Please note that this is an Archived article and may contain content that is out of date. The use of she/her/hers pronouns in some articles is not intended to be exclusionary. Eating disorders can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights.
By: Kipling Rasmussen, PhD
It’s difficult to convince clients with eating disorders that there is a limit to how little food they can eat and still live. Almost as difficult is helping them understand that there is also a limit to how little rest and relaxation they can get and still function. Clients often treat their daily planners like faithful companions. They often speak about the scheduling of their lives as if “living their lives to the fullest” is indisputable evidence of their acceptability. But this emphasis on achievement is often a particularly damaging part of eating disorders. In a way, workaholism can serve the same purposes as restricting or purging: to numb feelings or to prove self-worth. It is the desire to be “perfectly productive”.
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When asked how much sleep they are getting, bulimic and anorexic clients often respond with, “About three or four hours.” When challenged to make an effort to get more sleep, they often say, “If I do that, there’s no way I can get everything done!” One recent client was putting in 30 plus hours a week at her job, taking 20 credit hours of college courses, coaching youth basketball on a volunteer basis, participating in several capacities within her religious congregation, and insisted on pursuing a full social life. Although this schedule was driving her into a particularly serious relapse, her commitments were not substantially more than the schedules of a large percentage of her fellow eating-disordered clients.
When I point out the difficulty of keeping up a schedule of this type, clients often fear that I am trying to prevent them from “being somebody”. Not only am I trying to make them gain weight, but they feel I want to make them lazy as well. I find that I have to explore just how damaging to health and relationships workaholism can be. Convincing them that this level of activity is indeed a problem can be an exhausting process. This discussion usually involves at least three aspects: 1) defining workaholism as an addiction; 2) exploring why they believe they need to achieve all they are striving for, and; 3) helping them understand the problematic past results of their frenetic pursuit of acceptability through achievement.
Work as Addiction
Clients are often surprised to learn that work can be an addiction. Work can be a desperate search for self-worth through achievement. It is addicting because it tends to consume more and more time, and cannot deliver on its “promise”. It also leads to the sacrifice of other, more important things. These sacrifices include leisure time, sleep, and connection to the lives of those who love them. As the discussion progresses, clients often begin to intuitively grasp that they are indeed caught in a cycle consisting of work, restricting/purging, exercising excessively, then working some more, and that they are nearing the point of physical collapse.
The “Need” to Work
Almost inevitably, the obsession with achievement is rooted in the desperate search for acceptability. Just as in the pursuit of the “perfect” body, these individuals reason that if they just achieve enough, they will somehow measure up. Just as often, clients with eating disorders have at least one parent who is or was a workaholic. These parents were not willing to find time in their pursuit of work to nurture the emotional development of their young daughters. Indeed, clients with eating disorders are often unconsciously trying to emulate or honor the work ethic of these parents. Eating-disordered clients will often admit that they developed workaholic habits as a way to win approval from parents who were consumed by work. The eating-disordered daughter is left to work progressively harder and harder in frantic efforts to somehow prove to her parents that she is a “success”. After many weary years of this, clients often acknowledge the fact that, “No matter how hard I work, my father will never give me the attention I need.”
The Past Results of Workaholism
The third aspect of the discussion is exploring just what their work habits have gotten them thus far. This can be difficult because clients with eating disorders have often achieved notable, and even remarkable things. Many have won scholarships, have participated in collegiate athletics, or have amassed stellar grade point averages. But the important point to keep in mind (in terms of recovery) is whether these achievements have given them what they really wanted: a sense of worth. Indeed, clients almost always admit that it most definitely has not. In fact, it has isolated them from others, separated them from activities in which they wanted to participate, and brought them to the point of medical instability. In fact, their eating disordered lifestyle has finally destroyed their ability to achieve much of anything. Their concentration is disrupted, their grades have declined, and they are often struggling with both long and short-term memory loss. Clients often come to the realization that if they don’t slow down, they won’t recover from their eating disorder, and that if they still have their eating disorder, they don’t really have lives at all.
I don’t ask them to give up all their activities, just slow down to something approaching reasonable. I urge them to look carefully at their scheduling commitments and then to cut back. This intervention usually serves to reveal another area in which eating-disordered clients need improvement, i.e., assertiveness skills. This includes developing the ability to set more effective boundaries and to say “no” to excessive commitments. When eating-disordered clients come to accept the fact that their bodies must not only have food, but sleep as well; that their minds need not only nourishment but relaxation, they are on the road to recovery.
I often ask clients to “schedule their recovery”. This means taking out their planners and “scheduling” six to eight hours of sleep into their days. I ask them to commit to a time every day when they will retire to bed and to a time when they will get up. I invite them to write these “appointments with sleep” in their planners right there in the session. If they agree to this, I then ask them to hold these appointments sacred. If I have done my prep work on this issue, and they have accepted that 21-hour days are just as impossible for them to maintain as their extremely low calorie meals, they will tend to honor these agreements.
Finding Their Passions
Because the eating disorder and the obsession with work and “achievement” has consumed so much of their lives, I often ask clients to make a list of the things they love to do. These are the things they have for years given up as part of the suffocating course of the eating disorder. These activities often include engaging in hobbies, playing musical instruments, reading, going for walks, and spending time with friends and family. I then ask them to spend at least one hour a day engaging in these activities. Although this can be a long, slow journey, it is part of the process of learning to care for and honor themselves and their humanity.
The challenge to slow down also includes learning to get in touch with what I call the “softer pace” in their lives. Can they pause for sunsets? Can they spend time with pets? Can they renew their desire to play musical instruments or take naps? Can they look at their own spirituality and see if they want to increase their involvement in it? And perhaps most importantly, can they appreciate non-goal oriented conversation with people?
Bulimic and anorexic clients need to reconnect with who they really are. To do this, I believe they must turn away from the over-involvement with activities that will never fill the emotional void in their lives. In so doing, they will stop trying to impress people, and start spending time with them instead. They will find that people already love them for who they are, not for what they feel they need to become. They will find that the sheer, blurring speed of the journey has blinded them to the fact that they may have always been at their destination.Share