When the symptoms of an eating disorder are a sufferer’s go to “healer,” little or nothing else will interfere with the snake oil elixir they provide.  Psychological and relational distress are easily masked and relieved by the preoccupation with food, purging, restriction and the pursuit of the perfect body. 

Choosing to recover brings initial relief from the rigorous, relentless and inexorable preoccupation with the eating disorder and all its symptoms.  However, recovery often brings emotional distress, psychological confusion and existing and past relational conflicts come slamming in to focus.  

As an eating disorder therapist, It is easy to understand why ushering a patient to step in to feeling pain and confusion seems counterproductive.    Why would anyone want to deliberately feel bad as a path to feeling better?  

 
Many sufferers stay convinced that having an eating disorder is preferable to dealing with emotional states and issues that are difficult and often fear what they will uncover about themselves.   People in general go to great lengths to avoid feeling sad, confused, rejected, anxious and lonely.  Some people try avoid anger at all costs and others use anger as the only defense, or means, to counter their pain or perhaps guilt.  
Longing and sadness are painful emotional states common to all people, yet are often denied, or their impact minimized or avoided.  Eating disorder sufferers generally find these emotional states intolerable.  

Defensive systems are set up to protect against difficult emotions that often manifest as anxiety.  These psychological efforts are employed to conceal or camouflage significant emotional impact.  Anna Freud’s seminal book, “The Ego and the Mechanisms of Defense,”  identified patterns of defense (protection) that the Ego employs to survive emotional pain and avoid psychological exposure.  

Ego Psychology has taught us that substitutions, sublimations and displacements for feelings and uncomfortable thoughts and wishes enable us to cope and keep anxiety at bay.   Sublimating wants and desires on to food and displacing guilt, shame and anger on to one’s body are prime examples of defense mechanisms at play.  Having issues about food, eating and body image take the place of deeper emotional needs, and unconscious wishes and states that have nothing to do with food and body.  The longing for food is easier than the longing for relational comfort and physical soothing.  Competition, anger and jealousy are given a venue through the relentless pursuit of perfection.

Human-Energy
Source: Human-Energy

According to Ego Psychology, defense mechanisms are psychological attempts (strategies) that are unconsciously used to cope with anxiety arising from unacceptable thoughts or feelings. 
They operate to protect the Ego (the arbiter and the rational and observant side of our psyche) by keeping unconscious processes out of conscious thought.  Unacceptable thoughts, impulses and wishes are hidden from awareness i.e. negative emotions, aggressive and sexual urges, competitive and jealous thoughts.   Anxiety is a marker that is a beacon to call attention to the presence of deeper issues and is a mask of sorts to protect the Ego.  

Healthy people utilize defense mechanisms in every day life.  i.e. Even though the acceptance of mortality enables the ability to experience a full and satisfying life, the denial of the thought of sudden death by being hit by a truck when crossing the street makes living on a day to day possible. Defense Mechanisms are used by all people throughout the life span and only become pathological when they are continually or regularly employed.    Psychological and relational well-being are impacted as authenticity goes underground and the individual operates from a continual and often patterned ‘defensive’ structure.   Symptoms (abnormal behavior) and impaired functioning often emerge i.e. an eating disorder. 

Uncovering defensive patterns and how they operate enable an individual to explore and accept what lies beneath thereby influencing behavioral changes and insight about motivation.   From a psychoanalytic perspective, the more someone knows about their unconscious motivations truthful, self affirming and honorable choices can be made in life.  The difference between right and wrong decisions for the individual and the impact on others become crystal clear.  

Based on the formulations of Ego Psychology, it is easy to understand how someone who has experienced significant and repeated hurt and disappointment, fears rejection and abandonment, has been criticized or shamed would build a structure to protect from getting too close to people.  Longing and sadness are turned in to eating disorders (displacements, sublimations.)  Eating disorder individuals whose symptoms are entrenched or long term often utilize primitive Defense Mechanisms in order to keep themselves psychologically safe i.e. projection, externalization, splitting, acting out, omnipotent control.  

Understanding the defensive structure of patients with eating disorders significantly aids diagnosis particularly those who have accompanying character pathology.   Similar defensive structures emerge for people with addictive behaviors who often come from childhoods where emotional safety and trust were absent i.e. narcissistic, borderline, psychotic parent or a parent who is emotionally absent due to major depression, history of trauma or is substance abusing.

Making Loss and Longing More Comfortable

Many eating disorder patients feel like the square peg in the round hole and that not feeling understood by significant people in their lives has induced profound feelings of loneliness and sadness.  Eating disorder symptoms entered to find a way out of themselves emotionally and psychologically and as a means to concretize and make sense of their pain.

Sometimes physical, emotional or sexual abuse as well as emotional neglect initiates the same feelings of loss and longing and an eating disorder comes to the rescue.  
Sometimes families are ill equipped to speak an emotional language at home and so the attempts to fix feelings with concrete solutions, distractions, lists of things to do or using a credit card to buy one’s way out of feeling bad provides a solution.  The family is not bad or wrong because they do not know how to express, hold and soothe emotions in each other, but they are  limited to help, particularly for a child pre-disposed to an eating disorder.   Hard to speak a language that is not known.

Feelings are feelings; they won’t hurt the way eating disorder symptoms will.  Feeling sadness and getting comfortable with needing and loving are good.  Finding people who can receive and reciprocate love are often goals in treatment.  Strengthening Ego Defenses that reduce anxiety, help to increase personal responsibility, self-trust and authenticity in communication can occur by embracing a solid commitment to treatment and self-discovery.  Stronger, more evolved defense mechanisms allow for psychological clarity, experiencing true emotions and facilitate decision making about life and relationships.  Wonderful alternatives to an eating disorder.  

Best,
Judy Scheel, Ph.D., LCSW, CEDS 

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