Eating disorders (EDs) are maladaptive coping skills that serve to numb an emotion, feel an emotion, feel a sense of control, etc. As a therapist, it is important to validate this experience for the client. An ED can be a client’s sense of identity, their go-to when they are feeling lost or out of control. They find comfort in the numbness and destruction of their eating disorder.
It’s hard to imagine, but some clients enjoy the pain that follows. They do not have to face their problems or troubling emotions when using symptoms (restricting, binging, purging, compensatory exercise). This may not seem logical, but that’s because EDs are not logical, yet they feel logical to the individual who is struggling with them.
Eating disorder treatment
In eating disorder treatment, the treatment teams often see one of two things that generally happen. First, once the eating disorder is stable (decrease in symptom use) their emotions become more regulated (decrease in anxiety/depression). Second, once the eating disorder is stable there is an increase in specific emotions (anxiety, depression).
Parents and family members ask why an emotion would increase after an ED is stable. Treatment teams explain to families that clients have been using this coping skill (ED), to cope with the emotions they are experiencing. Once ED is regulated, they are presented with the emotions that they were avoiding or numbing, which can be extremely overwhelming if their main coping skill is no longer being used.
Clients have to learn how to manage their emotions without their eating disorder, which is hard because they feel like ED is part of their identity, the voice they listen to when feeling upset, insecure or scared.
Understanding the nature of coping skills: good and bad
So how do therapists tackle this shift? Therapists can teach emotion regulation skills, distress tolerance skills, thought-challenging techniques and mindfulness, to create a coping skill toolbox that clients can pick from when feeling overwhelmed with emotions.
It’s important to discuss that coping skills do not eliminate an emotion, rather they decrease its frequency and intensity of it. This is hard for clients to grasp at times because they are not receiving instant gratification as they receive from their eating disorder.
Overall, it’s important to view eating disorders as a coping skill. Viewing it as a maladaptive coping skill can validate each client’s experience, and can also tell you a lot about how the eating disorder developed/how it functions. Clients are seeking to protect themselves in some sort of way, even though it can lead to sabotaging their mental health, physical health and the relationships around them.
Written by: Vanessa Zottoli, MS, NCC