Treating Eating Disorders

Upcoming Satanic and Nazi holidays – sundown 6/11 to sundown 6/13 (Nazi) Shavuos (commemorates the giving of the Torah at Mt. Sinai): 6/19 Fathers’ Day (US, Canada, UK, and South Africa): 6/20 is both a full moon and the summer solstice: 7/19 S Full Moon: 7/29 (Nazi) Hitler proclaimed leader of the Nazi party: 8/1 S N Lamas: 8/18 S Full Moon: 8/15 Assumption of the Blessed Virgin Mary: sundown 8/13 to sundown 8/14 (Nazi) Tisha B’Av: (Day of Mourning)

Prior posts on eating disorders – 4/10 Eating Disorders (Introduction): 4/20 Over-Eating: 5/10 Ritual Abuse Issues and Eating Disorders: 5/20 Anorexia and Bulimia

Resources: The Eating Disorders Catalog site has a list of workbooks at Something Fishy at has helpful articles but some pages are under construction and other have mostly broken links.

Researched eating disorders, I found that there were two approaches to treating them. One is based on a blend of behavior modification and Cognitive Behavioral Therapy (CBT). The other is psychodynamically oriented and trauma-informed; it considers the eating disorder a result of and/or defense against dangerous feelings or memories.

CBT is based on the premise that our thoughts determine our emotions and behavior and that thoughts can be consciously changed.  If I think I am ugly, I slouch, dress without care, avoid mirrors and people. But we can think of a thought as a hypothesis and test it with facts. The new thought, or hypothesis, can then be the basis for our feelings and behavior until it is time for another reality check. If I think I am normal, I come out of my shell. If I look around and look at others my age, I may revise normal to pretty damn good-looking.

CBT is educative: the therapist teaches the client how to apply the techniques and assigns homework in the form of workbooks, journals, etc. The client sets the goal, and therapist and client together agree on a time frame for the therapy. Once learned, clients can apply those techniques by themselves for the rest of their life.

There are lots of variations on CBT; for example, DBT is Dialectic Behavioral Therapy and incorporates mindfulness and meditation. They all stem from Aaron Beck’s work in the late 60’s and early ’70’s. I remember reading “Cognitive Therapy of Depression” and “Depression, Causes and Treatment” and being very disappointed. Guess I wasn’t ready back then!

Behavior modification is based on B. F. Skinner’s work with animals and also with patients in a Massachusetts State hospital. Desired behaviors are reinforced with rewards and undesired behaviors are extinguished with punishments or lack of rewards (ignoring them). You can find examples of behavior modification in popular literature: every time you behave in the desired way, put money in a piggy bank and, after a set period of time, reward yourself with a movie or a piece of clothing – not a pizza.

Neither of these approaches takes into consideration where the behavior come from and what function it serves. When you look at it with complex trauma in mind, eating disorders can be seen as a protective mechanism, just like any other symptom.

The trust and stability of the therapist-client relationship is the basis for forming alliances with alters as well as the “apparently normal person” who came into therapy. In time, the alters will describe the meaning of the eating disorder. It can be an attempt to control one aspect of life, an attempt to disappear, or an attempt to become unattractive to avoid abuse, among other things. These beliefs can be challenged by teaching the alters about the passage of time and that there is no longer a need to use the eating disorder in this way.

It can also be a way of suppressing memories. “Don’t remember, don’t tell” programming is very powerful. Creating a serious present-day problem that takes up all one’s energy is a great distraction and all other goals and problems fade into the background.

If you have a therapist who is skilled with working with ritual abuse survivors, you will probably go back and forth between working on internal issues and attending to the eating disorder. If your therapist does not have this knowledge, see if they are willing to learn. If not, you might consider finding another therapist more tuned into the effects of trauma.

There are some things you can do outside of therapy. Probably the most helpful thing I did was accept the excess weight I had gained from antidepressants. Rather than feeling shame, I started to see my weight as battle scars – scars from wounds I never would have had if I had been born into a healthy family. Once I felt this in every part of my mind and heart, I could start changing my behavior. I am still working on it, and I am sorry I couldn’t have started sooner, but they were deep wounds and I believe they could have killed me without the antidepressants.

Trying to force yourself to give up a protective behavior before your system is ready will create internal chaos or lead to the substitution of another protective behavior. It’s not such a great idea to trade an eating disorder for an addiction to heroin or crystal meth. Communication and trust between alters has to come before an agreement to work on the eating disorder or you won’t get very far.

Journaling to increase internal communication can be extremely helpful. Alters can get to know and trust each other and learn to decide on mutual goals and co-operate in working towards them. Once everybody is on the same page you can turn to the techniques that non-dissociative eating disordered people use; CBT, nutritional programs, the Twelve-Step programs Anorexics and Bulimics Anonymous or Eating Disorders Anonymous.

It’s possible to give up a small part of the eating disorder temporarily, as an experiment, so that all alters involved can see what happens. If you don’t die and the abuse doesn’t escalate, everybody inside may be reassured. (This is assuming you are not still being abused.) A different approach is called for, though, when alters react to the experiment by flooding everybody with memories or threats because they are petrified that, without the eating disorder, the system will be destroyed. You need to calm those alters, strengthen communication, search for still unknown alters, and find out what everybody thinks will happen without that protective shield.

This post seems quite abstract to me. I think I was hoping to find something spectacular that will work tomorrow no matter what is going on internally. Instant relief! Of course it doesn’t exist. Dealing with eating disorders requires time, dedication, and a lot of hard work and courage. There is no magic wand and not a lot of helpful short cuts, either. It does help to know it isn’t your fault and that you aren’t the only one. If I do come across a magic wand, you guys will be the first to know!