“The journey of a thousand miles starts with one small step.” -Lao Tzu
Anorexia Nervosa is a puzzling and frightening illness to many caregivers, friends, onlookers, and clinicians due to the insidious nature of the disorder, difficulty in treating the disease, and potential for a fatal outcome.
Families and friends often witness the illness engulf their loved one’s personality, actions, and physical body, all while their loved one denies their behavior is problematic and presents surprisingly compelling reasoning of why their behaviors are “healthy” or otherwise valid. Despite the apparent detrimental effects of the disorder, Anorexia is a master of seduction, relentlessly persuading the sufferer to maintain the illness, and even convincing loved ones such behaviors are acceptable.
On the other hand, as a parent or friend you may find yourself tirelessly using logic to counter the eating disorder to little or no avail. Logic and knowledge, as much as I wish it did, does not lead to recovery.
In both cases, the ego-syntonic nature of the disorder is showing up.
For individuals with the illness, anorexia in many ways makes sense and “works” for the individual. Many people experience anorexia as “ego-syntonic” or consistent with their self-perception and deeply held beliefs and values. In other words, anorexia feels right and aligns with what is important to them and who they believe themselves to be.
Imagine for a moment that multiple people told you that deeply held behaviors, ideals, and self-perceptions needed to change and were no longer acceptable. Not a pleasant feeling right? This is often what it feels like to individuals entering treatment for anorexia or being talked to about their illness.
As you can imagine, making behavior changes when you experience the illness as an integral part of “you” is extremely challenging. People with anorexia often describe feeling safe, in control, elated, powerful, or successful when restricting or engaging in other eating disorder behaviors, which powerfully reinforces the illness. Recognizing the often ego-syntonic nature of anorexia is helpful for caregivers and others included in the individual’s life because it creates a context to understand why the individual may struggle to give up behaviors, why recovery can be slow, and why countering the illness with logic doesn’t work.
Some of the best skills a parent, spouse, or friend can develop in caring for a loved one with an eating disorder is compassion, patience, and persistence. Each of these are immensely taxed in caregivers. Remembering that anorexia is not a choice, even though it may appear to be by the individual’s actions and that suffering with anorexia is immensely painful, physically and psychologically is helpful when compassion and patience run low.
Hand in hand with the idea of the ego-syntonic nature of anorexia is the often blame and shame ridden word of denial. Yes, individuals with anorexia often minimize or “deny” the impact of their starvation, but it may not be as much denial as an inability to perceive or have a perspective of their illness, much like when an individual with a neurological disorder suffers from anosognosia.
If lost in a darkly forested valley, it is impossible to see the whole picture until you climb out.
Using the term denial, although grammatically accurate, establishes a punitive and blaming tone that in the end is not helpful. Telling someone with anorexia they are in denial doesn’t go too far and instead leads to conflict, dead-end arguments, or feelings of invalidation. Instead, helping them become curious, explore different perspectives, take recovery-oriented action, and look at other possibilities, reduces blame and shame thereby opening up a conversation that can be productive and helpful.
Developing a greater sense of compassion for how enmeshed the eating disorder has become in the individual’s life will set you up to validate, not approve of, the individual’s experience and the important role the eating disorder has assumed in their life. Adopting this stance does not mean passively standing by watching someone engage in the disorder without encouraging or requiring intervention and treatment. But rather, grasping the complexity of the illness, the arduous process of recovery, and the liminal bind “I want to change, but I don’t know what life will be like, or who I will be without the anorexia” that many individuals find themselves in when contemplating making steps toward recovery.
Even when individuals with anorexia hit the so-called rock bottom, it may not result in having the motivation to make changes. Family and friends need to understand that they can both be compassionate and understanding about the illness, but will likely have to intervene, sometimes rather dramatically, to help their loved one get the help and treatment they need.
When individuals engage in the recovery process and begin to separate themselves from the anorexia, external support and monitoring from a knowledgeable treatment team support sustainable eating behaviors, ensure medical and psychological stability, and help the individual stay on the recovery course. Enlisting the help of professionals also supports caregivers who may feel frustrated, confused, or stuck.
Even with the most recovery focused, all-in, motivated clients, anorexia will not go down without a fight, pulling hard not to resign its executive position in one’s life.
The good news is that over time with treatment, nutrition rehabilitation, and weight restoration the ego-syntonic nature diminishes and the person can externalize the anorexia as having hijacked many of their values and interests while beginning to see the illness in more of the same light as outsiders. They climb out of the valley and hold a broad perspective on the disease and how it impacted them. In recovery, individuals often return to old interests without the pull of anorexia or take the time to explore new interests. The same values and beliefs may exist but prevail in life-affirming ways.
Family and friends often are astounded by the return of the individual they once knew when a person emerges from the prison of anorexia. The personality that anorexia turned off comes back, and the temperament traits often associated with anorexia like perseverance and dedication become repurposed toward activities, school, work, or relationships that have profound meaning and value.
The road to recovery is possible. If you or a loved one is struggling, reach out for help today. You don’t have to necessarily “want” recovery to start the journey. You may find that your desire to change comes after you are somewhat mechanically participating in focused recovery like intensive treatment or regular outpatient meetings with a team of eating disorder specialists.