Eating Disorders: The challenge of making a patient know they matter

By Dina Zeckhausen

I’ve noticed a sad and strange paradox in my clients struggling with eating disorders. 
While sufferers are typically bright, compassionate and caring people, when they are in
the midst of an eating disorder, they can appear selfish, deceitful and even lacking in
integrity to those around them.   

To paraphrase author Anne Lamott (who has written about her battles with food): “I felt
like the piece of sh*t around which the world revolved.”

I believe this fundamental paradox (selfish yet lacking Self) helps explains the difficulties
that those in the eating disorder community have with increasing compassion and
understanding surrounding these illnesses.  In the wake of an eating disorder, loved ones
may be as emotionally and physically devastated as victims.  

Just imagine this scenario: your best friend gets cancer, but the cancer actually causes
her to believe that the life-saving treatment, chemotherapy, is toxic.  The cancer itself has
made her phobic of the cure.  Now imagine your friend has to get chemo three times a
day and you must convince her on a daily basis that she can no longer trust her own
brain. 

Some tense battles would ensue. You can envision how such an illness could tear at the
fabric of your relationship as you watched the person you love slowly commit suicide by
denying herself treatment.  

For people with anorexia and bulimia, the “chemo” is food.  Supporters become angry at
the illness that has stolen their loved one (who still walks and talks but is not really
there).  And there is no place to direct their anger except towards the person who is
already suffering.  Typically people-pleasers, the person with the eating disorder does not
want to upset anyone else, so she becomes an expert in faking, hiding, placating.  This is
but one of the ways that eating disorders destroy relationships.

Kate is a 30-year-old client who has had an on-going battle with bulimia for over half of
her life.   Bright, beautiful, outgoing and funny, she used to binge and purge a dozen
times a day.  She has worked hard in therapy and is down to a once-a-week binge-purge
episode.   Married to a patient and supportive guy, they have an adorable 2-year-old boy
whom she “loves more than life itself.”  She refrained from purging during her
pregnancy, but relapsed immediately after his birth.

While her husband is aware of her on-going struggles, despite my urging she will not
reach out to him for help before an “episode” (even though at this point he could likely
talk her out of it). On the contrary, she diligently works her bulimia around him,
squeezing it into her moments alone and then “not lying, but just not telling” her husband
about them.  He tells her how gorgeous she is (of course she thinks “he has to say that”)
and he just wants her to love herself and her body as much as he does.

And yet when he leaves the house for a trip to Home Depot, she sneaks in a binge and
then heads to the bathroom to throw up.  According to her, they have a “Don’t Ask, Don’t
Tell” policy about her eating disorder: “What he doesn’t know can’t hurt him,” she
rationalizes.   This is a woman with strong morals who will teach her son the importance
of honesty and trust.  

She only lies in the service of her eating disorder.  

I believe that she will only let go of her eating disorder when she realizes how important
she is; how much she matters to those she loves.  I am hoping she can remember in those
alone moments, to put her marriage and her love for her child above the ”secret love
affair” she is having with “ED” (Eating Disorder). 

I reach for analogies about secret addictions and affairs. Her husband has been trying to
quit smoking for years.  “How do you feel about your husband smoking?”  “I hate it!  I
think it’s a gross habit!”  “But what if he only smokes when you aren’t around and hides
the evidence so you never find out?  Is that okay?”  She smiles, ”OK, I see where you are
going with this.  But I don’t want him to die from lung cancer!”  “Well, I’m sure he
doesn’t want his wife and the mother of his baby to die from a heart attack or esophageal
cancer from years of purging, either.”  

You see, Kate, when you walk into that kitchen to binge and the bathroom to throw up,
you bring your child and your husband and me and all the people who love you in
there with you. Not only are you NOT alone in that bathroom, it is very crowded in
there. Every one of us hurts when you binge and purge.  When you injure this person
that we all love, when you are not fully present in your life, you not only deny yourself
of life’s joy, but you deny the entire Universe of the gift of wonderful YOU.

Yes, Kate, you matter that much.  

Dina Zeckhausen is a nationally-known psychologist who specializes in treating adults,
teenagers and children with eating disorders and body image issues.  She is a
regular ShareWIK.com columnist and the author of the children's book, "Full Mouse,
Empty Mouse: A Tale of Food and Feelings."  You can visit her on the web
at dinazeckhausen.com and MyEdin.org.

 More Dina Zeckhausen articles, click here.