Eating disorders are usually treated as a problem with food. They make more sense as an answer to a different problem.
A solution to something else
Clinicians who work with eating disorders tend to describe the behaviors as attempted solutions. They're maladaptive ones, with real costs, but they are aimed at something. The something is usually wanting.
Wanting is risky. To want food, comfort, attention, or another person is to be at the mercy of whether you get it. The psychoanalyst Adam Phillips put the general predicament this way: "everybody is dealing with how much of their own aliveness they can bear."
Food is a place where that question can be managed. Restricting says: nothing comes in, so nothing can overwhelm me. Bingeing and purging say something different: I take in more than I can hold, and then I get rid of what I can't digest. Neither one is really about the meal.
How a person learns this
Our sense of hunger and fullness isn't installed at birth. It's shaped early, in feeding and in attachment, by whether someone noticed what we needed and responded to that instead of to their own worry.
Anxiety is contagious between a parent and a child. When a parent can't process their own fear, the child often ends up holding it. A child in that position learns to send their own needs underground, because having needs threatens the relationship they depend on. That isn't a story about bad parents. It's a story about what gets passed along when nobody has help with it.
Later, the pattern can show up in the body. A person who felt intruded on refuses what comes in. A person who had to absorb everything expels it.
Shame keeps it alone
Shame's first instruction is to hide. The second is to deal with it by yourself.
That's what makes it so effective at keeping a disorder going. Restricting can quiet shame for a while. When the restriction breaks, the shame comes back louder, and the cycle starts again with one more thing to hide.
There's a version of this that is easy to miss. Some people have every mental and behavioral sign of anorexia at a weight no one would worry about. They often feel "not sick enough" to deserve help. Some get complimented on the weight loss, which is its own kind of shame: being praised for the thing that's hurting you.
Managing a body versus living in one
None of this happens in a vacuum. We see hundreds of images of bodies a day, nearly all of them presented as projects. The message is that a body is something you correct.
Susie Orbach has argued that preoccupation with the body isn't really a health concern. It's a longing for stability. If everything else feels uncertain, the body is at least something you can work on.
The distinction I find most useful here is between managing your body and living from it. Managing means the body is an object you supervise. Living from it means it's where you are, the place your hunger and tiredness and pleasure actually register. Many people with eating disorders have become expert managers and have very little experience of the second thing.
Why wanting to get better isn't enough
Most people who come to therapy for an eating disorder want the destructive parts gone. They'd like to keep the rest: the sense of control, the structure, the feeling of being good at something.
Addiction work has a name for a similar spot. A "dry drunk" has stopped drinking and changed nothing else. The substance is gone and the life that required it is intact.
People don't resist change so much as they resist loss, and an eating disorder has things to lose.
By: Julia Mattis, LMSW
