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Running head: EATING DISORDERS AND THE DUAL ROLE THEY PLAY 1

New Ways of Understanding Eating Disorders and the Dual Role They Play

A Master’s Project

Presented to

The Faculty of the Adler Graduate School

In Partial Fulfillment for the Requirements for

the Degree Master of Arts in

Adlerian Counseling and Psychotherapy

By:

Aimee R. Bey

Chair: Richard Close

Member: Amanda Luedtke

December 2015

EATING DISORDERS AND THE DUAL ROLE THEY PLAY 2

Abstract

The specific psychopathology of eating disorders is complex. Although the study and treatment

of eating disorders has been thorough and satisfactory to date, there is room for improvement in

the understanding of the cognitive processes involved, the bearing of typical common causes,

and an increased awareness of the dichotic nature of the relationship between the person and the

disorder. For this reason, common causes juxtaposed against key Adlerian concepts have been

evaluated in order to increase the effectiveness of diagnosis and treatment. In addition, a graphic

novel featuring the metaphorical relationship between a person and their eating disorder will be

used for outreach with potential and existing clients seeking help with eating disorders.


Acknowledgements

I'd like to give thanks to my family, particularly my mother and father, for all their

support through the years, without which none of this would be possible, and to Jeremy for his

patience. Finally thanks to those at Adler Graduate School, especially Richard and Amanda for

their continuous support and guidance.


Table of Contents

The Psychology of Use in Eating Disorders ................................................................................... 6

Striving for Superiority and Significance in Eating Disorders ....................................................... 7

Private Logic in Eating Disorders ................................................................................................... 7

Fictional Final Goal in Eating Disorders ........................................................................................ 8

Masculine Protest in Eating Disorders ............................................................................................ 9

The Cognitive Processes Behind Eating Disordered Behaviors ..................................................... 9

Metacognition in Eating Disorders ............................................................................................... 10

Changes Related to Eating Disorders in the Diagnostic and Statistical Manual (DSM) .............. 12

A Critical Look at Common Causes of Eating Disorders ............................................................. 13

Social Media as the Cause ......................................................................................................... 14

Personality as a Cause ............................................................................................................... 15

Media as a Cause ....................................................................................................................... 16

Negative Self talk as a Cause .................................................................................................... 17

Valuing the Eating Disorder ......................................................................................................... 18

Strong Without It .......................................................................................................................... 18

Resistance to treatment ................................................................................................................. 19

The Seekers Graphic Novel .......................................................................................................... 20

Conclusion .................................................................................................................................... 20


New Ways of Understanding Eating Disorders and the Dual Role They Play

Adler lived at a time when eating disorders were largely unidentified and unclassifiable.

Now, clinicians can look at his theories and apply them to the understanding and treatment of

eating disorders. Adler's theory of Individual Psychology incorporated family, personal,

sociological, and biological aspects into the understanding of human behavior. This theory helps

mental health professionals look at more than the symptoms of an eating disorder and more into

what keeps it prevalent in all areas of a person's life. Eating disorders reflect a lack of trust in the

world’s ability to get a person's needs met. That’s why they will seek out this most dangerous

alliance. What starts as a source of strength and accomplishment, slowly and sneakily becomes a

villainous invasion of a person’s individuality, sense of self, morals, wellbeing, and their very

life. Adler’s theories on the psychology of use, striving for superiority, private logic, fictional

final goal, and masculine protest may all shed some light on what keeps an eating disorder

thriving while its sufferer degrades. The public’s general understanding of eating disorders is far

from accurate and steeped in outdated stereotypes and viewpoints based in ignorance.

Professionals have attempted research into the cause and precipitating factors of eating disorders,

everything from social media to magazines, all skirting around the most integral part of the

disorder; the eating disorder as both a friend and nemesis. It is impossible to underestimate the

control it has on a person. This control is rooted in what starts as unwavering trust and sense of

belonging resulting from the coalition. This concept can be explained through metacognition

and self-talk in eating disorders. The eating disorder’s voice is an ever-present piece of an eating

disorder sufferer's experience and in countering it, an invaluable part of their recovery. This

project will address Adler’s theories and look at how existing theories can be enhanced or

reconsidered in order to provide the best treatment necessary for those battling such a formidable


foe. To further illustrate these concepts, the second half of this project is a graphic novel

featuring the metaphorical relationship between a person and their eating disorder. In it, we will

see in a literal way the complex and dual nature of the eating disorder relationship.

The Psychology of Use in Eating Disorders

Addictions or compulsions of any kind exist for a reason and become chronic when

negative behaviors are reinforced. Lacking different ways to get their emotional needs met

makes it both harder to seek out different ways to cope and easier to go back to those compulsive

behaviors. This is true for eating disorders. The eating disorder becomes not only the means

toward an end but the structure, the fuel, and the map for getting there. The three areas of special

interest to the psychology of use are "memory, emotions, and cognitive processes" (Mosak &

Maniacci, 1999, p. 24). Some memories stand out above others. These memories serve to

justify a person’s movement toward a goal. Memory plays a key role in eating disorders. For

Adlerians, emotions are seen as motivators. Adler wrote about two different types of emotions:

disjunctive and conjunctive emotions (Mosak & Maniacci, 1999). Conjunctive emotions pull

people together and disjunctive emotions push people apart. An Adlerian will look at what

purpose the emotion serves. For someone with an eating disorder, their disjunctive emotions rule

them. The eating disorder knows that pushing people away is the only way it can survive. To

elicit these emotions, an eating disorder will provide specific thoughts. Thought provides the

direction, emotions provide the force of a person's movements, so thoughts such as people hate

me and I think I’m fat lead to feelings of social anxiety, secrecy, and manipulation. Returning to

Adler’s psychology of use, it is clear how an individual with an eating disorder uses their

thoughts, emotions, or even their symptoms to achieve a social end.


Striving for Superiority and Significance in Eating Disorders

One of the most basic drives for human beings is to feel capable and part of their

community. Humans want to feel that their lives matter or more simply that they matter as

individuals. Eating disorders provide a sense of significance and superiority. Through engaging

in disordered behaviors, the sufferer may feel worthy of love or protection in their social circles,

a sense of control in their lives, or to feel unique and special. Considering how important it is to

feel these elements, it's not difficult to see how difficult it is to abandon an eating disorder;

however, the costs of an eating disorder are great. In addition to the perceived benefits, a person

will have constant thoughts about food and diet, they may feel taken over by the goals of the

eating disorder, and there is often significant damage done to their personal relationships

(Serpell, Treasure, Teasdale, & Sullivan, 1999). In this constant search for superiority, Adler

identified what is known as the final fictional goal as a way to get there (Mosak & Maniacci,

1999). The trap is that they may never get there. It becomes more if and then rather than now

and I am. For those facing the unattainable “perfectionism” often demanded by eating disorders,

it can leave them in a very discouraged place. The eating disorder's fictional final goal is

unattainable and dangerous. Despite the promise of happiness, and that sense of superiority and

significance, there is no reaching it.

Private Logic in Eating Disorders

Private logic is the reasoning invented by an individual to stimulate and justify a style of

life. Often a person with an eating disorder will adopt their own logic that drives the eating

disorder behaviors. Private logic has three components: "immediate goals, hidden reasons, and

life style goals" (Mosak & Maniacci, 1999). Eating disorders are very much a creature of a

private world run by an individual’s private logic. A person with a mental disorder may have


common sense but make excuses in order to follow their private logic (Mosak & Maniacci,

1999). Convincing a person with an eating disorder that the logic they are being driven by is not

based in reality is part of the recovery process. Yet the eating disorder’s voice is so strong and

convincing, it is profoundly difficult to silence. It cannot be disproved by logic. Professionals

have to look at the private logic of eating disorders. To those experiencing it, the unpleasantness

of an eating disorder and its consequences are more desirable if it provides them with attention or

a sense of power or reinforces a false self-concept (Tierney & Fox, 2010).

Fictional Final Goal in Eating Disorders

A person with an eating disorder may start out with a goal weight. They may achieve the

goal weight, but there is always, without fail, another tier. The eating disorder itself has a

fictional final goal: To maintain constant control over the person. It will occupy a small amount

of space in a person’s mind then, like invasive barnacles thriving in murky waters, it will

multiply, consume, and occupy as much space as possible in a person’s mind. The person with

the eating disorder may not be aware that this is happening. They will not always know what the

eating disorder really wants. They might be under the deception that the eating disorder wants

the same thing: to increase their happiness and sense of belonging in the world. Classical

Adlerian psychology describes the growth and forward movement of life along a path governed

by a person's individual goals and private logic. It is a future-oriented strive toward an ideal goal

of significance, superiority, success or completion. The fictional final goal of a person with an

eating disorder is unachievable. They will die in the attempt. Every time they get close, it will

be moved further away.


Masculine Protest in Eating Disorders

Masculine protest is a concept described by Adler that pertains to eating disorder use. In

women, it describes a rejection of their feminine condition, the consequence of a devaluation of

girls in their family or cultural environment, and subsequent choice to pursue the masculine ideal

in guiding their lives. In men, this concept expresses itself as a superiority complex. The

masculine protest leads to overcompensation when a young child feels weak in the face of adults

or adult situations. They develop an intense need for support and a demand for affection.

Intensified dependency on outward forms of support or affection, rather than from a true place of

self-esteem, leads to increased feelings of littleness and weakness, often paralyzing them through

an inhibition of aggression and anxiety. If they are uncertain about their own abilities they

experience extreme doubt and where they see feminine tendencies come out as anxiety and

weakness they waver between that and the more masculine tendencies of aggression and

compulsion. The unquenchable drive experienced by those with an eating disorder, the extreme

focus and disregard for their own bodies is reflective of that desire for power through rejection of

the feminine tendencies.

The Cognitive Processes Behind Eating Disordered Behaviors

Progress in the treatment of eating disorders will best be made by increasing the

understanding of the underlying cognitive processes of eating disorders. A recent study has

shown that dysfunctional metacognition plays a role in the maintenance of anorexia nervosa

(Cooper, Grocutt, Deepak, & Bailey, 2007). As metacognition is about thought processes it

makes sense that process-based therapies for eating disorders would be most effective.


Metacognition in Eating Disorders

A very important, very nefarious aspect of eating disorders is metacognition.

Metacognition is the knowledge about one’s own thoughts and the factors that influence one’s

thinking; a concept that suggests that distress in psychological disorders, such as eating

disorders, is generated and maintained by cognitive biases that arise from dysfunctional

metacognition (Davenport, Rushford, Soon, & McDermott, 2015). These distorted

metacognitions then contribute to a maladaptive style of thinking known as cognitive attentional

syndrome which is characterized by repetitive and difficult-to-control worry and rumination,

threat-monitoring, self-focused attention, processing of negative self-beliefs and unhelpful

coping behaviors (Cooper et al., 2007). This type of thinking is very difficult to shift and thus

more helpful coping skills are not easily taught (Dahlgren & Rø, 2014). And for eating

disorders, these metacognitions are a large part of their difficulty in constructive thoughts as they

are constantly ruminating about distorted thoughts about food, weight, and shape. (Davenport et

al., 2015). It would be important to add that not only are they ruminating about food and their

own body, they are thinking of themselves in distorted ways, which is at the core of why and

how the eating disorder persists. Although metacognition is seen in a range of mental disorders,

metacognitions have been examined infrequently in eating disorders (Vann, Strodl, & Anderson,

2014). Dysfunctional metacognition is measured through the Metacognitions Questionnaire

(MCQ; Cartwright & Wells, 2008; Spada, Mohiyeddini, & Wells, 2008). The factors featured in

this questionnaire are positive beliefs about worry, negative beliefs about worry, cognitive

confidence, beliefs about the need to control thoughts, and cognitive self-consciousness. In

patients with eating disorders like anorexia nervosa, each of the metacognitive factors, except for

positive beliefs about worry, has been reported as significantly more dysfunctional than in


controls (Cooper et al., 2007). People with anorexia nervosa had less confidence in their

cognitive functioning, were more aware of their worrying thoughts, experienced worry as more

dangerous and uncontrollable, yet saw greater benefits in worrying (Spada et al., 2008). They

also believed more strongly in the need to control their thoughts to avoid negative consequences.

The findings support and expand on previous descriptions of poor sense of control in anorexia

nervosa, demonstrating that the perceived lack of, and struggle for, control extends to the higher

levels of cognition (Sassaroli, Gallucci, & Ruggiero, 2008). One way metacognitions has been

address, though not fully explored, is through cognitive remediation therapy (Fergus, Valentine,

McGrath, Gier-Lonsway, & Jencius, 2013). By understanding not necessarily the content but the

process of thought, it’s believed that the core process of sufferers can be determined. One article

asserted that the drive to be thinner is a key indicator of the intensity of core symptoms of

anorexia nervosa and is central to its etiology and maintenance (Chernyak & Lowe, 2010). An

assessment called The Drive for Thinness (DFT) subscale of the Eating Disorders Inventory-3

(Garner, Olmsted, & Polivy, 1983) highlights the perceptions, attitudes, and behaviors associated

with an intense desire for thinness, such as an excessive preoccupation with weight, dieting, and

avoiding weight gain (Grilo, 2006). Though this is, of course, how eating disorders present

themselves, professionals would be remise if they just looked at the surface desires of the person

with an eating disorder, like to be thin, and didn't look at what is actually driving them that is not

about food or weight. The majority (92%) of the patients checked their bodies to assess their

shape or weight and this was associated significantly with eating disorder symptoms (Shafran,

Fairburn, Robinson, & Lask, 2004). There was a strong association between eating disorder

psychopathology and body checking and avoidance. These findings supported the view that

body checking and avoidance are direct expressions of the over evaluation of shape and weight.


By doing so, the eating remains unchallenged and keeps a hold of the person’s cognitive

processes.

Changes Related to Eating Disorders in the Diagnostic and Statistical Manual (DSM)

Luckily, changes to the DSM (Davenport et al., 2015) have allowed for a less restricted

look at eating disorders. From onset, through recovery and onwards, how it is diagnosed is

important in understanding the progression of an eating disorder. The Diagnostic and Statistical

Manual of Mental Disorders (5th ed.; DSM-V; American Psychiatric Association [APA], 2013)

splits the feeding and eating disorders into several types: anorexia, bulimia, binge eating, and a

non-specific category. Anorexia nervosa is characterized by three diagnostic criteria: distorted

body image, excessive dieting or restriction of energy intake resulting in a significantly low body

weight, and an intense fear of weight gain or becoming fat. The DSM-V also rates the severity of

the disorder, from mild to extreme, based on their body mass index (BMI). The DSM-V changes

included removal of the word “refusal” when it comes to maintaining a healthy weight and

removal of the criteria of missing three or more menstrual cycles. There can be many crossover

symptoms in anorexia and bulimia, necessitating subtypes of eating disorders in the DSM-V or

the classification of as “Eating Disorder Not Otherwise Specified”. With these new changes,

people at a higher weight, or atypical anorexia nervosa could be considered in need of targeted

treatment where before (with previous editions of the DSM) they may have been over looked due

to this rigidity. It includes individuals with the clinical features of anorexia nervosa who do not

meet the weight-related criterion laid out by the DSM (Birgegard, Groβ, Lapidoth, & Norring.

2013). Although this is positive in changing the way we look at eating disorders, particularly

anorexia, there is need for further study. One study has looked into other indicators of diagnosis.

The main objectives of the study was to determine whether metacognitive factors between


typical or atypical anorexia nervosa, and whether the drive for thinness can be predicted by

metacognitive factors (Davenport et al., 2015). The findings supported that weight is not an

accurate indicator of the severity of the disorder or of recovery. It also suggested that being of

normal weight does not equate with normal metacognition in anorexia nervosa (Davenport et al.,

2015). Despite having restored weight to within the normal range they still exhibited clinically

significant symptoms requiring intensive treatment. Furthermore, ideal weights reported by both

groups were below their present weights. The findings suggested that distress and obsession

around weight may be driven, at least in part, by dysfunctional metacognitive beliefs, for which

current practices of cognitive behavioral therapy and pharmacotherapy are inadequate. In

addition, when offering treatment to patients with atypical anorexia nervosa, the severity of

psychological dysfunction should be taken into account.

A Critical Look at Common Causes of Eating Disorders

One well accepted concept is that a patient’s over-evaluation of shape and weight is the

so-called core psychopathology of eating disorders (Levine & Smolak, 2002). Professionals are

now looking more into the cognitive processes rather than cognitive content; which ultimately

will be more accurate in the treatment and understanding of eating disorders. It would appear

that dysfunctional metacognition serves to maintain anorexia nervosa. Rumination, a word often

associated with eating disorders and disordered thinking, is a large part of how an eating disorder

functions. That engagement in constant work, both positive and negative, leaves the person

concentrating only on their fears which leads them to engage in avoidant behaviors (Wells &

Matthews, 1994). A metacognitive approach, looking at ways to help eating disordered clients

be more comfortable with uncertainty, thus not necessitating worry, will likely improve

treatment outcomes (Fisher & Wells, 2009). Because unfortunately, a predictor of a chronic


disorder is the time span itself; the longer anorexia nervosa persists, the less effective therapy

will be (Fichter, Quadflieg, & Hedlund, 2006).

Social Media as the Cause

Appearance comparison has consistently been shown to increase body image

dissatisfaction (Cohen & Blaszczynski, 2015), and social media is a platform on which many

adolescents compare themselves to each other. Young person's self-esteem has become so

intimately wrapped up in this nonphysical world online yet there are still physical pressures. In a

recent study, participants completed questionnaires assessing how much they internalized the

thin-ideal, how much they felt like they were comparing themselves to others, and self-esteem

before and after image exposure on social media. The study was meant to look at the possible

connection between Facebook use and eating disorder risk. In the study, Facebook use was

found to predict higher baseline body image dissatisfaction and was associated with higher

eating disorder risk. Social media has also shown to provide a virtual forum for fat talk,

conversational threads about eating and exercise habits, weight concerns, and ideal body shapes

(Nichter & Vuckovic, 1994). Of 600 Facebook users aged 16 to 40, 50 % reported that

Facebook content made them more body-conscious; 31 % feeling “sad” as a result of comparing

photos of themselves to those of Facebook friends, and 44 % reported desiring the same body or

weight as Facebook friends (Clemmer, 2012). This is all evidence toward social media's ability

to affect our sense of self and particularly in young people, instill them with an over

preoccupation in an unachievable physical ideal but this doesn't necessarily mean that the

exposure to images is causing more eating disorders. Looking critically at this potential

contributing factor may lead us to look at deeper motivations for the participation in social media


sites. Adler would point out that it is a motivation to feel like they belong and that their social

media posts, and thus themselves, are significant.

Personality as a Cause

Eating disordered patients have been theorized to have a distinct patterns of personality.

Identifying and focusing on personality traits may aid in understanding eating disorders, help

therapists enhance the treatment alliance, address underlying problems, and improve treatment

outcomes. In eating disorders, personality has been shown to play a major role as a risk factor

(Lilenfeld, Wonderlich, Riso, Crosby, & Mitchell, 2006), as a moderator of symptomatic

expression (Tasca, Demidenko, Krysanski, Bissada, Illing , & Gick, 2009) for choice of

treatment, and as a predictor of outcome (Wildes, Marcus, Crosby, Ringham, Dapelo, & Gaskill.

2011). Personality traits commonly associated with eating disorders are high perfectionism,

impulsivity, harm avoidance, reward dependence, sensation seeking, neuroticism, and obsessive-

compulsiveness in combination with low self-directedness, assertiveness, and cooperativeness.

Research has demonstrated that the outcome of treatment is improved when addressing

personality features in conjunction with eating disorder symptoms (Fairburn, Cooper, Doll,

O’Connor, Bohn, & Hawker, 2009). Even as eating disorder patients recover, they appear to

retain a personality pattern differing from that of women who have never had such disorders

(Wildes et al., 2011). From young adulthood and onward we are expected to mature in

personality by gradually becoming more emotionally stable, more conscientious, agreeable, and

assertive, and yet less gregarious and less open to new experiences (Roberts & Mroczek, 2008).

Important life outcomes such as general happiness, physical health, work satisfaction, job

performance, quality of close relationships, and identity formation can all be delayed, avoided, or

somehow altered by the presence of an emerging, existing, or perpetuating eating disorder. But


the eating disorder, though at time seeming like a separate entity, did not just appear out of

nowhere. It is still a part of that person suffering from the disorder. Honoring and accepting the

parts of yourself that are useful to the eating disorder and reintegrating them into more healthy

parts of your life, is major part of work in recovery from an eating disorder. There is also room

to grow in the over generalization that all people with eating disorders are perfectionists.

Vilifying that, or any, personality trait doesn't help the person build their self-esteem. Adler's

concept of the creative self, wherein a person, not an outside force, is responsible for their

personality is applicable here. That creative force, which shapes all people, was warped and

perverted with an eating disorder. Healing the creative self would seem a more effective

approach than focusing on certain personality traits.

Media as a Cause

First, body dissatisfaction is exceedingly common particularly among females and as

noted above it is a variable risk factor for an array of negative outcomes, including eating

disorders and depression (Levine & Smolak, 2002). Recently, significant attention has been

focused on the effects of photo retouching in popular media where in magazines or online media

they correct flaws in the appearance and body shape and size of individuals featured in the

photograph or article. The main concern is that the result of retouching presents to the public,

and potentially those vulnerable to eating disordered behaviors, an extremely unattainable, in fact

physically impossible, image or body type for individuals to achieve, thus increasing body

dissatisfaction. Research clearly supports the negative impact of thin-ideal media images on

body dissatisfaction, and body dissatisfaction is a potential risk factor for eating disorders and

depression. This very popular common cause is supported by research but missing the true

impetus of eating disorders. It's true, the ideal of beauty has changed over the years, and women


are men are surrounded by standard images of acceptable figures; yet this alone will not cause

the kind of self-criticism, indeed self-hatred, which can lead to an eating disorder. Everyone sees

these images, on buses and on television, and not everyone is anorexic. They don't start because

someone wants to look like people in magazines; it's deeper and more complex than that. Eating

disorders have much more to do with inner pain then outer influences. Professionals have to stop

thinking about it as a desire to be thin; it's a desire to be something that you're not. It's a

rejection of self and a departure from one's own reality. That desire is the one to really look at.

Negative Self talk as a Cause

This cause is perhaps closest to the truth about eating disorders. The voice that someone

with an eating disorder hears, day by day, minute by minute, can seem like an entirely different

person than themselves. Its constant presence plays a crucial role in the development and

perseverance of disordered eating behavior. This voice's primary goal is to ensure that weight,

shape, and eating issues are never far from one’s consciousness (Cooper & Fairburn, 1992) that

self-worth remains integrally connected with how thin a person is, and that the sufferer’s original

self-identity and values are subjugated (Higbed & Fox, 2010). Research into this voice reveals it

as multi-dimensional; often speaking in the second person, and sometimes possessing a different

personality type. This is not considered psychotic. It is dichotic. Sufferers both depend on,

thrive on, yet hate the eating disorder voice. On one hand, the self-talk with the eating disorder

keeps them from being lonely and provides them with a sense of satisfaction and

accomplishment in what they have achieved as a result of following orders. And on the other

hand, underneath this incessant internal conversation is the quiet suffering inherent in living with

an eating disorder, the weariness resulting from constantly worrying about not only food but

their own worthiness to be alive, and during moments of clarity the sense of loss regarding


identity and life ambitions (Serpell et al., 1999). Close examination of the abusive relationship

component suggests a need to break-up the cycle of abuse. Further, in seeking to counter the

impact of the eating disorder voice, it is suggested that the seducer and abuser roles require

primary clinical focus (Scott, Hanstock, & Thornton, 2014). In spite of their voice's harsh and

forceful character, participants felt an affiliation towards it. Which makes treatment very

difficult.

Valuing the Eating Disorder

For those who haven’t experienced an eating disorder it would be difficult for them to

understand the incredible strength and incomparable sense of accomplishment it gives them.

How it relieves loneliness and provides, at times, an encouraging, trustworthy voice unlike any

other. For various reasons related to personality, environment, or comorbidity, a person may

need this relationship and the allure is too great to avoid. During trying circumstances the

budding eating disorder is reinforced every time it is affective in managing inner turmoil, gaining

recognition from others, or from providing a distraction from different stresses and demands. As

previously stated, certain personality types may be a better fit for eating disorders, mainly in

parts of the personality to do with trust, achievement striving, and facets of neuroticism (Tasca,

Demidenko, Krysanski, Bissada, Illing, & Gick, 2009). If this is part of a person's make-up, if

it’s difficult to trust people, they are always striving for more, prone to worry, anxiety, and

loneliness; an eating disorder can move right in and serve a very important purpose.

Strong Without It

An eating disorder can be considered a source of strength for sufferers. They see it as a

way to focus, to motivate and encourage themselves ever further. The relentless nature of the

eating disorder and its ability to get the person to comply with its wishes may look like strength


but it's the opposite; the sufferer's will is not their own. One of the largest and most important

steps into recovery is realizing those qualities that are admired so much in the eating disorder,

and that they believe they don’t possess without it, are all a part of themselves. An eating

disorder can’t create something out of nothing. Eating disorders are associated with a tendency

to worry about mistakes, a low sense of self-esteem, and a low perception of control over internal

feelings and external events and that perception of control and self-esteem is what makes the

eating disorder so difficult to give up (Sassasoli et al., 2008). Without reclaiming their personal

strengths, believing they are strong enough not only to escape the binds of the eating disorder but

tackle the fearful world without it, the eating disorder will maintain control.

Resistance to Treatment

Notoriously, eating disorder patients are noncompliant with treatment goals or in the

completion treatment in general. Or, if there isn’t outright noncompliance the eating disorder

will manipulate its way out of a situation which is threatening for it; all so it can survive.

Therein lies its trickery. An unpracticed ear may not be able to tell when a person is being led by

their disorder in a way that may appear compliant, but only to a point where attention is drawn

away and it can steal away, again, with the upper hand. This too highlights the complexity of

this disorder. For those that go in and out of treatment, their disorder isn’t always weakened; in

fact the opposite. It will become cleverer, more adept at hiding or stowing itself away. The

more a person learns and grows, the older and more mature they get, the more mature their

disorder becomes. If the reputation of eating disorder patients is going to change, if they are

known less for running out of treatment, treatment options need to become more varied and

affective in general.


The Seekers Graphic Novel

The second half of this project is a graphic novel about the relationship between a heroine

and her sidekick. The sidekick character is representative of the eating disorder. The comic

illustrated many of the concepts aforementioned in this project. The idea that an eating disorder

makes you stronger and more capable of handling life's challenges is reflected in the idea that the

heroine's powers are interlocked, or so she thinks, in the powers of the sidekick. They work as a

duo and are very close friends, intent on a purpose, and often absent from other areas of their

lives. Near the end of the comic it becomes clear that the sidekick, or the eating disorder, is

actually the villain and stealing her strength. It is only by defeating her former friend and

sidekick that the heroine realizes she is fully capable of great things all by herself.

Conclusion

The research and treatment efforts in the fight against eating disorders isn’t wrong. It’s

just incomplete. There is a current need for an expanded understanding of eating disorders and

the role they play in the lives of those experiencing them. The theories and methods used in

addressing this problem so far have been based on ideas of gender, body image dissatisfaction,

fear of maturity, management of perceivably insurmountable life problems, societal pressures

precipitating a drive to be thin, and distorted cognitions related to food. As admirable as these

attempts have been they are incomplete because they do not address the intricate and symbiotic

relationship between the eating disorder and the person whereby the symptoms become

psychologically necessary in order to maintain a sense of self and to manage the tasks of life.

This need to remain symptomatic can be seen in adolescent girls by their inability to sever ties

completely with the eating disorder, causing it to reoccur without finding new and healthier ways

to live without it. This project has taken a look back at Adler’s concepts of striving for


superiority, psychology of use, private logic, fictional final goal, and masculine protest in order

to communicate the reason adolescent girls not only develop an eating disorder, but why it

reasserts itself at different times in their lives. As with any mental disorder, a person’s

experience in all of life’s tasks is stopped and perverted; drawn into a pin point where years can

go by wasted in serve to mistaken beliefs and private logic. For those suffering from an eating

disorder, a small, unexplored life is exactly where it thrives, feeding off of a person’s sense of

self and hope, unchallenged where it is loved and depended upon. And in this way people can

live until it kills them. But this doesn’t have to happen. Not only lives can be saved but years of

suffering can be avoided. Detached from the eating disorder a person is more than capable of

thriving. In fact some of the qualities of the eating disorder, like commitment, toughness, and

perseverance; in reasonable measures, may be an integral part of who they are. And peace in

understanding that fact is also part of recovery. Give thanks to the part it played. And say

goodbye.


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