This is the 1st of 3 posts from the Eating Disorders, Compulsions and Addictions Service (EDCAS) of the William Alanson White Institute in recognition of National Eating Disorders Awareness Week (February 24th through March 2th).

Eating disorders are disorders of desire. Longing, hunger, and wanting connection with others: all subverted. The eating disordered patient stands frozen in the space between two worlds---the world of food and the world of people--haunted and psychically alone. In my work as a psychoanalyst with eating disordered patients I encounter the agony of bright, insightful people who cannot use their thoughts or words to process emotions, nor can they use language to manage their feelings. It appears confusing to many, and is often mind boggling to patients’ family, friends and lovers.    

My patients are at war as they battle internally over the simplest of experiences.  Whether or not to lift the fork to her mouth creates intense inner turmoil.  And if she manages to persuade herself to take in some food, the end result is that she can only taste shame; shame that breeds insecurity and loss of confidence.

To lose confidence in one’s body is to lose confidence in oneself. Bodies desire to be loved, accepted, and admired.  Beauty is not manufactured; it is felt, and is about much more than just looks.  Rather than striving for perfection, a misguided goal that many eating disordered patients share, I try to help my patients recognize that perfection is not possible or sustainable; that this search ends up creating more agony than joy.

I try to cultivate curiosity—my own and my patient’s—and to inspire my patients to tell their story, to articulate their pain and narratives without judgment; to tolerate their disgust, their skeletal pieces, their fat, and their hurts.  Curiosity converts strangers into people with whom we can empathize, even the garbage-eating-violent-vegetable-purging ones.  I am curious about my patients’ histories in order to initiate a process of reflection, exploration, and self-discovery; to increase their capacity to have more fulfilling relationships, and experience less guilt and shame.

I work with my patients to help them experience a wider range of emotions, to face their challenges with greater flexibility, and to embrace uncertainty with less fear of the unknown. We strive together towards tolerating imperfection by accepting bodies as “good enough”; as remarkably designed organisms that afford us the abilities to function, work, think, play sports, be physical, have sex and enjoy life. Most importantly, I try to help them establish a sense of self that is not based on their eating disorder.

Must bodies conform to a culturally defined category or can we allow for a more fluid definition of being “a little of this” and “a little of that”? Making peace with oneself, respecting limits and histories, helps the patient discover who really lives inside her body.  I help my patients understand the historical causes of negative feelings toward their bodies. This sometimes means uncovering painful body memories

One patient struggling with anorexia remembers the shame she felt when her grandmother made the insensitive comment, “Everybody has a fat part--yours is your ass. Why buy those pants when in two weeks you won’t fit into them?” Thoughtless comments are often a reflection of the other person’s self- judgments and insecurities. Such comments don’t have to take up residence in one’s body.

I challenge my patients to unearth privately held beliefs, interpretations and assumptions. False beliefs are sometimes held by the patient in the service of providing an illusion of protection.  For example, one patient’s narrative always ended up with the conclusion, “There’s something wrong with me.” This patient’s story of disordered eating begins at age 6. Her mother thought she was a chubby child who was unnecessarily taken to Weight Watchers. Imagine this naïve tot among overweight elders! Although strangely out of place, she undoubtedly enjoyed the attention directed toward her. The message she took from this experience was, “As long as there is something wrong with me I will be loved and cared for.”

As an adult, desperate for love, attention and a relationship, this woman came into treatment engaged in self-defeating binge eating. She is now learning to face her limitations, and find strength in the face of adversity. The eating disorder had validated her long held belief that “there was something wrong with me.”  When I asked her what would be in her mind if she believed that there was no longer something wrong with her, she looked stunned, was at a loss for words, and finally muttered…. “I don’t know.” This is a new place for her.

This patient and I are now beginning to explore and reconstruct a new way of understanding her old story. In order to enhance her relationship with her body this woman is developing a sense of mastery over a range of activities, as well as cultivating the purely pleasurable. She is digesting, savoring, experiencing, feeling.

Creating a confident, affirming relationship with her body means authentically understanding her own passions, attributes, and accepting all aspects of herself.

It takes hard work, commitment and time to encounter--and own!--one’s desire. The message is simple to impart but complicated to put into action:  Create the life you want to live and live the life you want to create.

Jean Petrucelli, Ph.D., is Director and Co-Founder of the Eating Disorders, Compulsions and Addictions Service (EDCAS); Supervising Analyst and Faculty at the William Alanson White Institute; Adjunct Clinical Professor at New York University Postdoctoral Program in Psychotherapy & Psychoanalysis. Dr. Petrucelli is the editor of several books including Hungers and Compulsions: The Psychodynamic Treatment of Eating Disorders and Addictions (J. Aronson Inc., 2001; Rowan & Littlefield, 2009) and most recently, Body-States: Interpersonal/Relational Perspectives on the Treatment of Eating Disorders, which is set for release in 2013. Dr. Petrucelli specializes in the interpersonal treatment of eating disorders. She is in private practice on the upper west side in New York City.

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