Contributor: Melissa Carey, LMFT, Director of Reasons Eating Disorder Center
After a decade of working in the area of eating disorder treatment I found myself asking what makes recovery seem temporary and relapse likely. What is it that brings individuals who are at one point fighting for their lives, through a period of being asymptomatic and then back into the abyss of eating disorder thoughts and behaviors?
After discussing this with colleagues and clients, it seems that having daily connection and support afforded in higher levels of care is what allowed the behavior to take a backseat. In a treatment process this generally means that stepping down to less restrictive treatment is also stepping down to less support.
As clients transition back to outpatient therapy and dietary support, is this what makes the behavior return, at times with a vengeance? The answer, I believe, lies in the concept of connection.
The Isolation Is Killing Them
At the outset it is simplistic, bordering on absurd to believe that an eating disorder is about vomiting, starving, exercising, or any of the other abusive tactics one reaches for to “solve” a body problem.
Recently, it occurred to me that unless you have sat with these women, men, and children and looked at their faces and into their frightened eyes, and heard the tightness of their voices that you may not know that it is not a behavior that is killing them, it is isolation.
“Something Is Wrong with Me”
Imagine for a moment a world that is focused on one solitary belief. A remarkable shared belief that is held by nearly every client I have had the honor to work with has some version of “something is wrong with me”.
If you live your life according to that one belief, your world becomes so small there is nothing else. What does it feel like to live your life through the lens that you are wrong, period? Some of the answers I have heard from clients have been: shameful, humiliated, and embarrassed.
Isolation As “Coping”
If you walk though the world in this way, isolating seems a logical response to that answer. Who wants to be seen or experienced in that way? It is with this level of intense emotional pain that isolation becomes a welcomed disconnection from self and others.
The focus on eating disorder behavior can provide a sense of belonging, perhaps to a mission or in the service of making one less thing wrong with you.
Loneliness and Isolation
Loneliness is perceived social isolation: it is the distressing feeling that accompanies the perception that one’s social needs are not being met by the quantity or especially the quality of one’s social relationships (Heinrich & Gullone, 2006).
Eating Disorders provide the sense that social needs are being met due to comments on weight loss and support around perceived “ wellness” or “sickness”. In the development of an Eating Disorder, loneliness comes before isolation, stemming from experiences in life that make one feel different from others.
This is the birthplace of the idea “something is wrong with or about me”. This idea can come as a whisper from within that is reinforced by environment and external relationships.
Pushing Away Emotional Support
Isolation is the experience of being separate from others, either by choice or circumstance. Emotional isolation occurs when people keep their feelings to themselves, do not allow themselves to receive emotional support from others, and lack willingness to share their feelings and experiences with others.
This often leads to a disconnection that allows for the continued focus on food and weight.
While isolation can be a healthy and revitalizing experience for those who need space to reconnect with themselves, for those that struggle with shame and the self-hate found in the fabric of dysregulated eating behaviors, choosing to be alone is often a choice that serves to validate worthlessness.
Isolation is deeply connected to the development of an eating disorder in that perceiving oneself to be alone in the world is painful and frightening. Isolating oneself socially exacerbates beliefs of shame, self-hate and increases the likelihood of compensatory eating disorder behaviors.
Multiple Sources of Support
Circling back to my opening question: What makes people open to healing in the context of a treatment center and what creates difficulty in outpatient settings? The answer seems to be multiple sources of support and tolerating socialization.
Treatment settings allow for this to come not just from the obvious sources such as the therapist, dietician, and psychiatrist, but also importantly from the people who surround the clients all the time, the nurses, mental health workers, diet techs, and their peers.
All of these people create a beautiful network of compassion, love, support, and interpersonal challenges that you cannot avoid.
Feeling Vulnerability Again
Most people who live with an eating disorder have been disconnected from people in very fundamental ways and have not had the experience of being held in their worst moments by others.
The work of healing from an eating disorder is allowing yourself to be seen again with all your fear and shame and allowing what can feel like unbearable vulnerability to be present.
Understanding the Role of Isolation in Eating Disorders
- Isolation allows for distancing oneself from pain and fear of being present in life
- Isolating oneself comes from lived experiences of being shamed or humiliated and not wanting to return to that place
- Isolation maintains the theory of “something is wrong with me”
- Isolation does not allow for other contradictory ideas of “something is right with me”
- Maintains privacy and shame around lack of self-worth
- Helps cope with fear, anxiety and loneliness
- Isolation is actually experienced as unbearable and is not the preference of the person in the eating behavior
- A basic lack of trust and fear of rejection maintain the isolation
Leaving Your Island
In treatment, we frequently look at challenging clients to “get off their island” that is comprised of deep loneliness and suffering.
We work to establish productive communication with support people, limit-setting skills with those who are not able to support our clients in the changes they are making, and developing a network of people, something we call creating a family.
The good news is that this is not only possible in a treatment setting!
Creating a Family of Trust
Creating a family for yourself of people that you have chosen to trust and support you can happen anywhere at anytime. Sharing in community the ideas one holds about themselves that involve shame and fear of rejection allow for a new experience of self.
Only by challenging yourself to step out of the confines of fear and shame can you consider any other possibility.
Learning You Are Not Alone
Learning that you are not alone and not uniquely flawed is a powerful experience. Sitting with another person and realizing that you are not in fact as alone as you believe can bring not only relief but create space for new ideas about who you are and what you can do.
Sharing pain and fear with others aloud directly challenges isolation and opens a new narrative about oneself. Although the idea can be terrifying, allowing yourself to exist openly as your own complex and nuanced self is the prescription for the illness of isolation.
Community Discussion – Share your thoughts here!
What has been your experience with eating disorder recovery and overcoming feelings of isolation? What advice do you have to share with others?
- Heinrich, L.A., &Gullone, E. (2006). The clinical significance of loneliness: A literature review. Clinical Psychology Review, 26, 695-718.
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 discussion of various issues by different concerned individuals.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 12th, 2015
Published on EatingDisorderHope.com