By Lakshmi Krishnan, MSW, RSW
The conversation of “recovery” starts almost as soon as an eating disorder has been identified and diagnosed. Whether the person is a child or an adult, family and friends view the person as having “the issue” which must be fixed, cured or removed. Almost always, the person is also surprised to find themselves with a diagnosis and unsure of how to reverse the situation. The whole family now has to become acquainted with certain facts and ways of thinking to understand the situation and find the way out. In this series of blog posts, I will address some of the common terms and questions that arise in treatment:
Part 1: Why Teenagers And Why An Eating Disorder?
Eating disorders rarely start later in life. The underpinning anxiety almost always starts in early teenage years where the young person associates the internal feeling of emotional discomfort with the changes happening in their developing physical body. There are common jovial and flippant comments made about teenagers being ‘out of control’ or difficult to understand. The truth is, the teenage years contain the most significant metamorphosis we will ever experience in our lives, in a very conscious way.
Such a profound change will inevitably be accompanied by anxiety. I often talk about the caterpillar changing into a butterfly. However, the caterpillar has the comfort of his homespun cocoon to hide his messy business. Teenagers are on display in their awkward, gawky bodies. Some lucky teenagers happen to have found their groove and manage to feel supported and successful as they change, whether it be in athletics or academics or the chess club. Yet, others struggle. Add on to all of this a sensitive temperament and the social pressure of a 1000 pictures of perfectly symmetrical bodies and we have the makings for an eating disorder. It is good to know that an eating disorder is not a teenager “acting out”, but rather a deeply internalised expression of distress that is oozing despite the teenager’s efforts to not rock the boat.
The teenage years are also the period of differentiation.
What is differentiation? We start out in a highly enmeshed state, completely dependent on our parents. As the years go by, we move through numerous little separations towards adulthood where one is expected to make decisions, move out, and care for oneself. The teenage years are a period where expectations of independence go up exponentially. At the same time, we are also making peace with our emerging sexuality, differences and defining the self. This does not go smoothly very often. Anxiety accompanies every separation and every transition. Some anxieties might have been invisible, while others not as much. When the anxiety of transitions overshadow excitement, the process becomes scary. The teenager might retreat back into the last safe place they experienced. In a way, the ED becomes the cocoon that the teenager finds comfort in.
The anxiety, discomfort or awkwardness connected to puberty has always existed. The language of diet culture that suggests you can change your body into what you want it to be exists louder than it ever did before. Coaches and dance teachers use body-focused language to achieve goals without considering the mental state of their students. Parents are simply people who are also trying to live in their bodies as they adjust and experiment. We live in a time of diets, botox, plastic surgery and Ozempic- All quick fixes that imply magical solutions that take us far away from finding peace with the body we inherited.
The body is talked about as a separate entity without loving ownership. Control is misunderstood as “care”. A young person, desperate to dispel the ordinary anxiety of growing up, grasps around for a solution and quickly realizes that they can count calories, keep track of numbers and over-exercise or vomit. In the beginning, these things feel like a magical solution… until the person realizes the battle with a hungry, growing body is a conundrum that will not go away.
The anxiety of puberty requires co-regulation with a regulated, patient, adult who understands that this anxiety is a normal part of this evolution and does not feel challenged by it. Simplified solutions like “getting over it”, focusing on the positive, moving on or “pulling up your bootstraps” do not work and make the individual feel there is something wrong with them that they cannot dismiss their feelings successfully. The absence of attuned co-regulation results in a teenager who is ashamed of expressing their struggle and starts believing there is something fundamentally flawed in them.
Co-regulation requires a parent to slow down, listen carefully and be able to find the careful words that allow the teenager to breathe easily and feel understood. The goal-oriented busy-ness that many families have fallen into (albeit for the wellness of the children) leaves little room for this. A child might not express their distress if they feel a parent has too much on their plate or a parent cannot tolerate distress in an attempt to “not rock the boat”. Many children cannot actually keep pace with all the activities they are enrolled in along with the weight of growing up. An eating disorder interrupts this fast moving train. If therapy works as it should, the eating disorder brings attention to what the teenager needs and when the train starts again, we will move at a pace where everyone can breathe easily.
Check out Teen Support Group and Parent/Loved ones Support Group.