The Metaphors of Eating Disorders

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'Awareness Weeks' have now become a trending way to educate the public about the seriousness and prevalence of many mental health issues. Eating Disorders Awareness Week, a nationally driven effort, is especially one that our community should pay heed too, as it shines a spotlight on the gravity of injurious behaviors including anorexia, bingeing, and bulimia. Eating disorders affect millions of people and can lead to serious, even life-threatening symptoms.

There are many variables that can trigger the onset of an eating disorders including:

• Genetic predisposition
• Cultural and societal dictates regarding weight and beauty
• Dysfunctional family dynamics
• Unresolved experiences of trauma, abuse or neglect
• Biochemical anomalies
• Learned behavior and family modeling
• Inherited attitudes about body image and eating habits
• Pressure from athletic coaches

Adolescents and adults who struggle with these issues are certainly preoccupied with weight, body size and shape, food groups, and caloric intake. However, I believe it’s critical that treatment strategies look beyond getting people to “goal weight” or simply extinguishing the destructive behavior. If that remains the sole focus of treatment, relapse is almost always inevitable, or the eating disorder gets replaced with a different act of self-harm including substance abuse or self-mutilation.

In my work treating eating disorders, I have found that it’s really not about the food. The specific act of starving may be a metaphor for prior experiences of loss, neglect, unavailable or inconsistent emotional nurturance. Bingeing becomes a way to create a protective shield around the body, keeping others at a distance or reducing the likelihood of having to be sexually active. Purging can be a metaphor for needing to rid the body of an internalized feeling of “badness.” All of these behaviors can also be connected to an unrequited need to re-claim a sense of power and control over the body, to induce or short-circuit a dissociative state, or to punish the body for perceived “participation” in sexual trauma. In all cases, I advocate that in therapy the focus is taken off of weight or food journals and instead, a non-shaming exploration of the behavior’s deeper meaning and communicative value is pursued.

I believe that eating disorders, like all other forms of self-destructive behavior, are creative attempts to self-soothe, self-medicate, short circuit untenable thoughts and feelings, and share a specific, untapped, and unspoken “pain narrative” with significant others. If mental health professionals focus solely on clients’ “issues with food” then additional strategies to manage overwhelming emotions are never explored and prior painful experiences are never reconciled and healed.

It is gratifying to know that our culture has chosen to dedicate a week to acknowledge the seriousness of eating disordered behaviors. Eating Disorder Awareness Week is a powerful way to educate those who directly suffer, along with their loved ones, about the warning signs and treatment options that they can pursue. My hope is that we keep the conversation going way beyond a week’s time, and more and more clinicians and inpatient programs recognize the value and the importance of de-coding and unpacking the deeper meaning of these behaviors so true healing can occur.

Segments of this post are excerpts from "Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing," and Treating Self-Destructive Behaviors in Trauma Survivors, a Clinician's Guide, 2nd Edition." (Written by Lisa Ferentz / © 2015-Routledge) Please check them out to learn more!