Are You Missing a Key Ingredient in Eating Disorders?

I have been working for over three decades with individuals of all ages who struggle with eating issues. During my time spent either working on an eating disorder unit, an inpatient unit with those with a variety of diagnoses, or on an outpatient basis, I have noticed certain themes. As a young and new therapist, I relied on everything that I read and on supervision to help me make sense of how to work most effectively with patients with eating disorders. As a more experienced therapist, I still rely on those sources of information but I also rely heavily on the recurring themes that clients with similar presentations bring to their therapy sessions.

As parents, therapists, and those who have struggled with eating disorders are painfully aware, once eating disorders have gripped one's psyche, they are very difficult to address. Somehow, they dig roots, and, once planted, seem to grow and flourish and sprout new buds over time. They are like weeds, and they are resistant to all sorts of treatment.

After working for decades with those who diet relentlessly, I have observed with gratitude that a more recent approach to eating disorders seems to be much more successful than past approaches. In the past, I would focus relentlessly on family dynamics. I would create diagrams. I would speculate heavily about which of the parents was the critical and undermining one. I would wonder who in the family the child was worried about. I was convinced that family dynamics were the key issue, and that if I fixed the family, the child could be fixed as well. Similarly, with adult clients focused on the number on their scale to the exclusion of a number of other alternative activities, I wondered who in their lives was encouraging this obsession.

Today, I continue to focus on family and relationship dynamics. I continue to get a good and thorough family history. I am now convinced, however, that the relentless pursuit of a lower body weight is much more about an attempt to deal with one's mood. Think about it: When an individual falls into a depression, focusing on eating seems to provide a sort of numbness. It distracts the struggling person from having to feel the depths of their depression. It becomes obsessional and distracting. The focus on the scale is easier to deal with than the underlying mood issues.

As therapists, it is our job and obligation to help patients get a grip on their underlying emotional and mood issues before eating disorders effectively destroy their lives. This may mean recommending more intense therapy or even psychotropic medication. Our patients must get an understanding of how to deal with difficult emotions. If they do not, then their eating issues, even if they recede temporarily, can follow them throughout their lives—and sneak up on them whenever times get tough.