Off the Couch

Thoughts about the therapeutic process, and the dynamics of client-therapist interactions.

Eating Disorders Flourish in Spring Months

Eating disorders in spring may be linked to upcoming separations.

In spring, as the poet Alfred Lord Tenneyson wrote, a young man's fancy turns to love. And many women and men start getting their bodies ready to wear the revealing clothes of summer. While this may be good news for the diet and exercise industries, it's not so great for the mental and physical health of many of these dieters. Not surprisingly, spring is also a time when eating disorders start to flower.


One reason eating disorders increase during any period of heavy dieting is pretty straightforward. As every therapist who works with this population knows, the more we deprive ourselves, the more likely we are to binge!


Yet there is another dynamic involved here, particularly in young people at this time of year. After nearly thirty years of working with, writing and teaching about these problems, I have come to believe that the upswing of eating disorders in adolescents during the spring months is directly related to issues of separation and attachment.

I have never been a good separator. I was one of those kids who sent home letters from camp begging my parents to come get me. I added to the pressure by drawing circles around and labeling my teardrops as they fell onto the paper, just to make sure I was getting my message across. Leaving for college, as I describe in an earlier post, was difficult for me even though it was only ninety miles from my home; so I am perhaps particularly sensitive to these issues in my clients.

Yet it seems to me that even without my own distaste for separation, the link between the endings that occur every spring and the rise in eating disorder symptoms in young men and women at this time of year would be more obvious except for one thing: separation is generally viewed as an important accomplishment in our society. 

We look at all of these school year partings as standard. We see them as signs of growing and moving forward. And as a result we sometimes fail to recognize that anxiety and sadness about leaving classmates, friends, favorite teachers and familiar routines and settings is not only normal, but even healthy! Leaving home, whether for camp, a summer job, or college; or leaving a comfortable college or graduate school setting for the unknowns of new job and living situations, can be exciting. But even someone who feels empowered by the changes can feel a touch of anxiety; and some youngsters feel overwhelmed, at least some of the time, by the loss of the old and the beginning of new experiences.

In our culture, with its focus on independence and separateness, such emotions are often viewed as negative and unacceptable. Out of shame, self-criticism, or fears of not being understood or accepted by others, many of us push away these feelings. We try to ignore them, to pretend they just don't exist.

Although ignoring feelings can sometimes be a useful technique, it can also make things worse. Contemporary research has shown that eating disorders are often related to intolerable feelings. Anxiety about separation, if not recognized and appropriately addressed, can be so painful that it requires extra coping measures. Without necessarily realizing what they are doing, some youngsters use alcohol or drugs to deal with their discomfort. Some turn to sex for comfort. And some try to control their feelings by binging, purging, overeating, over exercising, and/or starving.

These eating behaviors dispel, at least temporarily, the bad feelings, and also provide a temporary sense of well-being. Since the emotions are often unrecognized, it is not a simple matter to link separation anxieties and eating symptoms. This makes sense. If the emotions were so clear, the behavior would be unnecessary. Many clients struggling with these behaviors have never thought of themselves as having difficulties in with endings; however, a little gentle exploration frequently turns up a few examples not so different from my tearful letters home.

I am not saying that all eating disorders are responses to difficulties with being parted from family or friends. What I am suggesting is that even when separation does not appear as an issue in the initial meetings, it is worthwhile exploring the possibility that they exist in some form. If this does seem to be the case, then a therapist can help both client and family talk about healthier ways to manage these feelings.

Adolescence has been called "a second individuation." While Margaret Mahler and her colleagues viewed separation-individuation as both a developmental stage and a lifetime's work, I prefer Karlen Lyons-Ruth's reframing of this idea. What she suggests is that we work throughout life to find ways to attach and individuate - that is, separation is not nearly so important as we in our culture like to think. What is important is being able to be individuals while also being able to be connected - to parents, lovers, spouses, and eventually our own children.

 I have found that when families are encouraged to focus not on separation, but on developing a new form of connection with one another, one that takes into account a child's growing individuation, separation feels less dangerous.

This means that frequent phone calls and face to face contact can be healthy, not infantilizing. Of course, a parent can have difficulty knowing when it is no longer necessary to stay in such close touch. This can be addressed by understanding separation anxieties as part of a normal continuum of human experience, and exploring the parents' difficulties in this area. However, sometimes parental anxiety is not neurotic, but is actually an appropriate response to an adolescent's struggle to become more independent.

Normalizing anxieties about separation and reinforcing attachment can help diminish the need for eating symptoms. And then both young men and young women can think about love without worrying so much about bodily perfection.

References:
F. Diane Barth, C.S.W. (2003) Separate but not alone: Separation-individuation issues in college students with eating disorders. Clinical Social Work Journal, Vol. 31, No. 2, Summer 2003

Lyons-Ruth, K. (1991), Rapprochement of approchement: Mahler's theory reconsidered from the vantage point of recent research on early attachment relationships. Psychoanalytic Psychology, 8: 1-23

Mahler, M., Pine, F. and Bergman, A. (1975). The Psychological Birth of the Human Infant. New York: Basic Books.

 

 

 

 

 

F. Diane Barth, L.C.S.W., is a psychotherapist, teacher, and author in private practice in New York City.

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