It's Not About the Food
The truth about eating disorders
By Lisa Ferentz
Early in my career the mere mention of an eating disorder by a prospective client would make my appointment book magically fill up. The studies I'd read indicated that 66 percent of clients with anorexia, bulimia, and bingeing and purging relapsed within the first year, and that their mortality rate, at 20 percent, was the highest of any psychiatric disorder. So I lumped eating-disordered clients with other "treatment-resistant" patients—like "borderlines"—to be avoided at all cost by any savvy private practitioner. But even the most vigilant initial screening could protect an anxious therapist only so much. Thus, it wasn't until an afternoon many months into treatment that I discovered that one of my favorite clients had an eating disorder. Molly was a smart, talented, beautiful, 17-year-old redhead, who got straight A's, starred in all the school plays, and scored winning points on the soccer and lacrosse teams. She'd first come to see me because, despite all outward appearances of success, her parents had began to sense a "personality change" in her. In the past year, their accommodating and easygoing child had become unusually irritable and belligerent. She was fighting with her mother, refusing to participate in family outings, and distancing herself from her closest friends. The therapeutic task seemed clear and quite familiar: to help Molly through the developmental angst of adolescence.
Even though she clearly didn't want to be in my office, we slowly began to build a rapport and she started to let me into her world. Some months into our work together, she opened up about an altercation with a friend at school.
"She was giving me crap in the hallway again, because she thought I was flirting with her boyfriend—which I wasn't. She called me a whore in front of my other friends and told them not to trust me. Now a bunch of them aren't speaking to me."
I must have looked concerned because she leaned toward me and added, "It's no big deal. This girl has been spreading rumors about me for a long time."
Trying to understand how she was handling this situation, I said, "Wow, that's a lot to endure. How have you been dealing with it?"
She nonchalantly shrugged her shoulders and replied, "Like I always do—I make myself throw up, and then I feel better." Sensing my anxiety, she added for good measure, "Or I don't eat for the day."
"Is this something new for you?" I asked, trying to appear calm.
"No. I've been doing it on and off for years."
This was a complete shock to me. I suddenly felt frightened, confused, and even a little angry, as if she'd somehow misled me. Didn't she get the memo that I didn't work with eating disorders?! Clueless about what to do, I went to red alert. I felt an immediate and intense need to get her to stop starving and purging. I didn't focus at all on the meaning of what she was doing—all I saw was behavior that was out of control, pathological, and dangerous. Just like that, what had been a warm and productive therapeutic relationship turned into a power struggle.
"Molly," I began, trying to keep the panic out of my voice, "We need to talk about what you do and don't eat, and how I can help you to eat more appropriately. We need to focus on your maintaining a healthy weight. Right now, you're doing something incredibly dangerous."