An honest dialogue on anorexia nervosa


Working together in understanding the inner you

 It’s quite something if you don’t want to nourish yourself anymore. If you deprive yourself from your daily needs. When you feel the inevitable need to control yourself in such extreme ways. If you starve yourself to death. That something must be haunting yourself so deeply that you aren’t able to get out of it, no matter what the people around you say and do. That there is such a big difference in the way you perceive yourself than that others perceive you. That the obsession of wanting to lose weight no matter what, makes you lose everything in life, including yourself.

Anorexia nervosa is a serious eating disorder characterised by attempts to lose weight to the point of starvation, with a lot of physical, hormonal, psychological and emotional complications. Almost 5% of the women in western societies suffer from this condition in a severe way. Amongst men we see a lower percentage, but we also know that it can manifest itself in other forms. And besides that, there are many people finding themselves in the grey areas, having issues with (not having) food, but living a kind of normal life. These are the highly functioning people on whom we will never get a grip on, because there’s no reason to change for them. However, the fact remains that there is a growing problem worldwide and the excessive food culture we’re living in is only making it worse.

As a child of a mother who was suffering from anorexia, I was a close witness for years of the physical and emotional imprisonment that this condition brings across. I saw its devastating effects on not only my mother herself, but on her whole environment that became smaller and smaller, eventually resulting in serious isolation. Health, work, relationships and love of many and even her children were falling apart, in the end being drenched in every aspect of life that was not only related to food anymore. The path of destruction pulls everything with it into a dark black hole, where it’s very lonely and scary.

It’s not only because of all the patterns of lying, manipulation, secretly hiding and obsessive compulsive behaviour people suffering from anorexia become isolated, but there’s also a lot of misunderstanding and judgmental behaviour in the outside world. Sadly I saw how pathological loneliness and emptiness led to ultimate self-destruction and finally to death. Often it has made me feel very powerless not being able to save someone so close from dying and I punished myself with feelings of guilt and shame, which was not always easy to turn around, but I did. In many ways I’m very grateful now for my life experiences so far that bring me back to the essence of my values as a human being – as a person and professional – in my daily life and how I want to connect and work on a therapeutic basis with others.

Ironically, I find myself nowadays working a lot with people that are suffering from eating disorders and body image issues that unfortunately are being increased by society’s emphasis on the physical appearance and the superficial ideal picture of a so called ‘perfect’ body. What is important in that for me, is that we go beyond that. It’s about finding the inner self that is deeply hidden underneath the layers of the physical body. Wanting to control the appearance for the outside world, its shape, form and weight is a way of coping with something that goes on deep down inside and trying to deal with the believed powerlessness of not being able to have any control on that.

Recently, one of the women that I’m seeing weekly expressed that she wanted to share in public for the first time how life is living with anorexia and believes that sharing her story can help many others in the path of healing. I believe deeply in that too, as well as in the collaboration of our therapeutic process and sharing that with others. Therefore, we will come up in the next period with sharing our dialogues and bringing them to the point where we can understand and connect from the perspective what’s needed when working with anorexia nervosa. In this article we address five major aspects that are needed in therapy to reflect upon and take into account to understand the inner you when it comes to dealing with anorexia nervosa.

At a young age I felt my life wasn’t going like in other families and I always felt different. My parents always had a lot of fights and as a child I had to jump in between, asking them to stop. I wasn’t aware of the situation I was being pulled in and it gave me a deep rooted feeling that I couldn’t do anything right as a child. I was seeking support in cartoon characters like the Care Bears stories on television and my biggest wish was that would be alive so they could give me a helping hand. In puberty life was hell on earth for me. My body changed from a child into a woman and I had my first sexual abuse experience, which I didn’t saw as abuse because it was all looking very nicely by good parenting. At school I had a difficult time, I had problems with concentrating and I was bullied for being too fat for two years. My second sexual abuse was during a high school party by two classmates. I couldn’t tell what happened at home, I was feeling ashamed of myself so I hided it for years.  I was feeling very lonely, ugly and fat which I could not change. I had no self worth nor self esteem. Years where passing by and actually nothing changed at home. During dinner I felt like an outcast of the family. Fights between my parents were always my fault. At the age of 20 I started with a diet and I allowed myself strict two pieces of food a day. I went to school by bike and work so I had my daily exercising. I started to control my weight every day. Nobody had any idea. I wanted to lose weight, only a few kilo’s. At the age of 36, I wanted a relationship so badly so I started to chat with a man on Facebook. I thought everything went right and I was hoping for a warm relationship. But it wasn’t. He had some serious problems with alcohol, and gambling and most time he was drunk, hammering on my front door of my apartment. Even in my own home I wasn’t feeling safe. I wasn’t able to say “No”. After eight months the relationship was over. During that time I was feeling depressed, didn’t understand wat was going on with me so started my diet again, this time with almost no food and started to throw up after eating. The first time it felt like a huge step like jumping in front of a car but after several times it went easy. It’s all about control. I fell of from 62.1 kg to 42.6 kg now on my age of 43. Every day is a new day, a new fight try to let go of control.

  1. Connection & trust in the therapeutic relationship

For me, one of the most important things I found in dealing with anorexia controlling my life, is that nobody sees me the way I do. I often felt misunderstood by mental health professionals or in daily life. I had moments where I didn’t even knew who I was and that made me feel very depressed. When you find someone (a good professional) to talk to and stay connected with, understanding and trust are so incredible important and valuable.

In every therapeutic relationship it’s crucial to establish a connection in which authenticity, honesty, safety, trust and compassion are present. I personally take a lot of time to build on these anchors, because I believe this is the key of progress in any form of therapy. Many studies have shown that a good therapeutic relationship has helped many in more ways than the therapeutic content of the therapy. For me this is what it’s all about.

  1. Working on (self) acceptance beyond shame

In most cases anorexia has an underlying deeper problem that causes the disease, which is also the case for me. I developed a PTSD (Post Traumatic Stress Disorder) because of something that happened in the early years of my life, and in a way I had lost control over my life and the situation. For me it felt that as long as I experienced someone else is having controle over my life, in an unhealthy way, it is pretty hard to let go the control of food and weight. Same for the feelings of unworthiness, insecurity and lack of self love. This causes for example loneliness and feelings of self hate. It was so important for me to face the problem and accept it the way it is. I realised that I can’t change the past. But I can change the future.

Feelings of self hatred, shame and unworthiness, not wanting to be here, even not wanting to exist at all are so painful to experience. But this is where the healing process starts. To be with all these feelings in all its heaviness and painfulness in the connection with someone you trust. Sharing that in itself is breaking through the barriers of shame. In the safety of the sharing you give it the space to just be. Someone else is seeing for who you are again and is being ok with that. This is a very big challenge and a process that needs a lot of time. Dealing with unresolved traumas or life events that are often the underlying cause of developed behaviour that gives someone in a way self control back, even though it’s destructive, and then letting that go again, requires a lot of strength and resilience. It’s not the food. It’s not the body. It’s what’s inside that needs attention and wants to come out in the presence of non-judgment and compassion.

  1. Feeling safe

It is normal when you are not feeling safe, talking about anorexia and the underlying problem is very hard to do. I have experienced that many times. For me it’s important to find a healthy adult modus in a person, who is there for you when you’re not coping with the pain inside. Someone who lays an arm around you, shows compassion, gives you a hug and cares for you. It took years finding the right person for help and acceptance of my underlying problem and a long time to find out what makes me feel comfortable. For example I like to write about beauty I see in things and in life, being creative, using my imagination to let go of fear, anger, grief and control.

I do too believe that safety comes first. Always. In the first place the safety of welcoming you with all your flaws. And that everything is just fine. To hold the space for whatever is going on. This can only happen when it feels safe. Besides this emotional safety, as human beings we also need a sense of physical safety. The nervous system can calm down when there’s a sense of physical connection and togetherness. A hand, an arm, a hug. Sometimes this might even be too much. Somatic approaches can help then to create a safe feeling within yourself. And journalling is always a great way to express what’s going on inside.

  1. Redefining perfect as whole

Facing my problem is pretty hard to do. I know that dealing with it takes time to cure. I noticed that the inner voice in myself will continually try to stay in control with food, weight and causes me to live my life in fear instead of facing and accepting the underlying problem. It’s important to find connection to your inner self, to live in the moment and find some kind of inner peace.

I believe that loving yourself is one of the hardest things to learn in life. It takes a lot of time and awareness is the first step in that. Of course you will fall back. And that’s ok. Just to realise that this is exactly what is being needed. The place where you need to be. For me perfect is being whole. Integrating all the parts of yourself, also the ones you don’t like about yourself and having the space and light to just let it be. Without darkness there wouldn’t be no light. Accepting that is seeing it for what it is and allowing it to be there without judgement.

  1. Working on finding inner peace

It’s easy to say ‘find inner peace’, but there are tools which may be helpful as I have found. I learned to look at nature around me. Try yoga, meditation, visit a good friend who is willing to help and look for distraction. I made myself feel valuable and it helped me to be proud on myself. Actually self love is the most important issue to heal from anorexia that gave me inner peace.

Inner peace is an easy term that is being used for many reasons. It’s important to find your own reason. Therapy only works when you find your way in that and what resonates with you. Yoga and meditation are anchors that can support you to find your inner peace. But in the end it’s all about that what brings you back to a consistent practice of mindfulness. Whatever that may be. Don’t forget to breathe.

Letting go step by step is the key

In the end I’ve learned it’s all about letting go. Letting go is all about acceptance and commitment. Commitment with your inner child or inner adult, commitment and connection with your heart. From my own experience I know it’s difficult, hard, very emotional and scary but also relieving just letting (little) things go, one by one.

In letting go of all there is, we need to take one step at a time and do this one day at a time. Working together in understanding the inner you is a process that can’t be forced, nor rushed. Everything takes time and that’s ok. Every step is a milestone and worth to stand still for together in many ways. And that’s the path that we walk together in therapy. Step by step.


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