome negative emotions, they are beyond one’s ability to withstand and therefore threaten emotional and psychological survival.
Disordered eating, as a maladaptive behaviour (which all addictions are), arises from the psyche’s desperation to self-protect despite not knowing nor having the internal resources to do so with healthy efficacy.
Challenging emotional states are always in reaction to, and interpretation of, external circumstances and encounters. It has much to do with the meaning and significance that one attributes to what takes place and so to engage with such loaded content requires a sensitivity to the subtext in story, symbolism in myth and power of archetypal resonance.
This way the unconscious mechanisms at play can be accessed, engaged with and rewritten in their own language, images and so collaborated with on their own terms. To undertake this with the aim of transforming an excruciating and yet vacuous inner world and sense of self is to journey through to a positive and integrated individual able to confidently assert oneself and desire openly in the present.
Confidence and Identity is Key
Dr Johnston states that she hasn’t had a client recover who hasn’t also learned to speak up and assert herself rather than holding in her true thoughts, feelings and needs and stopped putting her wants and worth second to others.
The onset of disordered eating typically takes place during adolescence, when discovering, owning and asserting oneself and independence would but is unable to take place. The lack of a healthy realisation of this stage of human development occurring means that adults with disordered eating typically lack a confident and independent sense of self.
Furthermore, Johnston claims that those who feel in someway different, like they don’t belong or fit in are prone to disordered eating. The question to be investigated is why the individual feels different, or as though they don’t belong or fit in. They are not born feeling this way about themselves so there must be something about their physical, familial and social environment and experiences that have either overtly or covertly implied and therefore taught them to perceive themselves in such a way. To identify what has compromised their developing sense of self and thwarted such growth is to discover what specifically needs to be addressed.
To be clear this is not about blaming or pointing fingers but rather about the necessity of identifying the underlying sources of the eating disorder so the suffer may understand what’s informing its origin and deactivate it by questioning it’s validity, authority and so begin feeling empowered enough to change the domination it constrains over one’s internal life. By doing so the role this maladaptive behaviour serves becomes obsolete. A sufferer’s capacity for self-discipline, order, love of beauty, connection and believe it or not, food and activity can then be healthily integrated and played out in everyday life.
Mirror mirror on the wall
why aren’t I ever here, at all?
Disordered eating is a coercive and at times violent form of self-rejection, harm and denial accompanied with feelings of humiliation and guilt. It compulsively repeats or acts out former experiences of having been erased, unloved and shamed.
It is something she has learned to use to help her deal with the emotional distress of being different, of feeling misunderstood, unaccepted or overwhelmed. She needs to consider the possibility that the development of disordered eating may not necessarily have been such a poor choice, given the limited options, resources, or coping skills she had available to her during stressful periods or times of crisis in her life.
Johnston, 2000, 19.
To acknowledge one’s eating disorder for what it is is to begin deactivating its power. To take the time to forgive oneself for the self-inflicted hate, denial as well as the shame and guilt surrounding the unnecessary wasted time, food, lies and opportunities is part of recovering. So is to love, accept and extend compassion unto the former self that has only ever needed love, acceptance and compassion.
Furthermore, the particular ‘helpful’ function or ‘role’ an eating disorder serves and story it tells for the individual must be known and appreciated for its assistance regardless of the negative consequences. This is the necessary step towards being able to replace it with an effective and sustainable adaptive behaviour. To hate oneself, feel shame and defective for having or once having had an eating disorder can only stall or threaten recovery just like hiding any addiction will.
To move forward is to accept all of who one is, openly own it, and appreciate that this is and always will be part of how one coped with pain and problems until knowing better and having developed adequate inner resources and strategies to manage challenges differently.
One of the first things a woman must do on the path of recovery from disordered eating is to reframe the concept of who she really is… She must begin to assert, both to herself and the world around her, that she is not defective. She must begin to review and retell the story.
Johnston, 2000, 18.
As discussed throughout this article to fundamentally change one’s unhealthy and potentially fatal relationship with food and the body is not solely about deciding to follow a well-balanced eating and exercise plan. Disordered eating is in essence a dysfunctional and destructive relationship with emotional pain, hunger and unmet primary needs such as love, security and sense of belonging. Thus changing one’s relationship with their overwhelming feelings including shame and guilt is also required and this is to go against precisely what the eating disorder helps to avoid; feeling one’s negative emotions.
To listen to, unpack and interpret the unconscious roles played and story told by distorted eating is to know its meaning and significance. “Knowledge is power” and like all archetypal clichés this never stops trying to remind us of what we already collectively know and accept to be a truism. “Knowledge is power” and as Albert Einstein astutely points out, “Those who have the privilege to know have the duty to act.”
To recover from disordered eating the person is required to know, observe and listen to the story being lived out through self-abusive and rejecting reaction to their hunger, body and natural process of elimination. To stop their story from concluding in premature death each must undergo an inner arc, reconfiguration or transformation that facilitates a capacity for self-love; nurture and life-sustaining behaviour.
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