On the last track, we discussed three aspects of early development in clients diagnosed with anorexia nervosa. These three aspects of early development in anorexic clients included: prematurely matured; identity development; and parental messages.
On this track, we will examine four similarities between anorexic and phobic clients. These four similarities between anorexia and phobia include: mental distortions; stress; destructive emotions; and rituals.
4 Similarities: Anorexic vs. Phobic Clients
Similarity #1 - Mental Distortions
The first similarity between anorexic and phobic clients is mental distortion. Both anorexic and phobic clients experience intense worry about their fears. While phobic clients focus on their own obsessive thoughts, anorexic clients may focus on gaining weight as their dominant fear. Both of these types of clients use such destructive self-statements as "what ifs," and "shoulds" and deal in absolutist terms such as "always" and "never." Both groups will tend to obsess about what others think of them and thus results in an overdeveloped sense of perfection.
This perfectionism in phobics and anorexics results from the mistaken idea that a person’s worth is equal to his or her behavior. Without control of his or her environment or behavior, the anorexic or phobic client feels as they have failed in some respect. Another chronic worry is the conviction of poor self-image. While the client believes he or she is worthless, he or she will simultaneously strive for perfection.
Liz, age 14, weighed 79 pounds and believed she could never do well in academics, sports, making friends, or being a model daughter. She stated, "I was worried that I was overweight. I hated the fact that I loved food, and I convinced myself that my life would be better if I were thinner! I lost ten pounds and nobody at my school noticed! So I continued to diet, and became more and more afraid that I would get fat if I stopped. The hunger made me irritable and anxious. Almost everyone and everything pissed me off."
Despite getting straight-A’s, Liz was convinced that she was on the brink of failure and studied compulsively. Social activities took second place to rigid eating constraints, strict study schedules, and periods of overwhelming depression and panic. Liz was unreasonably striving for perfection, driven by the fear that her peers may not believe in her worthiness.
Think of your Liz. Is he or she driven by a fear of not being perfect?
Similarity #2 - Stress
The second similarity between anorexic and phobic clients is stress. Both phobic and anorexic clients experience high levels of extreme stress manifesting in insomnia, headaches, hyperventilation, or panic attacks. This stress makes it impossible for the client to develop the basic skills to work and treat his or her disorder. Most do not try to reduce the stress and accept it as part of a lifestyle and even as a motivator to continue the behaviors. Some clients try common methods such as medication or yoga, which ultimately fail because the client does not keep up the practice.
Paul, age 22, was a ballet dancer and weighed 120 pounds. In his highly stressful job, physical perfection was often required. Paul stated, "They give weigh-ins every month. You have to stand on the scale and they put your weight on a sheet of paper and tape it to the wall of the rehearsal room! The weekend before every weigh-in I have panic attacks. My chest goes tight and I have trouble breathing. Then I get upset that I’m even having a panic attack and that only makes the situation worse!"
Paul’s panic attacks related to his fear of being found to be overweight and even a fear of being discovered to have an eating disorder. Think of your Paul. What sort of manifestations regarding stress is he or she experiencing? How does this relate to his or her eating disorder?
Technique: Educational Opportunities
To help clients like Paul with their stress, I try to reframe such manifestations of stress as being an "Educational Opportunity" I asked Paul to view his panic attacks as a time to practice and recover. I stated to Paul, "The decreasing of panic attacks rarely occurs without practice. Admittedly, panic attacks are uncomfortable and inconvenient. But the sooner you face your panic, float through it, and count your successes, the sooner the panic attacks will dissipate."
I also encourage Paul to give himself time and to remember that he doesn’t have to handle the next panic attack perfectly. I suggested to Paul that every time he makes it through a panic attack to reward himself in a small way. He stated, "I’ll take a nice relaxing bath. It’ll help me get back down to ground zero."
Think of your Paul. Would he benefit from reframing his panic attacks into being "Educational Opportunities?"
Similarity #3 - Destructive Emotions
The third similarity between anorexic and phobic clients is destructive emotions. Both types of clients experience a number of negative emotions including depression, guilt, helplessness, anxiety, and fear. Depression and helplessness set in when clients realize the options open to them, that of eating. Guilt is also prevalent when clients cannot live up to the expectations given by society. These destructive emotions continue the cycle of phobia and anorexia in that feelings of guilt and depression can lead an anorexic client to exercise and feel worthy while a phobic client would react to these emotions through avoidance.
Similarity #4 - Rituals
In addition to mental distortions, stress, and destructive emotions, the fourth and most visible similarity between anorexic and phobic clients is the presence of rituals. The phobic client will avoid certain situations that may put him or her in danger of meeting the phobia. Destructive emotions previously mentioned often cause the onset of these rituals. The anorexic client will perform eating rituals such as picking or even purging. Social avoidance also becomes another ritual. Phobic clients do not want others to find out about their fears and anorexic clients believe that social situations present an opportunity for others to discuss how fat he or she is.
Nina, age 18 and weighing 85 pounds, would go running for 11 miles when she began to feel depressed. She stated, "Whenever I get down on myself, I go for a run. I think that the endorphins help and then I don’t feel so fat either. It’s a win-win situation." However, this running coping ritual was continuing Nina’s anorexic behaviors.
Think of your Nina. Does he or she have any eating rituals instigated by destructive emotions?
On this track, we discussed four similarities between anorexic and phobic clients. These four similarities between anorexia and phobia included: mental distortions; stress; destructive emotions; and rituals.
On the next track, we will examine the four stages of the progression of the disorder. These four stages of the progression of the disorder include: achievement; security-compulsion; assertiveness; and pseudo-identity.
Peer-Reviewed Journal Article References:
Glasofer, D. R., Albano, A. M., Simpson, H. B., & Steinglass, J. E. (2016). Overcoming fear of eating: A case study of a novel use of exposure and response prevention. Psychotherapy, 53(2), 223–231.
Schwalberg, M. D., Barlow, D. H., Alger, S. A., & Howard, L. J. (1992). Comparison of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III—R anxiety disorders. Journal of Abnormal Psychology, 101(4), 675–681.
Spector-Dunsky, L. (1985). Review of Les thérapies au feminin. Dépression, hystérie, phobie, anorexie [Review of the book Therapies with females: depression, hysteria, phobia, anorexia, by D. Brunet]. Canadian Psychology/Psychologie canadienne, 26(1), 73–74.
What are four similarities between anorexic and phobic clients?
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