Many times, my clients come and tell me they feel so much shame around having Anorexia
because “I did it to myself” and “I am burdening my parents.” Parents also feel like they have failed as parents when their child has anorexia. “Where did I go wrong?” is the question parents often ask. The truth is that Anorexia is a brain disease and is Nobody’s Fault.
Anorexia may start out as weight loss during the course of a stomach virus, or an innocent diet designed to lose a few pounds, and with that weight loss, a switch goes off in the brain and the weight loss spirals into Anorexia. For most people, expending more energy than they consume leaves them feeling uncomfortable, and even a delayed meal can cause dizziness, irritability, or a low mood. According to Cynthia Bulik (2014) “People with Anorexia, however, experience this state of deprivation as anxiolytic because it calms their otherwise unsettled biology; what makes most of us irritable makes them calm.” This is why starvation is so alluring to the person who develops Anorexia. The Job of the therapist is to help the patient renourish their body and then to work on ways to achieve calm that are not life threatening.
People who go on to develop Anorexia after initial weight loss are predisposed to its
development because of temperamental factors such as: shyness, social anxiety or social
issues, cognitive rigidity and inflexibility, separation anxiety as a child, perfectionism, and conflict avoidance (Treasure et al, 2015). As weight loss progresses, preoccupation with weight and food, and adherence to eating disorder rules helps to alleviate negative emotions such as sadness, hurt, and anger, therefore reinforcing the symptoms. However, this same starvation results in increased irritability and depression which then feel “unacceptable” to the sufferer, and the adherence to food rules of Anorexia continues as a way to cope with feeling “unacceptable.” Thinking becomes even more rigid and more black and white which means that flexibility related to food or other decisions is reduced. In addition, friends start to drift away as the sufferer avoids social situations that focus on food and as the person with anorexia experiences difficulty actively focusing on conversation. As friendships are lost, the person with anorexia feels even worse and uses reliance on anorexia’s rules as a way to cope.
Refeeding is the first phase of treatment, and this is the phase where parents need to be most involved. Parents can portion out meals and sit and eat with their suffering child in order to help with the weight gain that must occur for recovery to take place. The therapist assists the client in being able to tolerate the anxiety that accompanies the refeeding and weight gain. In addition, the therapist collaborates with the parents to help them separate the disease of anorexia from their child so they can recognize when the eating disorder is making decisions about what and how much to eat. In addition, the therapist helps the parents assist their child to eat all the food when the anorexia is bargaining to eat less. Parents may be invited by their child to play games at meals in order to distract from the food and full feelings. Once weight is restored, the therapist helps the parents step back gradually from serving the meals and guides the client to serve him or herself. At this point in the treatment, the therapist can collaborate with the client on ways to regulate emotions and calm without using the eating disorder as well as help him or her recognize situations that may trigger a reoccurrence. Anorexia is a brain disease, not a choice; parents can be the number one allies in their child’s recovery.
References:
Treasure, Janet and Alexander, June (2013) Anorexia Nervosa A Recovery Guide for Sufferers, Families, and Friends.
Bulik, Cynthia (2014) Negative Energy Balance: A Biological Trap for People Prone to Anorexia Nervosa in her blog at University of North Carolina eating disorders clinic.