Everywhere we look, we get the message that weight is something we should perpetually be striving to drop. In our society, it is a accepted as a given that we are constantly on a diet or unhappy with our weight. For women, especially, it’s as if we live by some unspoken creed that we should always be trying to slim down and drop a few pounds.
My friend and colleague, Nicole Cruz, Registered Dietitian, writes an excellent article that speaks to this exact phenomenon. She writes:
“As a society, how have we come to the idea that food is something we don’t need and that we should actually try to avoid? How have we gotten to the point that a store like Home Goods, selling just that, “home goods”, is using weight loss to sell it’s unrelated products? We’re obsessed. We’re obsessed with the idea of losing weight and obsessed with ways to make it happen. We treat food like the enemy rather than the nourishment that it is…”
Check on the rest of her article at http://www.nicolecruzrd.com/apps/blog/show/8571275-zero-calorie-lunch.
My day job involves countless interactions with emaciated anorexics arguing “I’m so fat! I know I’ve gained way too much weight. I’m healthy now. I don’t need to gain anymore weight. I’m the fattest one here!” And boy do they believe it, as much as they do that grass is green. To them, it’s true. It’s their reality. While I sit across from them trying to understand how a 60 or 70 lb adult can be fat, they sit across from me trying to understand how I can’t see that it’s true! While I see an emaciated and undernourished individual, they look in the mirror and literally see an overweight individual.
This phenomenon is called body dysmorphia and it runs rampant among individuals who suffer from eating disorders. Body dysmorphia is when an individual obsesses over some “flaw” in their appearance. This can be over a specific body part or over one’s overall weight and shape. This “flaw” is typically over-exaggerated or not even present at all. If left untreated, body dysmorphia usually worsens over time and leads to compulsive behaviors such as body checking, eating disorder behaviors, excessive grooming, comparisons to others, social avoidance, low self-esteem, and numerous cosmetic surgeries with little satisfaction.
In my opinion, body dysmorphic disorder falls in the camp of an anxiety disorder, and more specifically, an obsessive compulsive disorder (OCD). OCD involves some sort of obsession which is followed by compulsions, attempts at reducing the anxiety produced by the stimuli, or obsession. For example, in the case of body dysmorphic disorder, one’s obsession might be weight. The stimuli is highly exaggerated and blown out of proportion so that the affected individual literally sees a much larger representation of themselves in the mirror than is reality. A healthy person from the outside would be able to see that they are extremely thin, not fat at all. But the affected person truly sees and feels fat. Consequently, this arouses extreme anxiety. In attempts to lower the anxiety, the individual will engage in compulsions, most probably weight loss behaviors such as restriction, purging, and/or compulsive exercise.
As in any manifestation of obsessive compulsive disorder, the issue is not about the reported obsession. The issue is about the underlying anxiety. In other words, the issue is not about being overweight, no matter how much the individual feels it’s so. The issue is about the underlying anxiety. In OCD behaviors, anxiety gets placed on, or manifested in, some sort of concrete worry, thought, rumination, or body obsession. In the case of body dysmorphia, the underlying anxieties literally get embodied. This is where therapists have to become detectives. They have to uncode, so to speak, what emotions and beliefs are getting acted out in what the client sees reflected to them in the mirror.
As a therapist, my job is to help my clients extract their feelings from their body and free them up to experience their emotions for what they are. Most of the time, body dysmorphia is caused by a mix of shame, low self-esteem and perfectionism. Many times, there are feelings of fear and disgust. Sometimes these feelings stem from a violation that has occurred against the body. Rather than confronting and experiencing these emotions, which may feel overwhelming and lethal, individuals have somaticized them into body obsessions. It’s a way of saying “if I can change and perfect my body then I can change and perfect these feelings. I can make these feelings go away.” Of course this is not a conscious thought transaction, but it is an unconscious protective mechanism that may have served to help them survive a real or perceived threat. With a lot of work and persistence, recovery is possible.
Many people who suffer from body dysmorphic disorder also suffer from anxiety, depression, obsessive compulsive disorder, or eating disorders. Treatment includes a mix of cognitive behavioral therapy to change the negative thought patterns, exposure and response prevention (ERP) to treat the obsessive compulsive component, and medication.
“Why would I want to recover the way things were before my eating disorder? Things are bad now, but they were even worse then.”
“They say I’m supposed to recover. But recover what? Recover whom? I have no idea who I was before my eating disorder.”
“How do I return to a life when I have no idea who I was? As least with my eating disorder I have some sort of identity. Without it I’m just a big blank.”
“Recover what? There’s no way I’m going back to my life before this!”
These are all common sentiments I have heard from my clients. What is recovery exactly? It’s a word we through around all the time in the mental health community. It’s supposed to be that thing we do when we’re trying to move past an addiction or a brokenness of some sort. We have clinics and treatment centers named after this word. In the dictionary, I found definitions such as:
”a return to a normal condition”
“the regaining of something lost”
“restoration to a former or better condition”
Let’s take the first one: “a return to a normal condition”. That’s sounds good, but what if what was normal for someone before the eating disorder set in was horrific? People don’t get eating disorders without a significant amount of pain. Who would want to return to that? And for many people, their eating disorder is, in a bizarre way, their saving grace. It has helped them cope with terrible circumstances and survive things that otherwise might kill them or literally drive them insane. Who would want to return to that without some form of numbing agent?
How about the second definition: “the regaining of something lost”. That’s all well and good if you know what you lost. Most people with eating disorders have no idea who they truly are inside. They are completely disconnected from any core identity, thus turning to externals to define them (looks, numbers, measurements, calories, accomplishments, approval, etc.). I have had clients who can’t tell me what their favorite color is or whether they want to turn right or left. The eating disorder takes on a life of it’s own, the sufferer merely the conduit. One’s identity becomes the eating disorder, and without that, many fear they won’t have an identity at all.
Healing from an eating disorder involves intensive discovery of one’s self. It is more than just returning to normal; it is a long and tedious journey of self-discovery. It is a blossoming of life, purpose, and joy. Many question whether it’s even worth it. Perhaps they have never known life as it’s meant to be and doubt that things can get better. It’s worth it! Because it’s not just returning to a previous state. It’s moving beyond that and going deeper than that. It’s engaging on an ever-unfolding journey of living as who you are created to be. And the work is never done. It’s discovering what you like and dislike, your dreams, passions, desires. It’s finding one’s unique expression through voice, art, dance… It’s fully experiencing all of your minute emotions, the pain and heartache as well as the ecstatic joy and laughter. It’s discovering where one begins and ends in relationship and knowing the joy of real connection with a friend. It seeing the world in full color and being an alert and present participant in your own life and in the lives of others. It’s not just about gaining weight; it’s gaining a life worth living.
Renowned fashion magazine, Vogue, featured three plus-size models on the cover of their July edition, “Real Beauties”. http://www.dailymail.co.uk/femail/article-1393482/Vogue-uses-plus-size-models-cover-bid-battle-anorexia.html
It’s well-known that fashion and media play a huge part in the image obsession of our planet. Throughout the generations, the female body has been treated as just another fashion. What’s in? Who has the latest trend in body shape. Women’s bodies are expected to be changed and updated just like the latest trend of fashionable jeans. Recently, emaciated and androgynous looking women have flaunted the current fashion trend. In centuries past, heavy and robust women were seen as desirable because their form indicated a lifestyle of wealth, ease, and abundance. So what does the current trend in women’s fashion indicate? Poverty, starvation, self-denial, masculinity, hatred of the feminine etc.? It’s about time for women’s bodies to be honored as they are. Well, the editor of Vogue, Franca Sozinna, is taking a stand against pro-anorexia websites and reports that she is committed to including more “plus-size” models in her magazine. Check out the article:
I was recently asked to come in and give a presentation on eating disorders at a local high school. I was excited about the opportunityto speak on such a pertinent topic to a group of young people, those heavily targeted with messages about image and body shape. I started my presentation with the basics: what is normal eating? Simply put, normal eating is:
- Being able to eat when you are hungry and continue eating until you are satisfied.
- Being able to choose foods you like and eating them until you’ve had enough- not just stopping because you think you should.
- Being able to use some moderate constraint on your food, but not being so restrictive that you miss out on pleasurable foods.
- Giving yourself three meals a day, or it can be choosing to munch along.
- Leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful.
- It includes overeating at times and feeling uncomfortable. It is also under eating at times and wishing you had more.
- Trusting your body to make up for its mistakes in eating.
- It takes up some of your time and attention, but keeps it’s place as only one important area of your life.
In short, normal eating is flexible. It varies in response to your schedule, your emotions, your hunger, and your proximity to food.
Looking around the room, I could have sworn I had somehow morphed into an alien talking about extraterrestrial TV dinners. They looked at me as if I was crazy. It was clear they didn’t buy it. My explanation of normal eating was quickly followed by a barrage of questions and myths:
“But isn’t fried fish bad?” “I heard that they put diet powder on Weight Watchers food.” ”Isn’t it bad to eat after 5 pm?” “My dad says that if I just drink water during the day and then pig out at night, I’ll lose weight.” “My sister uses diet pills and she lost a ton of weight.” “But I thought cakes and ice cream made you fat.” “Isn’t it true that if you starve yourself you actually get fatter?” “I heard that just eating protein gets you better abs.”
Wow. It was obvious that normal eating was as foreign a concept as extraterrestrial TV dinners. The feedback I received from the students was a direct reflection of the messages they see and hear every day from the media. I realized that what they hear is all they know. The disordered behaviors is what they know to be true and they have no idea that it could be, or ever has been, any other way. They have no other construct from which to form their relationship with food and with their bodies. Especially when they see the same beliefs and behaviors in their family members, friends, coaches, and teachers. They have no idea that it could be any other way, because the disordered is their normal. And how are these students to know any other way of relating to food and their bodies unless somebody tells them?
I tried introducing the concept that there are no good or bad foods. I explained that all foods can fit into a balanced diet. I explained that restriction and control creates a feeling of deprivation and only leads to overeating or binging. I introduced the idea that our bodies can tell us exactly what we need and that honoring our body signals also leaves room for enjoyable foods. I was shocked that this seemed to be the first time they were hearing this.
I left the campus saddened by the depth of our culture’s sickness and more deeply aware of the difficulties of growing up emursed in this pandemic. The disordered has become the normal. No wonder therapists and treatment centers are flooded with eating disordered clients professing that there is nothing wrong with them. As far as they know, they’ve just perfected the cultural ideals. When working with my clients, I find that I not only have to reduce the level of disorder, but I have to teach them how to live the rest of their lives in a counter-cultural way. Recovery for them will not be simply returning to a state of normal. That just returns them to the normal insanity from which they developed their eating disorder. They will have to take it a step further. Recovery for them will be constantly choosing to live counter-culturally by choosing to make different choices than those professed by our society.
