Dear Therapist:
I feel like eating disorders can be hard to recognize early because they do not always look extreme at first.
Someone close to me has become much more focused and rigid around food and eating habits, and I am not sure what is normal and what is cause for concern. Since nothing looks severe from the outside, it is hard to know when people should start paying attention.
What are some signs that eating behaviors may be becoming unhealthy or emotionally driven? And what are things families should understand about eating disorders that people often miss?
Response:
I’m not an eating disorder specialist, so I can respond only briefly and generally.
When someone becomes rigid and obsessive around thoughts or behaviors, this is often related to a need for control. Obsessive-compulsive disorder can relate to thoughts, behaviors, or both. Body dysmorphic disorder and eating disorders are ways in which obsession can manifest in relation to the person’s body.
Of course, I don’t know whether the person you refer to technically has an eating disorder. I don’t even know whether they would meet criteria for a clinical diagnosis.
People have their own highly individualized sets of coping skills. When people are faced with situations in which they feel a loss of control, they can react in a variety of ways. Some people try to regain their sense of control by focusing on things that feel within their power. Feeling that the only thing over which they ultimately have full control is themselves, they may focus inwardly. This can result in rigid or obsessive tendencies surrounding food, eating, weight, or their bodies.
Often, this process is not conscious. It usually has its roots in childhood coping skills. To varying degrees, we all rely on old coping mechanisms. They may no longer be adaptive or healthy—or they may simply not be optimal. Nonetheless, this is normal. We all have emotions, insecurities, reactions, and defense mechanisms that developed in childhood, based on our childhood understanding and perspectives.
As a temporary measure, these reactions and defenses can sometimes feel useful. We use them because they have been reinforced for most of our lives—and because they feel familiar. Although they may not be the best way to deal with distress, they can temporarily provide a sense of relief or control.
For issues that become more ongoing, however, the hope is that we transition from these short-term, instinctive reactions to healthier and more functional ways of coping. Sometimes people get stuck. When that happens, it becomes important to recognize these behaviors for what they are—attempts to manage difficult feelings in ways that may no longer be healthy or effective.
Awareness is the first step. Recognition that there may be a problem—and that there may be healthier ways to address it—gives people the opportunity to begin challenging maladaptive behaviors before they become more deeply entrenched.
-Yehuda Lieberman, LCSW
psychotherapist in private practice
Woodmere, NY
adjunct professor at Touro University
Graduate School of Social Work
author of Self-Esteem: A Primer
www.ylcsw.com / 516-218-4200
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