Eating Disorders: An Existential View

       The journey between birth and death can look like a pretty daunting business: we are born, we spend two decades learning the basics, three more decades creating our niche in the world and building relationships and family, we grow older, and finally we die. We can put this solemn prospect out of mind most of the time; we work and play, cry and laugh, complain and give thanks, make plans and get on with things.  But sometimes this larger picture intrudes in our thoughts or in our background awareness. Why am I here? Why can't I seem to get what I want? Am I the only one who feels this way?  Why are decisions so difficult? Sometimes we shrink from the enormity of it all. We hide in overwork, entertainment, busyness, blaming, smoking, shopping, or eating – all to distract ourselves from existential anxiety.         

       Existential psychotherapy responds to such large questions about life, helping people face them directly with courage rather than despair. Some of the themes pinpointed by eating disorder experts are existential themes.

• Fear of maturity is one of the areas tested in the Eating Attitudes Test and is considered by experts to be a common feature in many eating disorders.  Maturity means taking responsibility for one’s life; relinquishing the safe haven of parental protection; attaining sexual maturity; choosing some things and not others; creating effective boundaries between self and other. But anorexia nervosa and bulimia take so much energy that there is not enough left to make important life choices and live them out. Both disorders keep a patient frozen in time.

 
• Identity means knowing one's own feelings, preferences, and goals, and being able to express and strive for them. But roles and socially dictated standards of beauty or niceness can serve as surrogate sources of identity. The more insecure a person feels, the more urgently she clings to them, accommodating other people and desperate to be thin. Discovering one’s true self is one of the most exciting aspects to recovering from an eating disorder.
   
• Decision-making involves knowing the options, determining which one is best for oneself, being able to relinquish all options except one, and taking a stand at a moment in time. The eating disordered are often tormented by indecision, sure that there is a "right" answer which eludes them and that they will be judged mercilessly no matter which option they choose. Eating can serve as a procrastination device, delaying the dreaded moment of decision.
   
• Perfectionism is a difficulty in accepting human limitations and the fact that humans are finite, fallible creatures. In the mind of an intelligent and articulate young person, the contrast between what can be imagined and what can actually be achieved may be excruciating. Perfectionism is an attempt to deny this gap. For others, it is a way of substituting perfect performance for the imperfect self and striving for acceptance.
   
• Embodiment. One of the basic conditions of humanness is that we are embodied in a solid physical body. Insistent attempts to change and control it, or to undo certain of its natural functions, represent indirect rejection of this basic reality. An eating disorder may also reflect a tendency to identify with the mind. The body is seen as a sort of slave which should comply with any plan the mind devises, hated if it does not.
   
• Anxiety. The eating symptom absorbs the person's attention in a cycle of obsession, self-blame, promises and internal conflict. It may be easier to have a problem with a name-- bulimia or fatness -- than a problem without a name. An eating preoccupation, unpleasant as it is, can be a way to avoid other forms of turmoil.
   
• Boredom. My clients often say that they eat out of  “boredom.” But what is boredom? It means being left alone with oneself with no immediate activity. Such "unstructured time" is a known risk factor for overeating. Learning to deal with "boredom" means learning to be with oneself or to get involved in something interesting.

Giving up the whirlwind of an eating disorder means learning to live with the stresses of daily life, making decisions and commitments, developing an identity – in short, developing existential resilience.

               Adapted from Understanding Eating Disorders, 1988

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