The Real Issues Beneath an Eating Disorder

sad2For someone who is struggling with an eating disorder(ED), it can be very difficult to understand or explain to others why your ED developed.  This is a question that will continue to show up in individual therapy sessions and especially family sessions where parents or significant others are desperately trying to understand the reason for the ED and why their loved one cannot just let it go.  The list below is taken from the book, “Your Dieting Daughter: Is She Dying for Attention?” by Carolyn Costin.  It provides a very thorough list of the issues someone with an ED struggles with and will use their ED to cope.   Until these issues are acknowledged and addressed, the need for the ‘support’ from the ED will remain.  Often with my clients, I will give them this list in session and go through each bullet point, exploring if or how each issue resonates with them.  By doing so, significant clarity can be gained and then alternative and healthy ways to cope can be implemented.  Read my post on Self-Full versus Self-Less for ideas on healthy ways to cope.

Poor self-esteem/self-worth

I’m afraid of myself and of being out of control.

I’m not very worthy.

People don’t like me.

I’m no good.

I can’t trust my own judgments or make decisions.

Belief in a myth

I will be happy and successful if I am thin.

Eating helps me to forget my problems.

Thinner people are happy.

Being thin will make me attractive.

Need for distraction

When I’m bingeing or throwing up, I don’t think about anything else.

Eating takes my mind off things.

Worrying about my weight keeps me from worrying about other things. 

Need to fill up an emptiness

Something is missing in my life.

I feel empty inside, starving makes it better.

Eating fills up my emptiness.

Need for perfection and black/white thinking

I have to be the best at anything I do.

I will be the best dieter.

I will have the best body.

Black/White thinking:

     I’m either fat or thin.

     I either binge or starve.

     I’m perfect or a failure.

     If I can’t win, I won’t try.

Need to be special/unique

I get a lot of attention.

Who will I be without this?

I get to be taken care of, worried about.

Nobody is like me.

It is the only special thing I have.

Need to be in control

My family is too involved in my life.

I have to be in control of something.

I’m always in control of everything else, so this is my way not to be.

The eating disorder behaviors fill unstructured time.

I’m proud of the willpower it takes.

This is the one thing no one has control over but me.

Need for power

I base my feelings of self on how others treat me.

I feel powerless.

This gives me power over myself and others.

It’s powerful to be able to give up food, like a saint or a monk.

I can really get at my parents this way.

Need for respect and admiration

Everyone respects me when I lose weight.

People admire you if you are thin and/or if you don’t eat.

Society perpetuates respect and admiration for thinness:

     Obtains it through weight loss (restricting).

     Tries hard to get it through weight loss, but can’t do it (restricting and bingeing).

     Rebels against it (bingeing).

Has hard time expressing feelings

Very difficult time with anger, rebellion, resentment.

Symbolically swallows, denies or rejects feelings.

Can’t deal with conflict or confrontation.

Denies feelings or expresses them in destructive ways.

I don’t know what I’m feeling, even if I do, I can’t express it.

Safe place to go – doesn’t have coping skills

It’s a special world created to keep all the ‘bad’ out.

If I follow my own imposed rules, I know what to expect, how to ‘win’.

Lack of trust in self and others

I don’t trust myself emotionally.

I never know if someone really likes me.

I don’t trust anybody.

I can never make a decision.

It’s easier just to follow rules.

Terrified of not measuring up

I can’t compete, so this way I take myself out of the running.

What are my good qualities?

I won’t have anything if I don’t have this.

I’m constantly comparing myself to everyone.

Terrified of being fat.

Terrified of being deprived.

Terrified of being deprived and of being fat.


Shrein Bahrami, MFT  |  2146 Union Street, San Francisco, CA 94123  |  415.595.8963