Author: Espra L. Andrus, LCSW
EATING DISORDERS AND THE AVOIDANCE OF EMOTIONS
“I’m so scared.” “What do I do?” “What do I do with these feelings building up inside of me?” “How do I make it go away?” “I hate feeling like this – I just can’t stand it!”
Many individuals with eating disorders believe that other people have a secret understanding of ways to turn off emotions that they have not bothered to share with them. Women who struggle with eating disorders are prone to expect perfection of themselves, and often look for the magic button that will turn off the pain, fear, and anxiety they experience. As eating disorder behaviors decrease they naturally become less of a mechanism for a client’s focus as a way to cope with difficult emotions.
A critical part of the therapist’s role with a client in eating disorder recovery is assisting her in identifying, coping with, and demystifying emotions. It is an absolutely terrifying time for the client, as she is flooded by emotions instead of being numbed or preoccupied by them. Not only are familiar coping styles compromised, but unfamiliar and frightening emotions take their place. Because an individual struggling with an eating disorder is unfamiliar with the process of identifying and coping with emotions, the idea of taking a multitude of options for coping with emotions and exploring the alternatives to find those which fit best in her life is reason for panic. As anxiety and depression are quite common in individuals struggling with eating disorders, the presence of difficult emotions is compounded.
PERSONALITY TRAITS MAKE A HELPFUL FOUNDATION
Although overachievement and perfectionistic thoughts and behaviors are targets of work for recovery in someone struggling with an eating disorder, her expertise with achievement can actually be used as a resource to assist her in learning to cope with difficult emotions. Such a focus can assist with her development of emotional competence as opposed to avoidance in this area. As a result of the characteristics of overachievement and perfectionism, an individual struggling with an eating disorder is likely to have well-identified areas of accomplishment and skills which she brings with her to therapy. These skills may be in areas including, but not limited to, academics, the arts, or sports. Although coping with painful emotions is an absolutely foreign concept, working through pain or difficulties in building skills and proficiency in other arenas is more familiar to her.
USING EXISTING SKILLS TO CREATE EMOTIONAL COPING SKILLS
When working with an individual struggling with an eating disorder, it is useful to normalize coping with difficulties, whether they are physical or emotional. To demystify emotional struggles it is helpful to ask her what things she has worked hard in life to learn or to accomplish. It is helpful to listen to her talk about the process of practicing and building skills, if she ever grew tired, felt like giving up, felt overwhelmed, or felt afraid that she could not finish what she started. Since she has experienced such emotions when working on building a skill, she can also explore what thoughts or characteristics have kept her going, what she has said to herself to keep going, what she has done to remain motivated, and how she has coped with the pain and fatigue that accompany learning new things. This approach begins to place the skills of managing emotions in the same context as managing other aspects of the self that are less mysterious to the client than emotions. She can begin to identify that the same skills that she uses to learn to play an instrument or to endure a physical challenge are identical to those used to endure emotional challenges. The opportunity is created to explore self-talk and other behaviors that honor the time-limited nature of intense emotions and begin to teach an individual struggling with an eating disorder to trust this fact. She can begin to generalize that practice of all skills builds strength, endurance, proficiency, and confidence in her abilities.
It is important to draw correlations for the individual struggling with an eating disorder that coping with difficult emotions does not mean that the emotions go away any more than a few pedal strokes on a bicycle get her to the top of a hill. The skills do, however, allow her ways to decrease the intensity and duration of difficult emotions, just as continuous pedal strokes on a bicycle eventually get the rider to the top of the hill in front of her.
NORMALIZING THE STRUGGLE
Often the dichotomous thinking characteristics of an individual suffering with an eating disorder put her in a position of expecting that her emotions will be either present or absent. It is critical to correlate that in any other endeavor, a single practice session or action results in a small amount of movement, just as practicing any single skill will only create a small amount of movement emotionally. It is useful to integrate the cognitive-behavioral technique of helping the client understand a numerical scale which she can use to measure the intensity of her emotions and any quantitative benefit of any skill with which she experiments. It is beneficial for her to identify a set or series of skills which has the greatest impact in assisting her in coping with difficult emotions. An individual struggling with an eating disorder may hold the belief that it is possible to identify one skill that will allow her to cope in any difficult situation. As this is yet another risk of her dichotomous thinking, she is better served by identifying and experimenting with as many skills as possible. It may also be useful to predict for her that the more useful skills will result in a decrease of only one to three numerical points on a one-to-ten scale of emotional intensity.
As identity formation is a critical key to eating disorder recovery, an individual’s particular style and combination of skills used to cope with difficult emotions is an important component of this identity formation. Difficulty coping with emotions is not, therefore, a defective and permanent aspect of an individual struggling with an eating disorder. It is a set of skills to be explored, learned, and revised in a process of lifetime learning. As an individual struggling with an eating disorder is able to integrate these concepts she is already exploring additional aspects of her recovery.