On the last track, we discussed the four stages of the progression of the disorder. These four stages of the progression of the disorder included: achievement; security-compulsion; assertiveness; and pseudo-identity.
On this track, we will examine three concepts of obsession in anorexic clients. These three concepts of obsession in anorexic clients include: obsessional behaviors; abbreviations; and internal withdrawal.
3 Concepts of Obsession
Concept #1 - Obsessional Behaviors
The first concept of obsession is obsessional behaviors. As we discussed in track 5, clients who are diagnosed with anorexia undergo different obsessional behaviors. Anorexic clients effectively become solely dependent on themselves and their obsessional behaviors to complete and define their personality. They use these all-consuming behaviors to regulate their daily activities.
The constant repetition of these methods of cleansing and under-eating become one never-ending process and a pursuit with no finish line. Unlike other addicts, anorexics cannot limit their immediate behavior. However, these clients still become addicted to these behaviors. As a result, many researchers will classify anorexic clients as having obsessional behaviors with addictive features.
Brittany, age 16, had become addicted to her anorexic obsessional behavior. She stated, "It’s like wanting or needing a drug! I get kind of shaky and anxious if I’m not exercising. I feel like I can breathe in calories by just smelling food. If I can smell it, I need to workout. I am addicted to this!"
I stated to Brittany, "Your addiction is much different than a drug or alcohol addiction. Rather than causing a pleasurable change in the way one experiences consciousness, obsessional behavior such as yours usually adds to your anxiety level. Additionally, your behavior is subject to infinite repetition because there is no finish line. Whereas the addictive personality can get high enough or drunk enough, the obsessional personality will never ‘get there.’ There is no ‘fix’ for what you’ve got."
Think of your Brittany. How would you explain the idea of obsessional behavior to your him or her? Would playing this track in your next session be beneficial?
Concept #2 - Abbreviations
The second concept of obsession is abbreviations. Abbreviations are ways in which an anorexic client’s mind teaches itself to move from step one because of learned patterns of thinking, and this abbreviation or short cut can occur on the mental and emotional levels. This concept allows clients to learn new skills without cluttering the mind with details of every step in the process, and anorexia uses a pathological use of this concept.
Thoughts of being fat or needing to lose weight become automatic. For example, a client in the early stages of anorexia may think, "I feel anxious so I’ll eat less, lose weight, and feel better." A client who has abbreviated or shortened his or her thoughts may just go straight to thinking, "I’m having a fat day!"
The client skips over the feelings and thoughts that are making him or her feel worried or upset, and, because of the practiced pattern mentioned above, immediately equates not feeling better with not having lost enough weight. These abbreviations often manifest themselves in the forms of mantras, or certain phrases that can cut off the rest of the world until all that exists in the client’s conscious and subconscious is the mantra.
Cheri, age 24, would obsessively view herself in the mirror while maintaining the least attractive posture in order to make herself look less appealing. Cheri slouched, thrust her stomach out and pulled her chin into a folded-in chest. She accentuated the "S" curve of her back and pressed her hands against the backs of her thighs to spread them out more. Cheri stated, "Look—look how fat I am! Look at my thighs! Look at my stomach!"
I stated to Cheri, "When I look at myself in the mirror, I stand as straight as I can. I pose to see myself in the best possible way. When you look at yourself in the mirror, you try to see yourself in the dumpiest way possible. Why would you want to see yourself at your worst?" Cheri replied, "I’m just a realist. I don’t try to disguise what’s there. I am too fat." Cheri repeated this last phrase "I am too fat" over and over again as though it were a chant. This is Cheri’s mantra and allows her to skim over emotions to reach one exact point.
Think of your Cheri. What mantras is he or she utilizing to avoid emotions? Would play this track in an session be beneficial?
Technique: Obsessive Thought Checklist
To help clients like Brittany and Cheri overcome their obsessional behavior and their abbreviations, I asked them to complete the "Obsessive Thought Checklist". I gave both of them a list of thoughts and asked them to score them from 1 to 3. A one indicated that the thought may pop into her head every few days, but it isn’t strong or frequent. A two indicated that the thought occurred to them at least every day, but didn’t absorb her time. A three indicated that Brittany and Cheri become obsessed with the thought that triggers an obsessive trance. This trance can last for hours.
Cheri’s Thoughts included but were not limited to the following:
--1. "I’m fat."
--2. "That girl is skinnier."
--3. "Mom hates me because I’m fat."
--4. "I hate myself."
Some thoughts that Cheri rated with a three were: "I’m fat" and "I hate myself." As you can see, Cheri’s most obsessive thoughts dealt with her appearance and how that appearance reflected on her own feelings of self-worth. Think of your Cheri or Brittany. Could he or she benefit from the "Obsessive Thought Checklist"?
Concept #3 - Internal Withdrawal
In addition to obsessional behavior and abbreviations, the third concept of obsession is internal withdrawal. Anorexic clients who have lost the ability to trust will withdraw into themselves in order to find a support system for their disorder. In the absence of interpersonal attachments, anorexic clients can become self-stimulating. They invent their own meanings for thoughts, actions, and events. In some clients minds, everything that happens to them is caused by them, and thus they keep their own minds under constant observation.
Thad, age 22, was six foot one and 105 pounds. Four years ago, Thad had developed irritable bowel syndrome, an early deterioration of his stomach lining that would eventually lead to an ulcer. Because of these two afflictions, whatever food was good for Thad’s stomach caused bowel inflammation, pain, and diarrhea. Conversely, whatever he ate that was good for his bowel hurt his stomach. After years of unsuccessful treatment, Thad lost faith in the medical and nutritional specialists he had turned to for help and began to withdraw from the people around him.
He was afraid to eat anything for fear that the wrong choice would cause him one sort of physical distress or another. Reducing his eating in an effort to avoid the pain caused him extreme weight loss. He reconciled himself to the idea that he was simply a thinner person than he had been. Losing weight had not been a goal, but just an unexpected outcome. As he slowly withdrew from the advice of others, he also withdrew from his emotional attachments to people, preferring to avoid pain at all costs.
Think of your Thad. How has he or she withdrawn from others and from his or her emotions?
On this track we discussed three concepts of obsession in anorexic clients. These three concepts of obsession in anorexic clients included: obsessional behaviors; abbreviations; and internal withdrawal.
Peer-Reviewed Journal Article References:
Darcy, A. M., Fitzpatrick, K. K., & Lock, J. (2016). Cognitive remediation therapy and cognitive behavioral therapy with an older adult with anorexia nervosa: A brief case report. Psychotherapy, 53(2), 232–240.
Engel, S. G., Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Crow, S., Peterson, C. B., Le Grange, D., Simonich, H. K., Cao, L., Lavender, J. M., & Gordon, K. H. (2013). The role of affect in the maintenance of anorexia nervosa: Evidence from a naturalistic assessment of momentary behaviors and emotion. Journal of Abnormal Psychology, 122(3), 709–719.
Fischer, M. S., Baucom, D. H., Baucom, B. R., Abramowitz, J. S., Kirby, J. S., & Bulik, C. M. (2017). Disorder-specific patterns of emotion coregulation in couples: Comparing obsessive compulsive disorder and anorexia nervosa. Journal of Family Psychology, 31(3), 304–315.
What are three concepts of obsession in anorexic clients?
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