University of Rochester pediatrician Richard Kreipe, MD, an expert in treating eating disorders talks to his patients about the “food rules” created by the eating disorder in the following way. Dr. Kreipe kindly has given me permission to share this information to share this information. To hear Dr. Kreipe talk about the importance of incorporating schools and families in an adolescent’s health care click here.
Food Rules that Govern Eating Disorders
1) I acknowledge the hard-work and determination that my patients have in following such strict rules. I do not say that facetiously, but am truly impressed by the ability of patients with restrictive patterns to deny giving in to hunger, appetite or cravings. That behavior is very difficult to maintain…it takes a lot of will-power, determination, strength and focus. I believe that it is worthwhile to recognize this explicitly.
2) Then, I point out that eating “rules” have many features of “laws”. That is, a person breaks a rule in a game and one may be “penalized”, but it’s only a game and one can still go on to win. Laws, on the other hand, when broken, have much more dire consequences—in some countries, the death penalty, depending on the infraction. No matter what happens when one is caught breaking a law, one “gets in trouble" with the legal authorities. I believe that many patients perceive rules more like laws.
3) Next, I ask them where the eating disorder laws come from. Most patients can’t really articulate a source, but they do acknowledge that following their rules and “not breaking the law” helps them feel less anxious.
4) I then ask them if they feel like they control the laws or if the eating disorder controls the laws—depending on where they are in recovery, they are usually able to acknowledge that the eating disorder controls them more than they control the eating disorder.
5) Now here’s where the Independence Day stuff comes in, I ask them if they would be a traitor if they went against the eating disorder rule of law. Almost universally, the answer is “Yes.”
6) Then, I ask them if a traitor is a good thing or a bad thing. Again, almost universally the answer is “A bad thing. It’s someone who is weak, gives in, goes back on one’s word, can’t be trusted, etc.”
7) Moving forward, I ask if George Washington, Samuel and Abigail Adams, Thomas Jefferson and Dolly Madison were traitors. The immediate answer is something like, “No. They are our country’s heroes. They made us independent from England.” Then, I ask if they have ever heard of Benedict Arnold, the General in the American Revolutionary Army who was a spy for England and considered a traitor. Depending on their level of education, they may or may not have heard about him, but often it is just something about him being “bad”.
8) Next, I point out that people who we consider American Revolution “patriots” were considered “traitors” by the King of England, while Benedict Arnold was considered a loyalist in England, but a traitor in America. Patriots and traitors are on opposite sides of the same coin in a conflict. So, the question I pose to patients is, “Now that you are engaged in this battle for your body, mind and spirit, you are going to have to decide which side you want to be loyal to, and for which side you therefore need to be a traitor. You didn’t have a choice about getting an eating disorder, but you are going to have to make a choice sometime. To make no choice really means that you choose to continue being loyal to the eating disorder.
9) Along with the Independence Day theme, I then ask them if eating disorder sometimes feels like a dictator. Again, depending on where the patient is in recovery, s/he may be able to acknowledge a dictatorial feel. How do dictators maintain control over the oppressed people in a dictatorship? By lies, threats, intimidation and increasingly severe penalties—including death—for going against the dictator. In the case of King George of England, he demanded more and more of his former countrymen and women living in America, giving them less and less. Does the eating disorder demand that more and more weight be lost, and that more and more dieting and exercise are required?
10) Finally, how are dictators thrown out of power? Only by a revolution. Which is a scary thing, because no one knows how a revolution will turn out. I then offer my services to work with the side of her that is willing to be a traitor to the eating disorder while supporting the patriot side of her that seeks recovery and no longer being under the dictatorial rule of “King ED”.
Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books, Marcia is also author of the recently published Nutrition Counseling in the Treatment of Eating Disorders (Routledge, 2013).
Copyrighted by Marcia Herrin and Nancy Matsumoto.