When Dieting Behavior Becomes an Eating Disorder
Angela R. Wurtzel, MA, MFT
Licensed Marriage & Family Therapist

    Most people who want to change the way they look and feel about them selves believes dieting and losing weight will increase self worth and esteem. In my practice, for instance, a woman who was overweight came to me for therapy. She had been dieting and exercising, but felt demoralized when she just couldn’t lose weight.

The nutritionist at her health club was aware of my work with binge eating disorder suggested that she call me. During the course of therapy we examined her real behaviors with food and explored her feelings and thoughts when she indulged in a binge. We also talked about her resistance to exercise and her underlying need to remain overweight to protect herself. With these insights and the support to change her behavior, this woman is now eating sensibly, exercising, dealing with her underlying issues in therapy and succeeding in her professional life. She still struggles, but has developed a strong sense of self and point of view and has reported losing weight. This type of weight loss is not what I am concerned with because a nutritionist and a psychotherapist monitored it. I am concerned with the dieting that takes hold of a person and can eventually lead to a serious eating disorder.

    Those who are prone to eating disorders have different backgrounds and life experiences.  For instance, a young woman entered therapy a few years ago stating she began dieting as early as her teens when it was suggested that she “lose a few pounds.” At first, the dieting was difficult, to not eat what her more “thin” friends were eating, but she stuck it out and then experienced the gratification of attention, acknowledgment and praise from others for being thin and having “will power.” She said for the first time she had felt in control of herself. She said she felt attractive and didn’t want to stop losing weight because if she did give in to her urges to splurge, she would lose all that she had worked for. She explained that she engaged in specific rituals of eating, cutting food into small pieces and only eating certain foods. She became overly concerned with counting calories and began noticing flaws in her body that others did not notice. After months of therapy, she developed the insight that more was going on with her emotionally than wanting to lose weight. She realized she had a history of depression and anxiety, particularly in relationship to grades, performance and her future. She also discovered she had become out of control in other areas of her life and her dieting provided her a source of control.
 
    People with anorexia intentionally starve themselves and lose at least 15 percent below their normal body weight. Once the initial weight loss from the “diet” is accomplished, anorexia tightens it’s grip and the sufferer sees oneself as overweight even when they are not, this is called disordered body image. Bulimia includes the consumption of large amounts of food and then purging through vomiting, abusing laxatives or diuretics, and obsessive exercise. Weight loss may occur at the outset but, the body begins to adapt to the fluctuations in caloric intake and to protect itself from further danger weight maintenance or gain can be the result. For instance, a woman in her late 30’s came to me after struggling with bulimia for close to 15 years. She engaged in bingeing and then purging late at night when she was alone. In her mind, she did this to herself because she could when she was alone, rather than noticing she felt loneliness and the cycle of bingeing and purging provided her with something to do with herself. Through the course of treatment, she eventually gave up the purging and bingeing behaviors and has been able to tackle her fears, including being in social situations, intimate relationships and outspoken. There are times she reports feeling like she wants to binge and has to feel her frustration and fears. She says that having therapy, a place to honestly talk about herself, has been able to save her from giving in to the binge.

    The beauty of seeking psychological help for an eating disorder is a relief occurs inside the person by establishing a trusting relationship with someone who understands their fight with feelings and food.  Many times, shame interferes with starting therapy, but the person really wants to stop their behaviors. Recently, a woman came to my office that had never been in therapy before and been bulimic for several years. She had not told anyone until a few weeks ago and still feels ambivalent about starting therapy. She is uncertain of the results and still addicted to her eating disorder behavior. But, she realizes that the dieting that worked for her before no longer pays off and she isn’t losing weight or feeling like a strong person. Her bulimia is her crutch and she is not sure she wants to stop completely because she then feels anxious and that she has to throw up because it has worked before and she has done it before. The eating disorder behavior and its compulsions have become the main defense system in her life. As a therapist, ripping away defenses is not therapeutic at the outset of treatment. Replacing maladaptive defenses with more adaptive coping skills is the optimal treatment for anyone with an addiction or eating disorder.

    From my point of view, weight gain and inability to lose weight due to an eating disorder has its roots in the psychology of the person. There is no “one” reason why someone develops an eating disorder, but several that are personal and most having to do with life experiences. Psychotherapy for the dieter is my prescription. Understanding and getting to know one self and attempting a different kind of challenge instead of counting calories, burning calories and weighing in.



Angela R. Wurtzel, MA, is a licensed Marriage & Family Therapist specializing in the treatment of eating disorders. She offers individual, group and conjoint/family therapy in Santa Barbara, CA. She has been in private practice for 7 years. She can be reached at (805) 884-9794 for consultation and appointments.