The term "eating disorders," like so many diagnostic labels, describes a spectrum of experiences and dynamics; while two people might both overeat and purge, the psychological reasons why they do so can be very different. I'd like to discuss one of my clients who suffered from bulimia, along with the emotional factors involved, because her story sheds light on a much larger issue: how we may cope with unbearable emotions and feelings by trying to get rid of them.
When I began working with this client (I'll call her Sharon), I had little experience with eating disorders. I understood that there might be a connection between childhood sexual abuse and bulimia; I was aware that low self-esteem and perfectionism likely played a role. The first time we met, Sharon told me she'd been sexually molested by her step-father during her early teens; while she didn't strike me as having particularly low self-esteem, she did seem quite perfectionistic and self-critical. In our early sessions, however, what struck me most was how little she could tolerate her emotions and feelings.
A pattern began to emerge: whenever an experience threatened to stir up emotion (it could be an intensely pleasurable feeling just as well as an anxious or painful one) the powerful urge to overeat would arise. Eventually she would give in, binge eat and force herself to vomit afterward; an enormous sense of relief always followed. We came to understand that what she wanted was to feel empty, void of emotion. Her bulimia, in a very literal sense, was a process of emotional evacuation. By throwing up, Sharon felt she'd gotten rid of the unbearable emotions and feelings along with the food she'd eaten.
The solution wasn't permanent, of course: the feelings usually came back. Sometimes evacuating her feelings gave her enough time to find an alternative way to remove or avoid the cause of those feelings; on other occasions, emotions would resurface and she'd go through the binge-purge cycle again. In almost every situation, her goal was first to avoid having any feelings if possible, and then to get rid of them whenever she couldn't.
Sharon's mother was a very logical, remote woman who also tried to avoid any kind of emotional turbulence. The fact that she somehow managed not to know what must have been obvious, that her husband was molesting her daughter, shows just how far she would go to avoid facing painful and difficult situations that might agitate her. In other words, Sharon grew up in a family with little tolerance for emotions and feelings; she never learned how to cope with them in a mental way and developed bulimia, in large part, as a physical alternative.
There are many other ways to avoid or evacuate unwanted emotions and feelings; the process of projection isn't usually as literal as it is in this case of bulimia. But I believe it's something we all do at one time or another. On the other hand, when we're unable to get rid of such feelings, it may give rise to intense anxiety symptoms or even panic attacks. In addition, the inability to cope with sudden, overwhelming and unbearable emotion can also give rise to post traumatic stress disorder.
You might have a hard time identifying with Sharon's methods, but you may use eating in related ways. Many people turn to food as comfort, of course, trying to satisfy an emotional need by physical means. Others use food as a sort of numbing agent. As to the larger issue of avoiding intense emotions and feelings, you may find more common ground with Sharon. Here's a personal example. When my children were small and the emotional demands of rearing them were high (in addition to the emotional demands of my psychotherapy practice), all I wanted at the end of the day, after everyone was fed, bathed and in bed, was to watch repeats of "Law & Order" with a glass of wine. Nothing stimulating, nothing unexpected... just the comfortable routine of crime and punishment, with characters who never surprised me. Sound familiar? At the end of your day, do you numb out in front of mindless TV shows with alcohol or ice cream? Maybe it's because, after the stimulation of your day, you can't take any more intense feelings.
How does your own routine serve to limit the kinds of emotions and feelings you have? Are you a creature of habit? Sometimes repetitive ways of doing things allow us to know (or believe we can know) what we'll feel in advance. Who of us really likes the shock of unexpected feeling? It might be a wonderful surprise if the Publisher's Clearing House guy showed up at my door, telling me I'd won the sweepstakes, but I hate late-night phone calls that mean bad news, death or a serious accident.
You'd think, given the shortness of life and the wealth of possible experiences, we humans would constantly be searching for new sources of stimulation and excitement. It's surprising how many of us prefer the comfort of routine and the set of knowable emotions and feelings that come up in our ordinary day.
Joseph Burgo PhD is a clinical psychologist with 30+ years experience in the mental health profession. He writes two blogs, one called 'After Psychotherapy' where he discusses psychotherapy issues such as depression, anxiety, bipolar disorder, borderline personality disorder and post traumatic stress disorder from a psycho-dynamic perspective; on the other blog, 'Movies and Mental Health' hosted by PsychCentral, he uses classic and contemporary films to illustrate his ideas. Dr. Burgo also offers online counseling via Skype. His forthcoming book on psychological defense mechanisms will be released by New Harbinger Publications in Spring 2013.
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