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RunningOnEmpty

Eating Disorders

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I'm seeking to become a rational person and live a more meaningful life. Part of this includes fighting to put an end to an 11-year struggle I've had with an eating disorder. I've been through medical and psychiatric treatment and many types of therapy, but nothing has been fundamentally effective. When I face depression I fiercely cling to my ED, and sometimes resort to other self-destructive behaviour. I've been suicidal on many occasions though never "strong" enough to end my life. At those times, I decide to heavily restrict and over-exercise in hopes to starve myself to death. When things in my life are going at all well, I eat, but purge for fear of gaining weight. I am deathly afraid of gaining weight. In my sordid mind, fat on my body represents failure. I'm repulsed by any and every bit of it.

If there is any advice you can give, I would appreciate it very much.

I'm not right in body or mind. I need help. I'm running on empty.

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I'm seeking to become a rational person and live a more meaningful life. Part of this includes fighting to put an end to an 11-year struggle I've had with an eating disorder. I've been through medical and psychiatric treatment and many types of therapy, but nothing has been fundamentally effective. When I face depression I fiercely cling to my ED, and sometimes resort to other self-destructive behaviour. I've been suicidal on many occasions though never "strong" enough to end my life. At those times, I decide to heavily restrict and over-exercise in hopes to starve myself to death. When things in my life are going at all well, I eat, but purge for fear of gaining weight. I am deathly afraid of gaining weight. In my sordid mind, fat on my body represents failure. I'm repulsed by any and every bit of it.

If there is any advice you can give, I would appreciate it very much.

I'm not right in body or mind. I need help. I'm running on empty.

Dear RunningOnEmpty,

It sounds like you have had a terrible struggle with a very difficult illness. As a former medical director of an eating disorder program, your story is familiar to me. While I obviously cannot give personal psychiatric advice over the Internet, it is important not to lose hope. Most of the patients I have treated over the years with eating disorders are highly intelligent, with great personalities, and with a huge potential for success. Many went through several bouts of treatment before they found the treatment setting that helped them to concquer their disorders.

Although you may have heard these many times before in your treatment, there are some key principles regarding eating disorders that I believe are worth repeating:

1. Severe eating disorders rise to the level of psychoses or quasi-psychotic conditions. Aside from the effects of chronic starvation on the brain, which make it impossible to think rationally until the starvation effects are cleared up, I believe that there is a degree of cognitive distortion involved that prevents a person with an eating disorder from making use of the psychotherapeutic advice they may get, until the thought processes are straightened out. This may even require the judicious use of antipsychotic medication for a period of time. (For instance, one is not in touch with reality if one is anorexic, yet looks in the mirror and sees oneself as fat.)

2. Psychologically, eating disorders represent a defense mechanism in which all psychological problems are reduced to a few numbers: calorie intake and weight. Sometimes the only sense of control a person feels is over these numbers, even when they may feel totally out of control over their lives. A crucial aspect of treatment involves learning how to translate the obsessive focus on food and calories into the real issues that affect one's life. Eating disorders are not really about weight, psychologically speaking.

3. Issues that must be looked for and addressed in the treatment of eating disorders include: problems in the family, often saddled with all kinds of guilt trips, irrational demands and expectations; and a history of molestation or abuse. Support from family that is facilitated and helped along by a therapist, can sometimes mean the difference between success and failure in treatment.

4. Patients with eating disorders express their despair with their bodies, often because they literally do not know how to express themselves emotionally. It is very important to learn how emotions affect one, and how to express one's feelings to others - and how to feel safe enough to do so. Techniques like yoga are frequently helpful, because patients learn a lot more about how their bodies express their level of comfort or discomfort.

5. Values are what fills one up and makes life meaningful. Values, not figures or numbers. The more value-rich your life is, the less you will need to cling to numbers, such as weight.

I hope these brief comments are helpful.

Jonathan Rosman

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