When An Eating Disorder Reappears

Carol* was in her mid-thirties when she came to see me. “I had an eating disorder all through high school and college,” she said. “But with the help of a terrific therapist I got a handle on it and I haven’t binged for more than ten years.” Recently, however, she had been overwhelmed by a desire to binge. “I want to eat everything in sight,” she said. “I’m never satisfied, no matter how much I eat.”

By F. Diane Barth, LCSW
Created Sep 11 2010 – 8:19am

Carol* was in her mid-thirties when she came to see me. “I had an eating disorder all through high school and college,” she said. “But with the help of a terrific therapist I got a handle on it and I haven’t binged for more than ten years.” Recently, however, she had been overwhelmed by a desire to binge. “I want to eat everything in sight,” she said. “I’m never satisfied, no matter how much I eat.”

In therapy Carol had learned that both starving and binging were ways of managing difficult feelings. The therapist had helped her talk about the feelings instead. “It was a long, difficult process,” Carol said, “because for a long time I had no idea what she was talking about! But eventually I got to the place where I could see that I was feeling something – hurt or angry or frustrated or even happy or excited – and I could talk about the feelings instead of stuffing them down.” The therapist also encouraged Carol to take up some kind of exercise and to begin going to meditation classes, which not only helped her burn calories (yes, even in meditation!) but also helped her manage her feelings. With these new tools, she had been able to slowly change her eating habits and now she was having no problem maintaining her weight at a healthy 130 pounds.

Until a few months before she came to see me. Why was she suddenly experiencing herself as she had more than ten years earlier? What had made the eating disorder suddenly resurface?

In my experience, this is not at all uncommon. (I taught about it in an online seminar several years ago) Yo-yo dieting, where you lose and gain weight over and over again, is actually one form of this experience; but it is not at all odd for old symptoms of any eating disorder to return long after they seem to have disappeared forever. Let me say that this is not the case for everyone who has had an eating disorder. But when the symptoms do reappear, there are several things one can do to quickly address them.

1. First, know that the return of eating symptoms does not mean that you have done something wrong. Also know that their reappearance does not mean that you are going back to where you were! It is a normal occurrence and has meaning, although you probably don’t know what it is yet. Once you understand what the return of the symptoms is about, you can take action.

2. You already have many of the tools you are going to need.

3. Because it could be physical – the onset of diabetes, perimenopause, pregnancy and many other physiological changes can cause dramatic changes in how we eat – get a medical checkup before you do anything else.

4. Once you have ruled out medical issues, try to determine what might have changed in your life. Often it is something that occurred shortly before the old behaviors re-surfaced. Usually it is something that you know about, but have not connected to the eating symptoms.

These things can be emotional – Are you upset by something, angry about something, feeling helpless, hopeless, sad – or, conversely, happy and excited – about something in your life? They can also be related to life changes – have you recently fallen in love, gotten married or divorced, changed jobs, moved to a new home or city? Are you trying to get pregnant? Is someone you love ill, or have you recently lost someone? Both good and bad experiences can cause emotions that we have troubles managing; and therefore trigger old habits that are our psyche’s attempt to make the feelings more tolerable.

5. The solution is not too hard. Once you have determined what is triggering your return to old behaviors, and after you have ruled out or begun treatment for any medical issues that might be causing them, you just have to do one thing: talk to someone. Talk to a friend, relative, doctor, member of the clergy, or a psychotherapist. Find a group of people struggling with the same issues.**

The evidence is that just saying our feelings and thoughts out loud to another person changes the neurological organization of our brains, which in turn can change our emotions.

In fact, it is this idea that has neuroscientists supporting talk therapy. But here is one final thought to remember: during the time that you were symptom-free, you built muscles and developed skills for coping with life and managing your feelings. (You can learn more about these “feeling muscles” in my articles on hidden eating disorders  and talking about feelings (“Speaking of Feelings: Affects, Language and Psychoanalysis” in Psychoanalytic Dialogues, 1998). Those muscles and skills are still there. They do not disappear, they just get hard to find during times of stress. Often saying what you are thinking and feeling out loud, to someone else, has a second benefit – as your brain begins to organize itself differently, it re-opens your access to those skills you have developed already.

This is exactly what happened with Carol. A medical checkup showed no physical problems, so we began to explore what might be triggering these changes in her life. It turned out that she had begun to feel insatiably hungry shortly before her boyfriend had asked her to marry him. She had known it was coming, and was looking forward eagerly to getting engaged. But, as we began to put the puzzle pieces together, it also became clear that she was having difficulties finding ways to even think about the changes that were about to come into her life. “I was excited,” she said, “and worried. How was I going to make this work? Would I really be the person he thought I was? Would I disappoint him? Would he disappoint me?” Putting her worries into words out loud in therapy seemed to help. Once she knew what she was worried about, she discovered that most of her friends had similar fears. Finding out that they were normal anxieties helped; and then she found that she could also talk honestly with her fiancé, who admitted that he was feeling some of the same things. “He told me that he loved me and wanted to live the rest of his life with me,” she said, “but he admitted that he wasn’t sure about being married. His parents had a very ugly divorce and he wasn’t sure he had a good model to follow for a happy marriage.”

Carol’s symptoms soon disappeared, but as we closed our work together she said, “So I may be back when I get pregnant. That will really stir up some feelings, won’t it?”

She may find that she has all the tools she needs to cope with those feelings. Fortunately she and her fiancé found that they could talk about their worries to one another and be supportive at the same time. But if the symptoms return, Carol will know that it does not mean she’s done something wrong; it is actually a valuable signal that tells her she needs to talk out something. She may need to come back into therapy to figure out what is stirring up her feelings; but that doesn’t mean there’s anything the matter. It simply means she knows how to use the tool of therapy.

*names and other identifying information changed to protect privacy of clients and families

**You can almost always find a group of fellow sufferers online – the only problem with that is that you will ultimately need to find someone you can talk to face to face, since there is some question about whether chatting without physically talking out loud with another person has the same impact.

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