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On the last track, we discussed three concepts related to anorexic clients who are survivors of incest. These concepts of anorexic clients who were victims of incest included: inability to trust; skewed sexuality; and learned defenses.
On this track, we will examine three manifestations of anger in anorexic clients. These three manifestations of anger in anorexic clients include: repression; acting-out; and defense mechanisms.
3 Manifestations of Anger
Manifestations #1 - Repression
Because of this, the anorexic client becomes anxious and scared about the angry thoughts that continually pop into his or her head. These thoughts can sometimes call for violence and shouting and these emotions are then transferred into exercise and undereating.
One of the conundrums or a paradox of anorexia is the conflicting patterns of wishing to be accepted and at the same time beliefs in worthlessness. They wish to appear normal but still don’t believe they are worthy of acceptance. If the client has underlying issues such as mental or physical abuse, these sources of anger may never be revealed because of the client’s wish to appear normal and under control.
Delilah, age 20, weighed eighty pounds, and had been under the thumb of her controlling mother, Martha, for her entire life. Martha had once been a pageant queen and therefore demanded perfection in every aspect of her life, including her daughter. Since an early age, Martha forced Delilah into beauty pageants for toddlers. Each week was full of activities and every day was a ritual of makeup, exercise, and priming.
Delilah stated, "I don’t think I ever had a childhood! That woman was crazy! She stole everything that ever meant anything to me! I wanted to write, she threw out my novels. She told me real women don’t need to think, their husbands think for them. She always told me I was too heavy. All the time! Whenever I lost a contest, she would say, ‘Did you see how skinny the winner was? Winners are always skinny.’ I became wafer thin to threaten her with my death, but I don’t think she even noticed."
Delilah had repressed her anger for years and to express it, stopped eating. Think of your Delilah. Is he or she repressing any anger that is causing his or her anorexia?
Technique: Shout It Out
Delilah stated, "I feel so much better after all that! I feel relaxed and a bit foolish, really. Which is good. It showed me how irrational anger can be so dumb at times." By using other outlets besides anorexia to express anger, Delilah can also learn to be more assertive and less livid at the memory of her mother. Think of your Delilah. What other ways could he or she express anger?
Manifestations #2 - Acting Out
Tommy, age 16, had been acting out at home. At five-foot-six, he weighed about 105 pounds. However, in a joint session with his mother, it was clear that Tommy ran the household. Whenever his mother, Elsa, answered, she looked to Tommy for confirmation. Tommy’s posture was slouched and his gaze seemed almost internal. It was apparent from his body language that he did not wish to be in therapy.
Tommy stated, "I’m the one with the problem, and if anyone’s going to do anything about it, it’s me! I don’t need your babble bullshit to tell me I don’t eat enough! Tough titties. That’s my decision! Mom isn’t going to do anything about it either, so don’t bother looking at her." Tommy wanted to be in control of his environment and used his anger to do so. The introduction of myself caused a small ripple in Tommy’s world and this caused him to act out further.
Think of your Tommy. How is he or she using his or her anger to control those around him or her?
Manifestations #3 - Defense Mechanism
Haley, age 18, was a straight-A cheerleader who was president of her class government. In a few months, however, she had lost twenty pounds and her mother, Beth, had begun to worry about her. Whenever Beth approached her daughter about her weight, she was met with unprecedented hostility. Beth stated, "And it’s not just with me either! Her friends have stopped coming over. No one wants to spend time with her! She’s in her room all day, and I know she’s doing exercises."
Haley stated, "I’m just exercising my independence. Everyone just needs to get off of my back! I’m not doing anything wrong! I don’t drink, I don’t have promiscuous sex. No one knows what it’s like to be a teenager in this day and age! I look normal." I then asked Haley why she had started to lose weight. She stated, "Usual peer pressure stuff. I wanted to ‘fit in.’" I then stated, "If you wanted to be accepted by your peers, then why are you pushing them away? Could it be that it’s not you but your illness that is controlling your anger and your reactions?"
On this track, we discussed three manifestations of anger in anorexic clients. These three manifestations of anger in anorexic clients included: repression; acting-out; and defense mechanism.
On the next track, we will examine three difficulties in employing the family of an anorexic client for treatment. These three family treatment difficulties include: inability to dissociate; eating strategies; and allowing for client independence.
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