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Tuesday, 22 February 2011

Denial- Friend or Foe In Eating Disorders

I’ve been asked to blog about denial so here we go.
Denial is what happens when someone insists that they do not have a problem with food, usually in response to the concern of carers or friends who may notice that weight is low or that someone isn’t eating very well.
Some writers suggest that “denial is something that exists in the counselling room”. In other words the person who has a problem may know that there is a problem but doesn’t really want to be helped right now.

Let’s take some possible scenarios;
They do not trust that therapist.
They are afraid of getting fat or losing control.
They get benefits from their eating control such as feeling special and powerful , or getting some attention from loved ones – who would want to stop feeling these things?
They feel ashamed of their eating behaviour, especially if they are binge eating or purging.
Or, the anorexic voice drowns out the voices of concern from other people. This voice tells them that they will feel a little better if they lose a bit more weight.

Denial- any of the above - is more likely to be present in a person who is thin. Bulimics for sure know they have a problem although they may not want to admit to it. At the same time, denial can be real – not knowing that you have an eating problem and not knowing that you are very ill. Some people who are in recovery say that, looking back, when they were in the grip of their eating disorder they were so compulsive and obsessive with food, exercise and eating rituals that they had convinced themselves that they were fine. It was as if they had been taken over by an alien being, and only if they collapse might they begin to accept that they are weak and ill.

Even then, a few days of rest convinces them that they were just overtired and can continue doing what they were doing before. We use things like muscle weakness tests to help convince some people that they are weak and that they might need to get some long term help.

I see denial around me in a great many forms. I see it in people who choose unbalanced eating patterns and who are convinced that they are allergic to certain foods, or that they can’t eat meat because they “really love animals”. I see denial in people whose gym or running patterns are a front for an addiction to exercise and perhaps the only way that they give themselves permission to eat. I also see denial in people who say that they are “working on their problem”, by going to therapy and talking, but they may refuse to turn talking into action; probably because they are terrified of change.

I also see horrible and selfish denial in parents who insist that their child doesn’t have an eating disorder. The child is just doing a lot of sport and is getting along very well at school thank you very much. God forbid that this family has a problem. Let’s not rock the boat. On the other hand, about half of all the calls I get are from worried carers, saying “how can I get my daughter/son, wife and even parent to accept that they need some help”.

Us therapists have a hard time with denial; we either call it “unconscious incompetence” or we say that someone is really “in denial” when what we mean is that we haven’t the sensitivity, the skills, the patience, the pacing and the ability to bring ambivalence, fear and resistance to the surface and deal with it safely.

So how do we sum up all the above; perhaps to say that we are all in denial to some extent about the motives for doing what we do. We might be in denial about our eating habits, our use of alcohol, or the effects of too many late nights. There isn’t a one-size-fits-all solution to the problem of “denial” but if anyone out there has some stories or some perspectives to add, please email me on admin@ncfed.com. Please!

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