The first part of treating Antoaneta’s anorexia focused on her low self-esteem. I deliberately avoided discussion of eating habits, body image or weight.
The sexual abuse she suffered as a child 20-30 years earlier left her feeling like a third rate human being. I have learned it is of fundamental importance to help childhood stress survivors see their early trauma as analogous to being born on the far side of Mt Everest and needing to climb over to become an adult. This image emphasizes their lack of culpability and also the courage and perseverance needed for survival. I pointed out to her that a hero in our society is someone who has overcome a physical or emotional challenge for a good cause. Antoaneta had done exactly that. As a reminder, I gave her a business card, on the back of which I wrote “Antoaneta is a Hero!” and asked her to keep it where she would see it regularly. Some of my patients have kept these cards in purses or wallets (or taped them to their bathroom mirror) for years.
When you have been taught repeatedly by the most important people in your early life that your feelings and the boundaries of your body are unimportant, it takes time to craft a new way to think about yourself. During this process, many patients benefit by imagining how respectful they would feel toward a young adult who had successfully survived a childhood identical to their own. Gradually, they learn to transfer that respect to themselves.
To be continued…
Tags: anorexia, childhood stress
