Over 6-8 months, my visits with Antoaneta (every 2 weeks at first, then less often) led to complete relief of her anorexia nervosa. Her weight dipped from 110 lbs (50 kg) at our first encounter to 104 lbs (47 kg) but then began to rise steadily, reaching 121 lbs (55 kg) at our last visit and later achieving a plateau of 140 lbs (64 kg) where she has remained for the last 4-5 years.
This was a remarkably good result and I would love to think the same could be achieved with other anorexic patients. However, bear in mind that Antoaneta was relatively healthy both mentally and physically when we began treatment. In addition, my experience with eating disorder patients is with a relatively small and select group. Because of this, it is important to be cautious in considering whether Antoaneta’s treatment might be helpful to others.
My approach to her care began with the idea that anorexia nervosa is a means of coping with emotional pain and chaos. In my patients with eating disorders, the disease is not about food, weight or body image but about control. Anorexia counters and partially relieves emotional chaos by providing the sufferer with something they can control: their food intake and their body. Other examples of coping mechanisms (that Antoaneta did not have) include self-mutilation, other eating disorders and addictions (to substances but also to habits like sex, work, exercise or gambling). Antoaneta’s treatment focused on the cause of her emotional pain and chaos which was frequent sexual abuse as a child. I rarely mentioned calories, eating habits, food or body image. Instead, our time was spent primarily on two issues: her low self-esteem and unexpressed outrage at the maltreatment in her childhood. To be continued…
Tags: addictions, anorexia, childhood stress, eating disorders, self-mutilation
