When working in the executive coaching arena, I sometimes bump up against topics that require specialist expertise. One example is eating disorders – the umbrella term for a number of distinct conditions including Anorexia Nervosa, Bulimia, Binge Eating, Overeating or some combination of the above. Interestingly, eating disorders cut across all social classes – so none of us are immune. Let’s have a quick look at Anorexia Nervosa.
Teenage Girls: In the past, Anorexia Nervosa was mostly associated with teenage girls, who essentially starved themselves to conform to a ‘perfect’ body image. A typical profile was a high achiever (often an ‘A’ student) with tendencies towards perfectionism. Mentally, they wanted to be the best and, side by side with this, wanted to look the best. This accurate profile was surrounded by a couple of ‘myths’ around causes. For example, there was a belief that girls who suffered from this condition ‘didn’t want to grow up’ (delayed physical development and cessation of menstruation often accompanies undereating). There was also a correlation made with over-exposure to glamour models streaming from the pages of magazines and TV programmes like America’s Next Model. The goal of becoming size zero and images of Hollywood stars being unbelievably thin just weeks after childbirth, bombarded teenagers with a subliminal message: Being skinny is the route to becoming beautiful, successful and happy. Yet, while all teenagers are exposed to these images, only some go on to have an eating disorder – so the ‘trigger’ is something internal within the individual.
Recent Research: More recent research in this area has shown that an inner fear of gaining weight can be carried for life (it’s not just a teenage phenomena) and can impact both men and women. For example, many young sportsmen over-exercise and starve themselves in an attempt to develop the ‘perfect shape’. This broader concept, which can be labeled a ‘body image problem’, is not confined to a particular age profile (teenagers) or single sex (female) group. Now, and this is a key point, most of us want to buy new swimwear for the holidays and to look good during the rest of the year. There is nothing wrong with wanting to make the most of your appearance or eating healthily to achieve this. But the general psychology around wanting to look good is light years away from someone who is suffering from an eating disorder. People suffering from the extreme versions of Anorexia Nervosa would literally die rather than eat.
Emotional Iceberg: Moving towards a perfect body image represents a ‘top layer’, the thing that is openly acknowledged and spoken about. The presenting issues are typically about ‘not being in shape’ or ‘becoming fat’. Yet, like an iceberg, a complex matrix of fears and emotions often lies beneath the surface.
Treatment Approaches: Understanding the link between eating and emotions is usually the first port of call. Sufferers can get ‘a high’ by not eating (in essence, they have beaten their need to eat and are in control of their appetite and their bodies). Yet, a binge eater can get an equal high if they consume everything, which is in the fridge, or wipe out 5 Easter Eggs in a single sitting. The point here is that the exact opposite behaviour (overeating or starvation) can be used to satisfy a core emotional need. Yes, it’s confusing. Hence the need for a clinical diagnosis and treatment by a competent therapist.
How can you detect it? How can you detect whether someone has an eating disorder? The condition generally does not to lend itself to self-detection (there’s often a strong element of denial). The first signal is where someone is obsessing about food. The purchase of particular food, the exact method of cooking (e.g. low fat preparations), an obsessive focus on calories and so on. People suffering from Anorexia Nervosa often don’t want to eat food served with the family because they don’t control how this is prepared. Parents may face tantrums around mealtimes (sometimes teenagers ‘pick a fight’ as a way to get out of eating). Other signs include food hidden in bedrooms, throwing away school lunches (stuffed into the bottom of a schoolbag or a hedgerow near the house) and the use of laxatives. Hearing a person vomiting is a telltale sign (sometimes the sufferer will throw up in the shower to disguise the noise). A huge amount of obsessive exercise (not sports related) and weight loss can also be significant. However, the core issue is not always that easy to detect. For example, a person suffering with bulimia (where they force themselves to throw up after eating) may not have any visible weight gain or loss for a long time. Early detection is beneficial as behaviour patterns, like train tracks, can be difficult to change once they become established.
Physical Danger: Lack of a proper food intake can lead to a number of dangerous physiological conditions. Like cars, our bodies require fuel to function normally. For example, bulimics can have dangerously low levels of potassium from vomiting and this normally leads to a person becoming weak as cellular processes are impaired. Without wishing to be overdramatic, there is a very real risk of death. This ‘physical risk’, differentiates eating disorders from other psychological conditions and often requires a 3-way treatment partnership between a medical doctor, the client and the therapist (sometimes the doctor is substituted by a hospital). It’s generally unhelpful if the doctor ‘fights’ with the patient for not eating. While the advice, “Get sense, go home and eat a good dinner”, might be correct (in lay terms) it seldom moves the situation forward. The client needs access to a doctor who is experienced in working with eating disorders and who can work in partnership with the therapist. Family members, despite their concern, may not have the skills to help a loved one. Constant ‘nagging’ about this, can actually worsen this condition by driving the behaviour underground. Like an alcoholic hiding small bottles of Vodka around the house, a person with an eating disorder can disguise their behaviour, claiming that ‘everything is grand’, accusing the concerned person of being a worrywart.
The Treatment: Treatment for eating disorders has a number of separate strands.
1. Establish Rapport: As is all clinical interventions, the initial attempt is to establish a solid relationship of ‘unconditional positive regard’. In essence, the client has not signed up for a new parental figure and does not need to be berated for their behaviour.
2. Thinking Changes: Using Cognitive Behavioural Therapy (CBT), an effort is made to change the person’s thinking (and, subsequently, their behaviour). The focus in therapy is normally ‘softly softly’ on this. After taking an initial overview of the situation, the therapist starts to uncover the thinking, which underpins specific behaviour e.g. “How do you feel when you (do X)?” Unless the person can change their underlying thinking, the behavioral changes will generally be short lived.
3. Behaviour Changes: The therapist subsequently guides the client into areas of productive behaviour: Example: “If I eat breakfast, I will get fat” may have been a core belief. If that can be changed to “If I eat breakfast, I will have the energy to do my work”, can result in the person taking a solid meal at the start of the day.
4. Dealing with Emotions: The final step is to help clients deal with emotions in a healthy way. If they are not feeling good (“My boyfriend/girlfriend dumped me”) they may have historically used food as a drug to self-soothe. This part of the therapy process helps people to understand that there is no escape from normal life emotions and they have to learn to cope with this in a healthy way.
Just Ask: Executive Coaching is geared towards helping people to understand the ‘normal’ life challenges we all face. But sometimes we’re asked to swim in deeper waters and have to make a judgment call about our own expertise. It can be difficult to do this because of personal insecurity (“Shouldn’t I be able to help?”) or client fears (“I came to you for support. Am I now being abandoned, pushed onto someone else?”). We are all good at something, but none of us is good at everything. If you are really smart, you’ll acknowledge your own limitations and know when to seek specialist support for your clients. And, acknowledging what you don’t know applies to executives just as much as management consultants.
PS: Thanks to Linda Brunton (my wife) for the specialist input on this topic. Linda is a Psychotherapist/Counselor and worked in this area for many years.
PPS Lighter Note: “We are here on earth to do good unto others. What the others are here for, I have no idea”. WH Auden
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