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In the last section, we discussed three aspects of early development in clients diagnosed with anorexia nervosa. These three aspects of early development in anorexic clients included: prematurely matured; identity development; and parental messages.
In this section, we will examine four similarities between anorexic and phobic clients. These four similarities between anorexia and phobia include: mental distortions; stress; destructive emotions; and rituals.
4 Similarities: Anorexic vs. Phobic Clients
♦ Similarity #1 - Mental Distortions
This perfectionism in phobics and anorexics results from the mistaken idea that a person’s worth is equal to his or her behavior. Without control of his or her environment or behavior, the anorexic or phobic client feels as they have failed in some respect. Another chronic worry is the conviction of poor self-image. While the client believes he or she is worthless, he or she will simultaneously strive for perfection.
Liz, age 14, weighed 79 pounds and believed she could never do well in academics, sports, making friends, or being a model daughter. She stated, "I was worried that I was overweight. I hated the fact that I loved food, and I convinced myself that my life would be better if I were thinner! I lost ten pounds and nobody at my school noticed! So I continued to diet, and became more and more afraid that I would get fat if I stopped. The hunger made me irritable and anxious. Almost everyone and everything pissed me off."
Despite getting straight-A’s, Liz was convinced that she was on the brink of failure and studied compulsively. Social activities took second place to rigid eating constraints, strict study schedules, and periods of overwhelming depression and panic. Liz was unreasonably striving for perfection, driven by the fear that her peers may not believe in her worthiness.
Think of your Liz. Is he or she driven by a fear of not being perfect?
♦ Similarity #2 - Stress
Paul, age 22, was a ballet dancer and weighed 120 pounds. In his highly stressful job, physical perfection was often required. Paul stated, "They give weigh-ins every month. You have to stand on the scale and they put your weight on a sheet of paper and tape it to the wall of the rehearsal room! The weekend before every weigh-in I have panic attacks. My chest goes tight and I have trouble breathing. Then I get upset that I’m even having a panic attack and that only makes the situation worse!"
Paul’s panic attacks related to his fear of being found to be overweight and even a fear of being discovered to have an eating disorder. Think of your Paul. What sort of manifestations regarding stress is he or she experiencing? How does this relate to his or her eating disorder?
♦ Technique: Educational Opportunities
I also encourage Paul to give himself time and to remember that he doesn’t have to handle the next panic attack perfectly. I suggested to Paul that every time he makes it through a panic attack to reward himself in a small way. He stated, "I’ll take a nice relaxing bath. It’ll help me get back down to ground zero."
Think of your Paul. Would he benefit from reframing his panic attacks into being "Educational Opportunities?"
♦ Similarity #3 - Destructive Emotions
♦ Similarity #4 - Rituals
Nina, age 18 and weighing 85 pounds, would go running for 11 miles when she began to feel depressed. She stated, "Whenever I get down on myself, I go for a run. I think that the endorphins help and then I don’t feel so fat either. It’s a win-win situation." However, this running coping ritual was continuing Nina’s anorexic behaviors.
Think of your Nina. Does he or she have any eating rituals instigated by destructive emotions?
In this 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 the next 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.