Written by Elizabeth Bloomfield-Deal, MA, PLPC
The effect of eating disorders on partners and loved ones has not received much attention in the form of empirical research. However, the sheer nature of an eating disorder can be extremely difficult to understand and accept. Watching someone you love deprive themselves of food and care or cause damage to their body is traumatic. Frequently, loved ones try to help by managing the eating disorder through feeding, encouraging the patient to seek professional care, or supervising them throughout the day. All of these actions are ultimately an attempt to help, but can be perceived by the patient as intrusive and controlling, thus turning a loving relationship into a conflictual battleground.
Someone who is deeply committed to and suffering from an eating disorder will most likely not ask for what they need from a partner. The protective wall that tends to be erected out of fear and guilt should not be taken by the spouse as a rejection. Katherine Zerbe, psychoanalyst and author of The Body Betrayed, states, “So many people smile on the outside and cry within—the most common secret patients with eating disorders hide…” It has been my experience working with patients with eating disorders that they desperately want to be close to others, but are afraid to connect out of shame, fear of being vulnerable, or ultimately of being rejected. They may simultaneously ask for help, and shut out loved ones. Eating disorder behaviors can commonly be seen as a defense against uncomfortable feelings. Depending on the diagnosis, the patient may restrict feelings with anorexia or purge them with bulimia, instead of expressing them with words or through experience. As a spouse, the behaviors can be confusing and alarming. It is difficult to interpret one’s needs when they are not spoken, but acted out.
Because of the secretive and dangerous nature of eating disorder behaviors, it’s not difficult to empathize when a spouse may choose to collude with an eating disorder in order to avoid conflict or in an attempt to not make things worse. When we love someone, we will do almost anything to keep them safe, albeit sometimes misguided. I’ve sat across the consulting room from numerous husbands who have pleaded with me for answers and instructions. They’ve described their anxieties, desperation and motivation to do anything that might help. They’ve been tearful, frustrated, and exhausted. Mostly, they’ve attempted to manage the symptoms themselves. They’ve gone to great lengths to hide running shoes, scales and monitor meals. I met one man who had removed the bathroom door from the hinges in order to prevent his wife from purging after meals.
What we know as professionals is that it has become increasingly clear that the management of symptoms cannot be equated with recovery (Zerbe, 1993). In fact, eating disorders require a more long term and multi-dimensional approach. Once the time sensitive and critical medical concerns have been addressed, a lengthy and intense psychotherapy provides the most space and opportunity for positive change. According to the National Eating Disorder Association, “The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Some medications have been shown to be helpful. Ideally, whatever treatment is offered should be tailored to the individual; this will vary according to both the severity of the disorder and the patient’s individual problems, needs and strengths.”
Time and again, the first reaction of a spouse with an eating disorder is an attempt at becoming the hero who saves or “fixes” their loved one. Although well intended, the drive to be a hero will most likely lead to disappointment and frustration on the part of the spouse, and shame and remorse on the part of the patient. In order to make significant change towards recovery, the patient has to develop some motivation to change. What I’ve learned that the patient needs most from a spouse is a safe place where she is allowed to take risks, be vulnerable, and make mistakes.
Eating disorder treatment takes time, and it is not a linear journey. There will be set-backs, and ultimately change. Working alongside one’s partner through the change can be difficult, and requires a significant amount of emotional stamina. I find it is always helpful when the spouse seeks his own therapy to manage and explore feelings, take a closer look at the dynamics in the relationship, and to process the difficulties of loving someone who is battling an eating disorder. Being in such a relationship can feel isolating. Most often intimacy declines, and activities that were once simple pleasures can become stressful and dreaded. Spouses frequently report feeling anxious, angry and depressed. The support of one’s own therapy can provide relief and a space to explore personal feelings and conflicts.
Eating disorders are entirely consuming. They occupy a person’s mind with obsessive, critical, perseverative thinking that interferes with almost every aspect of their life leaving little room for a viable, healthy relationship. The eating disorder can become a third party in the relationship completely overshadowing the personality of the patient or making void the character and personality that was once present and cherished. Ultimately, whatever level of care in which one is engaged, the support and understanding of the spouse is integral to the success of the treatment. Through medical care, nutritional education, individual and couples therapy, the most successful treatment is intensive, rigorous, takes time and includes both partners.
Zerbe, K. (1993). The Body Betrayed: Women, Eating Disorders, and Treatment. Washington DC: American Psychiatric Press.
Elizabeth received her Bachelor of Science in English and Community health from Southern Illinois University and her Masters in Professional Counseling from Lindenwood University. She worked as a therapist at the Schiele Clinic of the St. Louis Psychoanalytic Institute and has completed the Advanced Psychodynamic Psychotherapy Program at the Institute. She is a member of the American Counseling Association. Elizabeth enjoys facilitating groups such as sexuality, life narratives and family systems. Elizabeth uses psychoanalytic theory to help the patients utilize the therapeutic relationship as a place to explore the function of their eating disorder. She works to help the patients use their strengths to find balance and joy in their lives.