My Abusive Eating Disorder

Contributor: Timberline Knolls Team at Timberline Knolls Residential Treatment Center

“The voice claims me.
I see therapists. These people challenge the voice, the thoughts.
My intellect begins to understand the illusion. But, the moment I begin to sense the almighty damage I am doing to myself . . . the voice becomes angry.
It warns me of a dangerous world and reassures me how much safer I am within its net” [1].

The Abusive Eating Disorder Voice

These compelling words from someone who struggles with an eating disorder allude to an all-important understanding of eating disorders that have often evaded popular discussion. Rather than trivializing one’s struggle with their weight and body image, these words point to the idea of externalizing one’s relationship with their eating disorder as a separate entity.

Many who struggle with eating disorders are already aware of that voice and relate to it often, especially as it grows and demands jurisdiction over their thoughts and actions. In utilizing this understanding of the eating disorder voice, and even in comparing the nature of it to those who are victims of abusive relationships, we may be able to further our understanding and our empathy for survivors of these vicious illnesses [1].

Research suggests the notion that clear patterns exist in these cases that resemble highly negative and enmeshed human relationships. Recent studies confirm that such conditions exist not only in anorexia nervosa but across all eating disorder diagnoses [2].

Some critics of externalization models for the treatment of eating disorders, such as those used in narrative therapy, state that this view of the disorder gives it too much power and absolves the individual of their responsibility to change. However, in this model, and in viewing the eating disorder as a relationship (with equal focus on both the actions and reactions of its members), the individual can be restored with the agency they need to feel capable of change, and practitioners can again hold them responsible.

It is believed that not only through identification of the eating disorder as “other” and not “self,” but also through learning to rebel against the voice, there exists a potential path toward recovery. Studies showed that those who were angry with their disorder were found to submit to it less and experienced fewer symptoms [2].

Similarities to a Domestically Violent Relationship

In 2011, Tierney and Fox presented research that compared aspects of the power and control dynamics present in relationships that contain domestic violence with writings from women who identified with the notion of an “eating disorder voice” [1],

Development of the Relationship

As one falls prey to the ploys of an eating disorder, they often believe the lies that the eating disorder has positive intentions, encouraging efforts to lose weight and change body shape while providing a newfound confidence and false sense of control. As the illness progresses, however, it appears to parallel the very same processes that feed abusive human relationships. Patients soon report that their disorder, like an abusive partner, becomes tyrannical, criticizing, and dominating, demanding priority over other relationships and furthering their social isolation.

Self-Esteem

As the eating disorder progresses, its role is often likened to that of a strict taskmaster, demanding compliance and unquestioning obedience. Fear of being unable to meet the demands contributes to a sense of helplessness, undermining their confidence and leading them to lose trust in their own decisions and abilities. This is not unlike a woman caught in the throes of an abusive relationship, the woman who slowly loses her identity (e.g., job, intelligence, friend groups, etc.) in order to appease the needs of the abuser to avoid provocation.

Control and Isolation

Women in abusive relationships often describe their experience as being confined in a prison, seen as property and under strict regulation. Those with an eating disorder are also confined to a limited existence ruled by harsh dietary restrictions and exercise regimens, with grave punishments reserved for stepping out of line. Both abusers continue to operate by instilling fear of retaliation and fear of the unknown should their victim decide to seek help.

Perceptions of Support

As eating disorders often carry the stigma of being difficult to treat, as well as a choice one makes, those who suffer from these disorders may have conflictual relationships with treatment providers due to clinicians’ own self-perceptions.

Conversely, in drawing from interpersonal theory (“the way we treat others in life is informed by the way that important others have treated us”) [1], concerns for the therapeutic relationship exist also from the viewpoint of the client.

Assuming that the eating disorder has indeed taken a dominant, controlling role in the person’s life, there is the risk that they will continue in their subservient, passive role, complying with treatment tasks but without the commitment to change.

The Process of Leaving

Deciding to leave an abusive relationship of any kind takes courage and tenacity, and it may not occur until one finally makes a move to reach out and seek support. The process of recovery involves rebuilding one’s way of life and their very identity. However, in many cases, recovery may involve returning to the safety of what is known and the security of the prior relationship from time to time.

Severing the ties and means of control from the abuser, and believing that life is possible without its demanding presence, takes time. For those who are battling an eating disorder, lasting recovery often requires the support of a dedicated recovery team, available through a residential or partial hospitalization program.

Conceptualizing eating disorders in this new way not only helps to increase empathy for the plight of the person who is trapped in an abusive and controlling relationship with their eating disorder but also offers potential solutions for recovery. If you or your loved one is battling an eating disorder, often the first step is to admit that the problem runs deeper than simple willpower and requires professional support.

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Sources:

[1] Tierney, S., & Fox, J. R. (2011). Trapped in a toxic relationship: Comparing the views of women living with anorexia nervosa to those experiencing domestic violence. Journal of Gender
Studies, 1, 31–41. https://doi.org/10.1080/09589236.2011.542018
[2] Mantilla, E. F., Clinton, D., & Birgegård, A. (2018). Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self‐image. Psychology and Psychotherapy: Theory, Research and Practice, 91(3), 302–316. https://doi-org.proxy.stetson.edu:2443/10.1111/papt.12161

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About Our Sponsor:

At Timberline Knolls Residential Treatment Center outside of Chicago, Illinois, we provide specialized care for women and adolescent girls who are living with eating disorders.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on February 28, 2019.
Reviewed & Approved on April 12, 2024, by Baxter Ekern, MBA

Published on EatingDisorderHope.com