Blog 33: Eating Disorders

Written by Jim Sheehy

This presentation is regarding people with eating disorders. What is at the root of why somebody becomes obsessive regarding what they eat? The actual behavior comes at the end of what has been a long journey around anxiety, lack of self-worth and the struggle in finding a place in which they can belong.

Eating disorders often present during teenage years. The sooner the behavior is noticed and treated the better. Why is this? Of all issues that present in a therapy room, eating disorders is probably the most challenging. Under-eating over a long period or a pattern of binging and purging reshapes the brain into an addictive or obsessive pattern that is extremely difficult to manage and treat.

The teenager or young adult has probably already tried positive ways in managing the anxiety. They may have done well in their studies and work; they may perform well in sports and they may be part of a vibrant family and friendship network.  However, they struggle in their thinking around negative beliefs. In their own room, they look into the mirror and what they see disappoints and even disgusts them.  Thoughts like ‘I am stupid’, ‘I am ugly’, ‘I am invisible’ lead to feelings of despair and frustration.  It is very hard not to look for some way of stopping these thoughts and feelings even though it leads to a behavior that threatens my health and even my life.

Clients speak of the buzz they get by controlling what they eat.  For the first time they feel in control and the power is intoxicating.  They probably have tried to control other aspects of their lives but this has not led to the negative beliefs and feelings going away.  We have five needs that we need to have met in our lives.  They are: love, belonging, power, freedom and fun.  The client has tried and failed to have these needs met.  Inside they feel an empty hole in their stomach or a tangled knot. When they begin to think obsessively about food they create a fantasy where shape and weight might help them to find themselves and a level of contentment in being in the world. Their identity becomes wedded with power in the adopting certain rules, believing that everything else will fall into place. Family and friends who love them become secondary relative to  their primary goal in life which is to control food intake. Focus on eating becomes an extension of controlling life so I can feel more connected to myself. It is who I am. It is preferable to the old identity shaped around shame. 

In therapy, the client has to recognize both identities as not true: the shamed self and the fantasy ‘perfect self in control.’  The client slowly creates a new identity based on the evidence of real life.  Evidence they accept as undeniable such as academic results, friends who treasure them, their skills in art, music etc.  This journey is slow and tortuous. Parents and siblings of the client are challenged to be calm, caring, consistent but also patient and firm in their relationship with the client. They, on the one hand, must cherish the client but, simultaneously, be firm with the patterns of disordered eating by sticking to agreed plans around nutrition.

There is usually a team comprising a psychiatrist, dietician and psychotherapist working with the client. The aim is to work with the client in their home setting. Only when body-weight seriously impacts a client’s welfare, physically and psychologically, is hospitalization considered.  In a specialized residential setting, the client can be helped by meeting other people who have travelled the same journey.   They laugh, cry, struggle with residents who similar issues and a staff who have the training and experience they need for a specific period.  Like any addiction, clients can have a relapse.  Every relapse brings new issues to explore and resolve before resuming normal eating patterns.  They need to believe and trust in themselves. They need a couple of wise and trusted figures they can resort to when in trouble.  They are often wonderful, caring, talented people and their mission is to manage their sensitivity and control what is possible in their lives while negotiating the unpredictable and unexpected.

If you enjoy the material, please get the word out there among those you care for.  You can contact me with comment or suggestion via Facebook at Jim Sheehy Therapy and on Twitter @jimsheehy2017

Take care,

Clarifying Disclaimer:  While the material I am presenting is well-researched and suitable for the general population, I believe each person’s issues and needs are unique.  I encourage you to seek medical and/or therapeutic support if you struggle with an issue or condition that negatively and seriously impacts your life.



Contact me:

Jim Sheehy M.Ed. MIACP
Co Donegal 
F94 WV99

087 2137922


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