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Hijacked by Shame: Understanding Eating Disorders
Summary: A description of what is happening inside the person, underneath the eating disorder behaviors.
This article is an excerpt of Chapter 3 from the book The Erasing ED Treatment Manual by Nicole Laby and Sheira Kahn. This chapter was written by Sheira Kahn. While the new edition is being written, the original edition is available on Amazon: http://www.amazon.com/Erasing-ED-Treatment-Manual-Foundations/dp/1468040138/ref=sr_1_1?ie=UTF8&qid=1464118274&sr=8-1&keywords=the+erasing+ed+treatment+manual

Hijacked by Shame: The World Inside
Family, friends, professionals, even eating-disorder sufferers themselves find eating disorders perplexing. Why would an otherwise intelligent and competent woman refuse to do the most basic thing to keep herself alive — to eat, or refrain from overeating if that were threatening her health? While the behaviors do not seem logical, they do make sense in the context of the eating-disorder sufferer’s inner world.

The inner world of someone with an eating disorder is constantly being hijacked by self-hatred and shame. Although we’ve all experienced shame, few people who have not had an eating disorder can imagine the intensity of the shame for someone who has. Recall your most excruciating, humiliating memory. Were you panicked? Did you want to escape? Were you so desperate in that moment that dying seemed like a good option? You have barely begun to experience what someone in the throes of an eating disorder deals with continuously. Triggers are everywhere, from the number on the scale, to a brief glance in the mirror, to the perception that she said the wrong thing to someone.

People with eating disorders are often intelligent and passionate. The part of the psyche that creates the shame fuses this intelligence and passion to create a conviction of failure so strong that the ED sufferer experiences it at a cellular level. Because it feels authentic, questioning the conviction would be inaccurate, disobedient — even blasphemous. In this way, the shame hijacks her body, her mind and her emotions.

For example, take the assertion, “You’re fat.” Imagine that a well-nourished, but not overweight person is continually hearing that statement echo in her mind. She compares herself to models such as Gisele Bündchen, Kate Moss, and Niki Taylor — all of whom met the physical criteria for Anorexia at the time of this writing. Strictly speaking, if that is the standard to which she is comparing herself, indeed she is “fat.” Her intelligence then tells her that the assertion “You’re fat” is accurate. This leads to despair, which she experiences as real because her passionate nature allows her to feel things deeply and directly.

The shame leads to a further conclusion: “Because you are fat, you are unlovable.” This produces such a desperate feeling of isolation and failure that the person would do anything — ANYTHING — to improve the situation. The easiest thing to control is her body, so the dagger of shame turns inward. The depth of the conviction that she is unlovable, corroborated by emotions that feel true at a cellular level, combine to make her want to die rather than eat or gain weight. (Conversely, the person may be dying TO eat as an escape from the desperate feelings inside.) What she is trying to control is not just her body, but also her intolerable sense of isolation and failure. Unfortunately, the eating disorder only magnifies what it seeks to assuage, since it amplifies her sense of weakness and despicability.

The Hijacker Uncovered

The shame and obsessive ED thoughts are best understood and treated through the lens of Freud’s descriptions of the psyche. A battle rages between the part of the person that naturally wants to eat, and the part that wants him not to. The battle is slightly different in each type of eating disorder. The way the battle unfolds determines what kind of eating disorder each person will have. The three main types — anorexia, bulimia, and binge eating — are described below, preceded by a brief review of Freudian psychology to clarify terms.

Freud understood the human psyche to be comprised of three main, interactive elements: the ego, superego, and id. These elements are not permanently fixed. They act as processes for moving psychic energy and they function together harmoniously or not, depending upon the health of the system. Here is a brief description of each:

“Ego” means “I” in Latin, and is the central identity or sense of self. The ego is the seat of consciousness, and includes perceptual, intellectual, and executive functions. It organizes us to learn language, drive a car, and sort out sensory input. The ego’s main function is to oversee, mediate, and house the different elements of the psyche.

“Superego” in Latin means “over-I”. The superego’s main job is to protect and guide the ego. It does this by providing information, regulations and boundaries. The superego is conceptualized as a person’s conscience. It is the moralizing and critical part of the psyche (hence its interchangeability with the term “inner critic”.

“Id” has been translated from the German word “it”. The id is the seat of the instincts, supplying to the system messages about physical and emotional needs. It is associated with the child part of a human being. The id’s main job is to supply psychic energy to the rest of the system.

In a healthy person, “…these three systems form a unified and harmonious organization. By working together cooperatively, they enable the individual to carry on efficient and satisfying transactions with his environment.” In this scenario, the ego reigns. It has wide and flexible — but reliable — boundaries, allowing a variety of emotions, beliefs, and experiences to be included in the person’s central identity. The superego and the id cooperate in service of the ego. The superego provides gentle reminders and boundaries that help a person take care of himself and fit in with society, such as “Study hard so you can get into a good school.” The id supplies messages about survival such as, “I am hungry. It’s time to eat,” and “I am lonely.” In a healthy person, the urges and needs of the id, both physical and emotional, are welcomed and heeded by the ego. Conflict is minimal.

When these three systems are not working together, the person “…is dissatisfied with himself and the world, and his efficiency is reduced.” Eating disorders are an extreme example of this. While some mentally unhealthy people are dominated by the id, people with eating disorders tend to be dominated by a tyrannical superego that battles the id, leaving the ego narrow and powerless, destroying the life force of the person it is trying to protect. A large number of feelings and experiences are excluded from the central identity, even common ones such as sadness and vulnerability. Instead of “study hard,” the superego in someone with an ED would say “You had better work your butt off to try and muster a decent grade because FAT CHANCE you will even pass this test, let alone get into a good school, MORON!” In this environment, when the id comes forward with its message of “I’m hungry,” the superego spews rejection and derision in words or via a silent, toxic energy: “You are disgusting and unlovable! Not another bite until you lose ten pounds, PIG!” The unhealthy superego hijacks all the emotional energy from the id and becomes inflated and blustery, leaving the ego contracted and depleted, with the id fighting just to stay on the radar.

The id is often maligned in earlier psychological literature and in society at large as an inherently hostile force that must be tamed. Yet the id plays a crucial role in human health as the supplier of psychic energy. No human can survive without it. This is why the perfectionism of eating disorders (perfectionism being an effort to satisfy the superego) becomes lethal. Freud is quoted as saying that suicide was an unhealthy prevalence of the “Over-I” in the system. When the id energy is gone, so is the life force and the will to live. At that point, self-starvation makes sense. Alternatively, the aggressive superego can force the id to get its needs met only through hostile takeovers of the psyche, resulting in bingeing or binge-purge behaviors, which can also be lethal.

Another aspect of the unhealthy psyche is that the superego and id can collude and destroy the ego — or seek to destroy another person. In this scenario, the caustic criticisms of the superego join forces with the raw energy of the id to direct hatred toward the identified enemy, whether it is the ED client herself or someone else. Each person’s process is different, so it is important to discern the cycle for that individual. This will aid you in identifying the best interventions to use as well.

Whether in conflict with each other or in collusion against a perceived enemy, the antagonized superego and id consume most of the person’s psychic energy and time, with little left over for the development of a sense of self or ego. The result is that what is acceptable to feel, say, and do, i.e., what is allowed to be part of the conscious self, is severely limited for people with eating disorders. (This is another way of understanding the low self-esteem in people with EDs.) Those limitations force eating-disorder sufferers into psychic territory where typical human feelings are met with the superego’s harsh criticism (hence the alternate name for the superego, “inner critic.”) At that point, the part that houses the emotions, the id, may wake up and seek relief from the intolerable pain of the superego’s abuse. This relief is sought in the form of food, exercise, or restricting. In order for its urges to be heard, the id must be loud and forceful. The id’s force only escalates the conflict with the superego, however, and a full-blown battle ensues.

Body as Battleground

In all three eating-disorder types, the body is the battleground in the conflict between the id and the superego, and food (restriction or consumption) is the ammunition. Each type of eating disorder is an expression of what is happening in the person’s psyche. The eating-disorder behaviors are a manifestation of the superego combating the id; the quest for a thin body is an externalization of the internal sense of a small and narrow ego. This is why it is important to conceptualize and treat eating disorders as mental illnesses with physical consequences, not as physical illnesses with mental consequences.

Anorexia

The superego has won the battle over food in people with anorexia so that they cannot hear the id’s urges and messages to eat. By restricting, they have “succeeded” in the eyes of the superego. All of their emotional energy and life force, when it comes to food, is housed in the superego. If they have an urge to eat, they refrain from food, channeling the energy instead into a “superego-approved” activity such as exercising.

When anorexics have satisfied the superego by restricting or doing something else of its bidding, they report feeling powerful since the superego has mastered its objective: obedience. Now that the ego obeys and the id has been slain, there is nothing on the horizon BUT superego, and the client begins to identify herself as the superego. This leaves the anorexic with a sense of superiority over others because she can do what they cannot: she can rise above her human needs. The identification with the superego serves to illustrate how eating disorders are mental illnesses with physical consequences: when the superego is “successful” at killing off the id, the body begins to die.

Bulimia

For bulimics, the superego reigns supreme, with episodes of the id fighting its way in for a brief takeover before the superego is victorious once more. Many bulimics report a period of being “good” with food, meaning that they have satisfied the edicts of the superego, quashed the id, and are restricting or compensating for having eaten. In contrast to anorexics, however, bulimics cannot banish the urges of the id completely. “I am hungry. I want pancakes,” says the id. The superego replies, “You can’t have pancakes. You had bread last night for dinner.” “But I’m hungry,” the id insists, escalating the fight. At some point, the id wins and a binge begins. People report an experience of a runaway train, as they cram everything they can into their mouths while they are still saying “Yes” to food.

While people who don’t have eating disorders see eating as healthy and necessary, bulimics feel differently (in part because of the out-of-control element associated with eating). Once they are being “good” again, giving in to the id by eating is seen as a complete failure and bulimics hate themselves for bingeing.

Binge-eating disorder

For binge eaters, the id is winning the battle between id and superego when it comes to food. Like people with anorexia and bulimia, many binge eaters start the day by restricting. As they become physically hungry, or begin to crave food simply because they are set up by the injunction that they shouldn’t have it, the conflict between id and superego escalates, just as it does for bulimics. “I’m hungry,” says the id. “Well no one likes you this way. Don’t eat!” replies the superego. “But I’m HUNGRY!” insists the id. As the fight heats up, the id’s urges get stronger until the desire to eat is too strong to be denied and the dam bursts. After a binge, many revert to siding with the superego; they hate themselves for overeating. Others go numb to how emotionally and physically uncomfortable they feel. Unlike bulimics and some anorexics, people with binge-eating disorder don’t have the luxury of hiding their eating disorder. They wear their illness on the outside. This creates an exorbitant amount of shame and personal pain, which makes it even harder for them to do the self-love work that is necessary for recovery.

Some of the treatment challenges with people who have binge-eating disorder are a lack of motivation due to despair about size (the fact of their weight causes them to agree with the superego) and reluctance to exercise because it puts them in touch with their bodies or they have weight-related injuries.

A Fight to the Death

In all three ED types, the ego is underdeveloped when it comes to eating and body image. That is the hallmark, in fact, of an eating disorder: the out-of-balance psyche, with a dis-empowered ego. The ego is not developed enough to register the pain, nor is it strong enough to come forward and say, “Break it up!” to the id and superego. This means that the superego and id continue to fight unabated. As long as they are fighting, their conflict dominates the psychic stage, removing the focus from the physical and emotional consequences of the eating-disorder behaviors. In this way, the conflict between superego and id is a tool of denial. In this battle, there is no winner. It is a fight to the death, killing the souls and sometimes the bodies of people with eating disorders. Intervention is required to break the cycle of internal violence.

How the Superego Became Aggressive and Violent

What follows is information on how the tyrannical superego develops, and indications for the treatment of eating disorders.

Freud teaches us that the superego forms in such a way as to ensure the survival of the ego and the individual. Why, then, would a mechanism whose purpose is to aid survival destroy the very being it is supposed to protect? What went wrong? The answer lies in recent research on attachment. When Freud astutely recognized that the superego develops in such a way as to promote survival in the person’s family, this was understood primarily through the lens of physical survival and adherence to the family’s moral code. While researching attachment in children after World War II, however, John Bowlby and Mary Ainsworth discovered that it is not just physical survival or moral approval that a child seeks, but a secure emotional bond with a parent. The child needs a safe attachment, meaning the consistent presence of and reliable connection with a caregiver.

Building on the research begun by Bowlby, Sue Johnson, Ph.D., developed a theory of adult love based on her findings that grown-ups have the same attachment needs as children. This expanded our understanding of attachment as essential to all humans. Johnson writes, “The need for secure emotional connection with a few key others is considered to be hard-wired by evolution,” and “…isolation, separation, or disconnection from an attachment figure is inherently traumatizing.”

The word “traumatizing” indicates that a break in connection is not simply unpleasant or irritating, but on par with serious physical injury. It is both excruciating and threatening to the core. The extra-large, tyrannical superego that drives eating-disorder behaviors can therefore be seen as an all-out attempt in the psyche to change the person into someone that the caregiver won’t leave. The severe isolation and failure described earlier is the felt sense of being out-of-touch with a caregiver or attachment figure.

Our physical world is not perfect, and neither is any parent. Breaks in the connection with a caregiver are inevitable. But when the caregiver is chronically unavailable and the breaks are repeated and/or severe, the child develops a character structure around the trauma. That structure is the “unhealthy psyche” of the person with an eating disorder, described earlier. It is the inner landscape that features the huge superego, the depleted ego, and the id suffering from various degrees of banishment. This inner landscape is the basis for the eating-disorder behaviors, which not only mirror, but also reinforce the ego, superego, and id in their malformation.

Many times, the person with the eating disorder will be seen as the cause of family problems and becomes the “identified patient.” While families and loved ones experience tremendous pain as a result of the eating disorder, it is not accurate to hold the person with the eating disorder responsible for the family’s pain. The eating disorder is the result of dysfunction in the family system; it is not the cause. A caregiver may be unavailable for various reasons, included but not limited to:

  • Physical illness or death
  • Substance abuse
  • Mental illness
  • Physical, sexual, or emotional abuse
  • Narcissism that makes the caregiver appear functional to the public but which, at home, does not allow the caregiver to see or relate to the child as she is
  • A parent’s depression, fear of abandonment, or anger which dominates the family (and for which the child may absorb responsibility)
  • Any relationship in which the child must take care of the parent
  • Workaholism
  • Oppression from the world at large that weighs on the parent, such as the effects of racism, war, or natural disasters
  • A preoccupation or obsession with something that takes the caregiver away from the child emotionally or physically

Again, this is not to set up a standard of perfection for parents, nor to place blame. No parent can be present and available all the time. The clinician must strike a balance that includes finding out what happened and supporting the client to grieve about it, without giving the client license to identify as a victim. This list above is offered to assist you in looking for emotional patterns in the family and/or social system that may be contributing to the client’s enlarged superego and subsequently, the eating disorder. The goal is to find the emotional root of the problem and address it, while working to contain the ED behaviors themselves.

The clinician must strike a balance that includes finding out what happened and supporting the client to grieve about it, without giving the client license to identify as a victim permanently.
 
An additional factor that contributes to the formation of the unhealthy psyche (defined here as when the superego and id are in conflict and their conflict dominates) has to do with early attachment. Recent interpretations of classic attachment research reveals that one of the key functions of the attachment figure is to help the infant process feelings. Emotions are overwhelming to an infant. He or she looks to the caregiver — quite literally, by looking for reactions in the face and body — to receive and re-process emotions, then reflect them back in a way the child can handle. When sad, an infant experiences herself as overwhelmed and overtaken by the sadness. The healthy (securely attached) mother or father may register the sadness with her own reaction, then put the sadness in a larger context. For instance, upon seeing her child cry, the mother may wrinkle her eyes in concern, say “Aww,” and then, “We waited too long and now you got hungry.” Registering the sadness but still letting the child know that the situation can be handled, the mother then may soothe the child — but with an acceptance that the child did, in fact, feel sad. The child then gets to experience, through the reflection by the mother, the original sadness, but in a form that is no longer overwhelming. This demonstrates to the child that she does not need to fear her own emotions, that her mother is not afraid of them, and that their connection is still solid, even though there was a lot of emotion happening. She therefore does not learn to reject feelings, or herself for having them.
Alternatively, the caregiver may not be able to re-process the emotions and mirror them back to the child. The child can elicit a parent’s own sadness and the parent herself may be overwhelmed by it. In this instance, instead of emotions being reflected back in a manageable state, there is even more unmanageability in the child’s experience. In this situation, the child learns early that it is dangerous to elicit a negative reaction in the caregiver. Two things then result: (1) the emotions remain overwhelming and (2) the child begins to reject herself for having them as she sees they create distance from or rejection by the caregiver. This sets the stage for the id to develop in such a way as to be scary and overwhelming, like the emotions themselves. The uncontrollable emotions, through the overwhelming id, then contribute to being “out of control” with overeating or restricting.

It is worth noting that if the caregiver cannot re-process a child’s emotions, this is likely an indication that her caregivers did not do so for her. Therefore her id and superego would have also had to develop in a vacuum, without the loving containment they needed. In this sense the parent’s inability to provide what the child needs is not something for which to blame her or him, but rather an entry in a tragic timeline that gets passed down from generation to generation.

When working with an eating-disordered client, it is key to find that moment when she got the message that she should repress the id, and when she learned to reject herself for having needs and emotions. This moment may be traced back to a discrete point in time, but sometimes you need only to search for a pattern, as the inspiration for the repression is often repeated in current communications with the parents, loved ones, and with the therapist. Psychotherapy provides the context for re-experiencing the emotions so that they become integrated in the person’s experience and psyche.

As the person gets older, the uncontained id develops along with its counterpart: a voluminous and punitive superego. When the child’s emotions are met with either the parent’s overwhelming emotions or by a parent who wants to fix the child or take her pain away, the child gets the message that the emotional part of herself is unacceptable. Since those emotions remain uncontained and they loom large in her experience, the child may then perceive them to be herself. A kind of core identity develops, leading the child to conclude at some level, “This mess of emotions is who I am and who I am is unacceptable.” The large, uncontained superego that develops along with the large, uncontained emotions (and id) then becomes the agent of unacceptability and rejection, showing up in the person with an eating disorder as the voice that says, “You are disgusting and you don’t deserve to eat.”

The enlarged superego provides three primary benefits. The first is that it takes a person out of the despair and abject terror of losing the connection with the attachment figure and dealing with the overwhelming emotions. It provides a sense of hope. The thinking goes, “If I change myself (by losing weight, not being needy, etc.), then the person will love me and not leave me. Also, if I can contain my id, then I won’t trigger negative emotions in my parent.” The second “benefit” is a sense of punishment that feels just and right. The unconscious logic is, “I failed at my job of bringing the caregiver toward me or sparing her pain, so I deserve to be punished.” The third “benefit” of an enlarged superego is that it gives the person an internalized version of the rejecting caregiver, so he does not experience the profound sense of aloneness that lies beneath — because anything, even abuse, is perceived to be preferable to isolation (as the research on attachment corroborates).

Note on Narcissism: The Other Killer 
The violence of narcissism is sometimes overlooked and misunderstood. Since it is such a big factor in eating-disorder formation, it deserves special attention in eating-disorder treatment. When an emotional exchange happens in such a way that a parent or caregiver’s feelings overwhelm the interaction, the child then becomes a projection of those feelings rather than a full human in connection with the caregiver. Psychologically speaking, the child is not in the relationship at that moment. This break in connection feels devastating to a child and is similar to what an adult experiences when having a bad fight with a loved one. The loss of relationships then sets off a cascade of events including changes in body and brain chemistry. When the connection is broken repeatedly, a person’s sense of self develops in response to the physiological and neurological reactions, creating the characterological foundation for an eating disorder. In this sense, a home with no physical or sexual violence can be violent nonetheless. Your ability to search for chronic breaks in connection and your understanding of attachment will help the client stop abusing herself and turn toward what she really needs. The importance of this cannot be overemphasized, as women and men who come from families where there is no physical violence still experience a threat to their lives, first from the insecure attachments in their families, and then from the eating disorder itself. They merit the same sympathy and concern we accord the people from physically and sexually abusive homes. 


External Factors
In addition to the elements already described, it is well known that external factors contribute to the occurrence of eating disorders. A Harvard researcher demonstrated that the incidence of eating disorders rose in Fiji when television was introduced. The onslaught of media images in the U.S. (reported as 247 commercial messages per day on the Consumer Reports website in 2002) created the nearly impossible standard by which women and men measure themselves. Researchers at The Children’s Hospital of Philadelphia have found a genetic link to Anorexia, indicating that biology also plays a role. Peer pressure and bullying have been linked to eating disorders in a study by Beat, the leading research and resource group on eating disorders in England. External factors such as these are just the seeds of eating disorders, however. They can only germinate and grow in a family system that supports them.

Toward Recovery
Pervasive and life-threatening as they are, full recovery from eating disorders is possible through a process of repairing internal and external boundaries and creating healthy cognitive, emotional, and physical processes to replace the unhealthy ones. The attachment wounds that give rise to the eating disorder can be healed through reducing the dominance of the superego, reintegrating the id, reflecting on life events in an emotionally engaged yet objective manner, and improving relationship connections. The next chapter describes the relationship between superego and id, with its resulting eating behaviors, in each of type of eating disorder.