My colleagues often ask me why I chose to specialize in the treatment of eating disorders. The point they are making is that an eating disorder (ED) is probably the most difficult type of psychological problem to treat. Why? Because your patient does not want to get better by definition. 

That is correct. Individuals with anorexia, or bulimarexia, a new version of the disorder, do not wish to recover. It’s not like treating depression or anxiety where the patient is desperate to rid themselves of the painful symptoms that are turning their lives upside down, threatening their job or academic security, and isolating them from loved ones. 

The ED does all of these things in spades. It also threatens the victim’s medical well-being and has a good chance of shortening their lives. Anorexia kills 1/3 of all of its victims. Yet still, they cling to it. The newest version of anorexia, bulimarexia, is even more dangerous as it includes bingeing and purging in addition to restricting. 

Despite these incredibly negative consequences, the anorexic/bulimarexic is psychologically unable to give up the disorder. Indeed, they will protect it at all costs, often going from honest individuals with great integrity and many gifts, to individuals who lie with ease to keep parents and loved ones at bay.

Once in treatment, which usually requires coercion, they will do anything to sabotage it, up to and including throwing their practitioner under the bus if necessary. If you look at it from the side of the patient, the therapist is a real threat and the better s/he is at the job, the more of a threat. So it is understandable that many practitioners shy away from treating these disorders. It is a shame because these individuals are exceptionally intelligent and talented. Helping them reach their potential is the most gratifying experience I can imagine as a practitioner.

Check back in tomorrow for more information on What Makes My Approach Different…