Eating disorders (anorexia nervosa, bulimia nervosa or binge-eating disorder) often co-exist with addiction. There are some interesting similarities between a person with an eating disorder and a patient with an addiction problem.
Some of the patients at Castle Craig may have a history of an eating disorder, or maybe they had one in the past but it was masked by addiction.
Sometimes an eating disorder appears “out of nowhere” while the patient is in residential addiction treatment. We would see the addiction problems fading into the background while issues around eating, appearance and dysfunctional thinking become centre stage.
Sometimes we notice there is a problem but the patient is in denial — and this denial is another similarity with addiction. We try to increase the patient’s readiness to accept that denial itself is a problem, and then help them develop the motivation to work on it.
In some cases the eating disorder predates the addiction, so we’re talking about entrenched patterns that go back to childhood. They would have been very focused on their appearance, their weight and their self esteem.
We hold an eating disorders group once a week where we offer education and therapy. The education is about developing healthy eating habits, body image, and the consequences of bulimia or anorexia. We don’t educate our patients in a dry or theoretical manner, we discuss their own stories.
The experience of being with people with similar problems — and being able to trust and open up — can be very therapeutic. Patients can see that others are further on in their treatment and they find hope in this.
The other therapeutic aspect is to do with cognitive therapy: restructuring patient thinking around eating, the body and self-esteem. The term “restructuring” means we teach the patient how to identify negative, automatic thoughts about eating, weight and self-image.
Once the patients can identify these thoughts they challenge them and replace them with thoughts that are more helpful, more orientated towards recovery. Some of these negative thoughts may be: “I’m fat and ugly! I will only be happy if I lose another 10 kilos”.
Those who have had an eating disorder for a long time tend to think about eating in a way that’s not based in reality — this is called magical or mythical thinking. This thinking is deeply entrenched and there’s denial all around it, and when the patients are confronted with evidence that their thinking is wrong they still hang on to it.
An example would be: “I must get down to size 10 so that I can feel good about myself!” If that person gets down to that size, the thinking would suggest that they finally feel good about themselves and the need to keep losing weight will just disappear. But in reality that does not happen.
Initially, in the short term, they will feel better about themselves because of the sense of achievement: “I reached my goal and I have control over my body”. In the longer term, that person will feel just as bad about themselves as they did before.
The common denominator between eating disorder and addiction is low self esteem. This thinking says “I’m worthless. I’m not good enough.” They might feel out of control, as if they are not in charge of their own life. They will try to have control over what they eat, over their bodies or they may try to escape by taking intoxicating substances.