Externalizing the Eating Disorder
Why do clinicians and researchers talk about the eating disorder (ED) as though it is separate from the person experiencing it? There are many reasons why externalizing the eating disorder during treatment and recovery can be helpful for both patients and their support system. Treating the ED as a separate entity can help build compassion and create an alliance against the disorder itself, rather than the individual. It can also allow the individual to separate oneself from the disorder instead of taking it on as a part of their identity.
Recovering from an eating disorder can be exhausting. It can take a toll not just on the individual but on their support system as well. In my experience working with families who have been supporting their child through eating disorder treatment, I’ve seen how easily parents and caregivers can reach a state of “burnout.” Parents have shared how it feels as though they’ve lost their child to the eating disorder, noting that they may do and say things inconsistent with their personality. In initial Family-Based Treatment (FBT) sessions, I provide various metaphors that capture how the eating disorder takes over the brain. It can be seen as a parasite, a monster, a puppet master, even a Dr. Jekyll and Mr. Hyde scenario. The eating disorder may be angry, cruel, deceptive, and selfish, while the person struggling with the eating disorder may not exhibit any of these characteristics on their own. It can sometimes come as a relief to parents to learn that this is not their child acting or treating them this way but, rather, the eating disorder. When we separate the disorder from the individual, we can get annoyed and upset with the eating disorder while still holding love and compassion for the person struggling with it.
The question remains: how do we externalize the eating disorder? How do we start to separate the actions and behaviors of the disorder from the person themselves? For caregivers, the first step is remembering the aforementioned metaphors when you notice behaviors uncharacteristic of your loved one. Start by trying to identify the telltale signs of when the eating disorder is at the wheel; maybe it’s the way they speak to you, the look they get in their eyes, their posture, or their actions that indicate this switch to you. Having this awareness can help you know how to best support both your loved one and yourself from moment to moment.
Another way to externalize the ED is to talk about it as though it is a separate person or entity. Many people in eating disorder recovery have named their eating disorder so it’s easier to speak about it separately. Some folks go with the classic name, “Ed” (for eating disorder), while others can get very creative with the naming process. I love picking names that make my clients cringe or laugh because it’s best for them to not relate to the name. In the same way that folks sometimes name their “alter egos,” naming the eating disorder gives the client the freedom to mentally and emotionally separate themselves from the ED. While clients are still accountable for their actions, this helps them build compassion for themselves by remembering that maybe “Gertrude” was calling the shots when they were arguing with a loved one, not them.
A word of caution to caregivers, loved ones, and clinicians alike: sometimes naming the eating disorder can feel invalidating to the person struggling with it. If they are deeply entrenched in their eating disorder, calling it by a different name can make some folks feel misunderstood, especially if the eating disorder feels like a part of their identity. I recommend talking to them first before naming it with them or giving them the space and time to name it themselves. I’ve had clients adamantly against naming their ED at the beginning of treatment come around to naming it on their own once they feel ready to see it as a separate entity. Even if your loved one isn’t ready to name their eating disorder, I’ve worked with caregivers who still refer to the ED by a different name with one another to help themselves build compassion for their child. These caregivers are mindful to not share the name with their child and only use it when speaking with each other.
Finally, I’ve found that engaging in values-based activities can help clients externalize the eating disorder and allow them to view it as a third party rather than a part of their identity. Many of my individual clients have shared experiences where their “ED voice” takes over and causes them to act in ways that are inconsistent with their values. Values-based activities can help clients determine what their own values are in contrast with the values of the eating disorder. Some common values of the eating disorder include secrecy, isolation, emphasis on physical appearance, and prioritization of the needs of the self over the needs of others. When clients notice that they’re sometimes acting in ways that don’t align with their own values, they can better recognize when the eating disorder has been activated and build compassion for the self over time.
Eating disorder recovery is not an easy journey. It’s critical to remember that we’re working against the eating disorder, not the individual. While this may not be an exhaustive list of how to externalize the eating disorder, it is a place to start building a person-first mentality. Folks with eating disorders are not “disordered people,” they’re people with a disorder. Viewing recovery through this lens can help kickstart the process because it gives us a task and a path forward rather than allowing for resignation to a fate we think we cannot change.
Lilly Shively Parks Springer, PsyD
