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in the last section, we discussed four similarities between anorexic and phobic clients. These four similarities between anorexia and phobia included: mental distortions; stress; destructive emotions; and rituals.
In this section, we will examine the four stages of the progression of the disorder. These four stages of the progression of the disorder include: achievement; security-compulsion; assertiveness; and pseudo-identity.
One way to view the progression of anorexia is through the four stages of behavior. I have found that each client has progressed through these stages almost without exception. The categorization of these stages I have found helps to understand the client’s motives behind his or her behavior itself and why he or she practices this destructive behavior.
4 Stages of the Disorder
♦ Stage #1 - Achievement
Hunger pangs seem a small price to pay for the inner feelings of virtue and success, and often are interpreted as proof of success. This first stage of the disorder does not indicate abnormal behavior. Rather, it is in line with the trend most people adopt who consider weight gain as socially unacceptable and an enemy to be fought with an all-out assault.
Jodi, age 13, had been a straight-A student and a cheerleader before the onset of her disorder. Jodi had stated, "Before I decided to lose weight, I had put all my energy into being a fantastic cheerleader and an A student. But I kept noticing that my thighs were a little bit rounder than the other girls and my stomach just a little chunkier, so I decided to lose weight. Once I started, I got so many compliments from my squad members that I couldn’t stop. I wanted to be skinnier than them all and prove to them how beautiful I could really be."
Jodi had already shown a predisposition to anorexia and the adulation shown by her peers encouraged her to continue with the diet. Think of your Jodi. What kind of influence did his or her peers have on him or her during the achievement stage?
♦ Stage #2 - Security-Compulsion
It is no longer an active choice to exercise or eat less, but a need to, and this compulsion becomes heightened as the client develops phobias. These phobias incorporate a fear of fat, fear of increased appetite, fear of food, and even fear of liquids such as water. To regulate these fears, the anorexic client exercises more and eats less as this is the only sense of security he or she can achieve, but it is an insufficient security as the client’s fears continually haunt him or her.
Kyleen, age 18, described her security-compulsion stage to me. She stated, "I started noticing these wrinkles where my arms meet me shoulders and behind my knees. Now I know that I had lost more weight than my skin could contract, but at that time, I thought it was fat. I also knew that because I wasn’t eating as much that my metabolism was slowing down, so I was afraid that my body would still gain weight! Every night, I would fall asleep thinking of food and I would believe that I haven’t done enough to lose weight, so I would wake up with an urge to exercise!"
Kyleen had begun to shift into the stage of anorexia that becomes dangerous and which can now be diagnosed as a mental disorder. Think of your Kyleen. What sort of phobias did he or she develop during this stage of the disorder?
♦ Stage #3 - Assertiveness
The client will become argumentative about correct weight requirements and will force parents or loved ones to comply with her own eating habits. Parents become frightened of their child’s change in attitude and are unequipped to handle the sudden burst of assertiveness. The client, however, is thrilled by this new sense of confidence and newfound voice, which ultimately becomes another barrier to cross when treating the client.
Vanessa, age 16, would force her parents to leave the room when she ate. Vanessa stated, "I didn’t want them to see how little I ate. I thought that if they really saw what I was doing to myself, they would try to stop me. So I made them leave the kitchen during dinner time, or I left myself! They knew I wasn’t eating enough, so they did anything to please me so that I would eat. It never worked, though."
Think of your Vanessa. Could his or her parents benefit from being more assertive with their child?
♦ Stage #4 - Pseudo-Identity
♦ Technique: Personality Picture
Vanessa wrote, "I want to become a doctor someday and be able to help people just like me. I want to be smart and confident, but healthy. Obviously, who is going to want health advice from a wafer thin doctor!? If I died from my disorder, I could never help those people and maybe they would not get healthier because I was not there to help them."
Think of your anorexic clients. How would you help them redefine their personality through writing a personality picture?
In this section, we discussed the four stages of the progression of the disorder. These four stages of the progression of the disorder included: achievement; security-compulsion; assertiveness; and pseudo-identity.
In the next section, we will examine three concepts of obsession in anorexic clients. These three concepts of obsession in anorexic clients include: obsessional behaviors; abbreviations; and internal withdrawal.