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Does Understanding What Causes an Eating Disorder Matter?

There are several questions I am often asked. First, if a person recovers from an eating disorder without ever understanding what caused it in the first place is the recovery any less real or lasting? And, if the treatment being provided is behavioral only (symptom focused) but is effective in recovery, then why need look any deeper at causes? The answer to first question is “No,” and to the latter, “It is not necessary to go beyond symptom based treatment.” However, here is why it may matter to delve deeper.

Understanding the motivations behind our behavior, thoughts and decisions is the driving force behind psychoanalytic and pychodynamic theory. These theories suggest that knowing what makes us tick can enable us to make choices fundamentally based on what is right and hopefully healthy for us. Exploring our deeper thoughts can ultimately direct our choices of how we choose to behave in the future so that we avoid history repeating itself. For example, “How on earth did I do that again, or make the same decision, or wind up with the same kind of partner I had last time?” This is no less true for eating disorder sufferers.

Eating disorders are complex on many levels. Though a driving force may be biology (i.e. predisposition to depression, anxiety or a nature that is more predisposed to specific personality traits later down the road) there are generally psychological, relational, familial, and environmental (including culture, media and social) reasons that contribute to their development. Exploring the “purpose” the eating disorder serves in someone’s life can be extremely helpful to curtail or ameliorate symptoms. Here’s an example.

M, has suffered from Compulsive Eating most of her adolescent and young adult life. Family eating patterns and biology, likely contributed to her disorder, however, in time, M. realizes that she tends to eat significantly more whenever she has an interaction with her sister,B, who is depressed. B. routinely tells M. that she is unhappy, binge eats and regrets about many of her life choices M. is supportive and has lovingly suggested that her sister seek professional help. M. notices that she feels guilty for feeling happier and more satisfied in her own life. Shas a successful marriage, career and relationship with her children; contrary to her sister whose children are estranged and who has never been satisfied with career choices. M. states that throughout their childhood and adolescence B. performed better academically, was more popular in school and had, according to M., had the “perfect” body, M’s guilt and the acknowledgement that she has been more successful as an adult than her sister influences her decision to eat compulsively. She expresses that when she eats she feels defeated and angry at herself but no longer guilty toward her sister. M. discovers that she has directed the negative feeling toward herself and turned her guilt and perhaps her victory in outdoing her sister into something self-defeating. M. also comes to realize that when she joins her sister in overeating that B. is less critical of M. Knowing the underbelly (motivation) behind her behavior has a significant impact on her ability to recognize her feelings, accept them and in turn enable her to gain better control over her emotional eating. She is now able to see what is driving her emotional “bus” and can make a choice about how she wants to respond. i.e. sitting with her feelings and using cognitive/behavioral techniques, or Dialectical Behavioral Therapy (DBT) techniques versus engaging in self-defeating behavior. Cognitive Behavioral Treatment might refer to this as identifying“triggers,” but triggers don’t go far enough to help someone integrate how deeply relationships affect behavior and our self-concept.

Understanding the psychological and relational issues underlying eating disorders as the only line of treatment does not typically make symptoms better in the short run. Sound eating disorder treatment must utilize more than one treatment approach; symptoms must be dealt with and medical stabilization is the top priority, particularly when dealing with low weight, malnutrition and purging. A well-rounded and grounded team of professionals including: medical care providers, nutritionists, psychotherapists (grounded in all relevant eating disorder theories) and psychiatrists, is often necessary for many patients.

Understanding motivation and the psychological and relational purposes that an eating disorder serves in someone’s life is, for many, a remarkable way to facilitate longer term recovery. Knowing what makes us tick can indeed help us gain control and make conscious choices about what is good for us.

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