Understanding the illness in full

Suggested Reading Instructions

Read this article several times - remember it takes time to grasp it in full.

'It is absolutely impossible for me to recover, maybe'.

I cannot stress enough the importance of realizing that sufferers are taken in by their own distorted thinking. Addictive compulsive thinking is not effected by intelligence. People who function at the highest intellectual growth levels are as vulnerable to these thinking distortions as anyone else. In fact, people of unusual high intellect often have more intense degrees of addictive thinking. Thus, highly intellectual people may be the most difficult patients to treat. How does addictive thinking develop? why do some people develop healthy thinking processes and others thinking distortions?

Addictive thinking is the inability of a person to make consistent, healthy decisions in his/her own behalf. This is not a moralistic failure of a person's willpower but rather a disease of the will AND inability to use the will. The peculiarity of addictive thinking is the inability to reason with oneself in a logical way.

The ability to reason with oneself in a healthy way requires certain factors:

• A person must have adequate facts about reality.
• A person who does not know the damage eating disorders can do, cannot reason correctly about it.
• A person must have certain values and principals as grounds for making choices. We all develop values and principals from our culture e.g. If family or cultural values are based on physical attractiveness or expensive luxuries, these will determine a persons behavior and failure to obtain them can generate deep disappointment.
• The last and most important of all a person must develop a healthy and undistorted self concept. The truth is that the world is often neither fair, nor just, nor rational. When anything happens that appears to be unfair, unjust or irrational, children cannot afford to see it in this way. Children conclude that because the world MUST be fair, just and rational, 'their perception is faulty'. 

They think 'I must not be able to judge things correctly. I am stupid'. Similarly, even when children are treated, for whatever reasons, in any manner they consider it unjust, they are unable to believe the statement, My parents are crazy. They punish me for no good reason. This would be too terrifying a concept to tolerate. To preserve the notion that their parents are rational and predictable, their only option is to conclude, 'I must somehow be bad to have been punished this way. However as children grow up, these misconceptions may continue to color their thinking and behavior. They continue to feel that they are bad people and therefore become vulnerable. They often consider their judgment grossly defective, which allows others to easily sway them. A person can feel bad or worthless even though this is a total contradiction to reality. Feeling insecure and inadequate makes a person more vulnerable to escapism.

Food, drugs and alcohol anesthetize the pain and allow this person to feel a part of the normal world. Fear of rejection, anxiety, isolation and despair often result from a low self esteem. Sufferers are not as illogical as they often appear if one can understand their concept of time. They make perfectly good sense to themselves when they say 'I can stop anytime I want'. However we must understand that the sufferer has a different concept of time as compared to ourselves. For the sufferer, time is measured in minutes or even seconds. I am referring to the sufferers intolerance of a delay for the sought after effect. The sufferer believes that food gives the effect on weight within seconds or minutes.

If the dietician tells them that she has a healthy meal plan for them, and the sufferer does not get immediate results, the sufferer tends to blame the dietician and refuses to go for any further consultations. Likewise if they do not see immediate results from the psychologist they tend to leave treatment. Often we become angry and frustrated with the sufferer, why can't they think normally and why can they not think of future consequences? Sufferers think about the future in memento, not days, months nor years. 

Cardiac failure, kidney failure, loss of a job or any other serious consequence are not likely to occur within minutes, so they do not exist in the addicts thoughts often because they are so pre occupied with weight and food. When they fully grasp the 'one day at a time' concept, they have begun their recovery. They must proceed cautiously. However, because a recurrence of time distortion is reason to suspect the possibility of a relapse. The time dimension of thinking is thus an important consideration for both the recovering addict and the professional in understanding and managing the addiction.

Sufferers turn logic around, they are convinced that their logic is valid. They not only resist rational arguments to the contrary, but cannot understand why others do not see the 'obvious' (Often you hear them say "You don't understand.") Similarly, a sufferer of dyslexia reverses letters in words, you show them the word 'dog' and ask them to spell it, they may spell God or odg. But they are certain that they have spelled it accurately. The problem involved is their perception of how the letters are re organized. This does not reflect their intelligence.
With a sufferer, perception of reality will continue to be distorted with or without medication or the use of substances until their disturbed perception that accompanies the obsessive behavior is corrected by psychotherapy.
One must realize that being dependant on others does not foster self esteem. Helplessness and dependency can generate feelings of inferiority. 

Guilt can lead to corrective actions, however, shame leads to resignation and despair. Feeling shame instead of guilt is a characteristic of the sufferers thinking. The remorse of the sufferer is not a guilt trip, it reflects self pity and shame. Recently a eighteen year old was asked by her mother to go on an overseas trip. She refused and when ask she replied "Firstly I don't deserve to go and secondly it is very expensive". Destructive behavior makes this person feel defective, rotten to the core and incapable of being anything else and for this reason psychotherapy is a necessity. O.A.'s Twelve Steps program converts shame into guilt, it also helps the sufferer deal constructively and effectively with guilt. Many sufferers are unable to see good in good happenings. Sufferers seem burdened by morbid feelings of being jinxed. When something good happens, they feel it cannot last or they don't deserve it. On one hand the sufferer fears anything that appears to be working well and believes it will eventually fail. On the other hand they then 'go ahead and do the very thing' that brings the failure they fear. Some sufferers have a pattern of building to the verge of success and then sabotaging it. One feature of the sufferer is the illusion of being in control. To some degree a delusion of omnipotence is present in every sufferer. This inability to admit loss of control in defiance of reality is characteristic of their thinking.

Anger is an emotion that is evoked by the occurrence of injustice toward ourselves or others. Bringing anger under control is necessary in recovery.
If anything seems to be present in nearly all sufferers, it is the conviction that the world has been unfair. They feel victimized by everyone and they are often angry at everyone. Sufferers often feel offended, belittled and humiliated by everyone. Their families don't love them enough, their friends don't value their companionship, they don't get enough recognition from employers for their hard work and so on. How much is enough? Given the hypersensitivity and the unstable needs of some people, infinity may not be enough. The problem then, for sufferers, is not in the abnormality of the reactions, but in the distortion of their perceptions.

While techniques for managing anger are important, getting rid of the distorted thinking that generates the anger would obviously be most helpful. Sufferers that recover get rid of resentments. When they develop a self concept and self esteem that reduces their hypersensitivity, they then begin to feel better about themselves and no longer need constant reassurance that others love and respect them. If your nervous system is intact, a burn should produce pain. If it does not than there is something wrong. Likewise voluntarily controlling one's reaction to anger is not wrong. It is perfectly safe to decide not to manifest anger but to feel anger is something else. Not feeling anger indicates an unconscious denial and repression of anger and this can cause problems. Anger that is denied and repressed can be converted into depression and various physical diseases.

Emotions are motivating forces, by definition, they are what makes us move. They are akin to a car's engine that provides the energy to propel the car. Sufferers may thus experience much anxiety and panic when confronted with new feelings they have never learned to manage. They may believe being angry means feeling homicidal. Loving means engulfing. Someone being loved means being engulfed by someone. Hating means alienating the whole world and so on. It is important for therapists and family members to understand what may be happening within the newly recovering person. They must be aware of the sufferers feelings were the target is food, discontinuing the control over food can result in emotional chaos which may occur as emotional paralysis. Learning to evaluate and manage feelings are major trials and errors. The sufferer must have a great deal of patience and those around the sufferer even more.

The denial of the sufferers way of thinking is neither conscious nor willful and the sufferer sincerely believes that she is telling the truth. I therefore consider denial and, for that matter, rationalization and projection to be unconscious mechanisms. While they are often gross distortions of truths. They are the truth to the sufferer. Until denial is overcome, sufferers are not lying when they say they aren't dependant on the control of food, they are truly unaware of their dependency of food or the control of it.
Rationalization and projection serve at least two main functions. They reinforce denial and preserve the status quo. Blaming someone else seems to relieve the sufferers responsibility of making changes and in so doing they enforce denial. It is only when they take personal responsibility that they overcome denial.

Sufferers often force family members into lying and covering up for them. Sufferers are people who develop expertise at manipulating and over time, this becomes an ingrained character trait. Early in recovery, some sufferers claim to have a flash of insight. It suddenly strikes them how blind they have been to their illness and how selfish and inconsiderate they have been all these years.
Having had this vision of truth, they may elect to leave treatment because they 'no longer need it'. Or if they do remain in treatment, they may become 'therapists' to other patients, helping them to achieve a similar flash of insight. The tragedy is that the sufferers have conned themselves into believing that they have achieved instant recovery. We know that a sufferer has a very low self esteem. If the distorted self concept of a sufferer is not corrected, it will be difficult or impossible to maintain recovery. The sufferer could develop psychosis, nervosa's or a substitute obsessive compulsive disorder.

Frequently, even when seeing reality, a sufferer will feel that reality is just not good enough. The normal rewards and pleasures of life are just not good enough. Something is missing and the sufferer feels cheated out of the true pleasures. Other people who appear to be content must be experiencing the 'real thing', but somehow the sufferer feels deprived of this. There must be more to life so the sufferer thinks true recovery from the disorder means more than simple abstinence. What It really means is relinquishing the pathological thought system and adopting a new healthy one. Therefore eating normally and the abstinence of binging and purging is only a partial recovery

Since this illness involves a distortion of perception, a person gravitates from a condition that appears to be of greater stress and never in the reverse direction. Food and other mind soothing medication provides some measure of relief from the discomfort, whether this is relief from anxiety, depression, loneliness, self consciousness, or just the compulsive urge. Abstinence, at least initially, causes distress, sometimes psychological discomfort, and often other severe physical discomforts. If we try to get sufferers to stop their obsessive control, we are essentially asking them to choose a greater distress. However, it is beyond human capacity to choose a greater distress. When pain and misery exceeds whatever relief the illness provides, then the persons perception of what is a greater or lesser changes.

This often happens when rock bottom occurs. Rock bottom is nothing more than a change of perception where abstinence is seen as a lesser distress. Should abstinence become greater again, a relapse will occur. The natural course of this illness is such that rock bottom will come if no one interferes. However, often family and friends in the sufferers environment, with every good intention, remove some of the distress that the addiction produces. This then prevents a change in perception of greater and lesser distress and permits the illness to continue. Coming in contact with people who have recovered and seeing that they are happy and productive demonstrates the rewards of abstinence. However, the sufferer may recognize all these rewards yet feel that they are beyond reach. This is when competent therapy, with realistic and appropriate self esteem-building can make a difference.

Successful treatment depends on the sufferers trust. Asking a sufferer to permanently abstain from the use of controlling food that has made life livable, Maybe the one thing that has made it tolerable. This is a very big thing to ask someone. A sufferer would say 'Doctor, when you showed me all my lab reports, you explained that not eating or vomiting would kill me and that I would die. That phrase didn't terrify me. I would have chosen to continue starving myself. I could not conceive of living without controlling my food'. Abstinence is often a formidable challenge, but even abstinence is not recovery, only a pre-requisite to recovery. Recovery requires a change in attitude and behavior which means a change in the way the addicted person thinks and has been taught for most of her life. The formula for recovery is as follows:

When pain and misery = or is > than the
relief the illness provides then abstinence takes place.
Therefore Full Recovery is ( + change - Abstinence . )

A recurrence of addictive thinking often precedes relapse and leads to other obsessive compulsive illnesses. Recovery is a growth process. Relapse is an interruption of the growth process but it is not 'going back to square one'. Yet almost without exception that is what the sufferer is likely to think. Unfortunately, the mistaken conclusion can negatively impact a persons recovery from a relapse.

Remember this, for it is important:
Be realistic about relapse, the growth in recovery that preceded relapse is not lost and a person can't expect the original experience in recovery the second time around.
These are two facts addictive thinking often distorts. Life is a series of ongoing challenges. We may put forth a great deal of effort to overcome one hurdle. No sooner do we begin to relax. Then we find ourselves confronting another hurdle, and this goes on. Sufferers who are addicted may believe that there is something unusual about this. If they find themselves unable to go for an extended period without some disturbance of their peace, they feel singled out and unjustly harassed.

Upon clear analysis though, a sufferers problems are not that different from any one else's problems. But, the perception of the sufferer is that they believe they are radically different. They think that other people get a break once in a while, but never them. Every aspect of recovery is subject to growth. Accepting life on its own terms, accepting powerlessness, surrendering to a higher power, taking and sharing a normal inventory, making amends - all these take place gradually.

Many sufferers naively believe that they have completed their course in recovery when they 'graduate' from a treatment program or begin eating. At this point, it is difficult for them to understand that they have not yet even begun recovery. The treatment program is only an introduction; Recovery is yet to come. We are all effected by other peoples behaviors in one way or another. Who is a co-dependent? A co-dependent person is one who has let another person's behavior effect him / her and who is obsessed with controlling that persons behavior. Obsessive thoughts crowd out all other thoughts, and then drain mental energy. Obsessive thoughts may intrude at any time, strangely enough, any attempt to rid those obsessive thoughts can increase their intensity.

At the risk of oversimplification, we might say that the addicted person is plagued by a compulsion: the compulsion to use food as a means of control. A co-dependent person is obsessed by the sufferers habits and by the need to control it. Much of denial is addictive, distorted thinking is often due to intense resistance to change. As long as a person can deny reality, he/she can continue behaving the same as before. Acceptance of reality might commit her to the very difficult process of change. Often sufferers have no problem with changes as long as the change occurs in someone else.

Just for fun, fold your hands across your chest and then observe the position of your hands. Some people fold left hand over the right, and some the reverse. After noting how you did it unfold your hands. Now fold them again in the opposite direction. You will notice how awkward this feels. The old way is normal and relaxing. The new way may seem strange and you may feel that you are unable to relax in this position.

If a simple change in position of your hands is so uncomfortable, just think how uncomfortable it is to change a part of your behavior and lifestyle. The more we understand how addicts think and function, the less likely we are to be paralyzed by the shock of their behavior, and the less likely we are to be taken in by their ingenious cunning and deviousness.

To parents, spouses and family members, now that you have read the above article and you are in one way or the other concerned about someone who suffers from Anorexia or Bulimia Nervosa. Remember as such, you can be vulnerable to the sufferers illogical thinking and manipulation. If this is so, participate in a support group as this will allow you to take a more object able view of your own life. With the help of others, you will be more able to clarify your own reality and learn to provide an environment for the sufferer to recover in.

"A Psychological Eating Disorder is an illness and not a weakness"