On this blog, Marcia and I have talked about the different ways one can interpret or understand eating disorders. Today, I have a few more for you. One of the hallmarks of a severe adolescent or adult eating disorder is a remarkable lack of joy, an inability to simply be in the moment. Instead, the anorexic or bulimic is always focused on a future outcome, such as “What will happen to me if I cave in to temptation and eat a peanut butter sandwich?” or, “If I don’t exercise every day I will feel like a pig.” Nancy Zucker, Ph.D., director of the Duke Eating Disorder Program at Duke University in Durham, N.C., brought up this singular lack of joy and a few other characteristic eating-disordered traits during a recent interview I conducted with her.
Another example: once on the road to recovery, both parents and those who struggled with an eating disorder will often experience what Dr. Zucker calls symptoms of “almost a PTSD [Post-Traumatic Stress Disorder] kind of trauma.” This is understandable because to be locked in the vise of an eating disorder is traumatic, resulting in a loss of identity, control over one’s life, and all too often, the will or physical strength needed to continue living. For the recovered or recovering patient, just the memory of the terrifying power of the disorder or the temptations that could trigger it once again can be disabling, leaving the patient feeling vulnerable and scared. For the parent, fear of an exacerbation of symptoms may lead them to be hypervigiliant to any slight change of eating behavior, an exhausting process for both child and parent.
Dr. Zucker sees eating disorders as “a disorder of self-regulation, a disorder of self-parenting.” The adolescent is “unable to respond to her own needs” and must be taught how to do that, she explains. Feeling lonely, depressed, hungry, angry or sad are some of the feelings that the eating-disordered child fails to be responsive to. It remains an open question whether it is a failure to decipher these cues, a failure to respond, or both. The individual with an eating disorder knows only that she feels badly, and treats this condition with her default response of self-starvation, or bingeing and purging.
To help parents deal with these emotional and behavioral challenges, Dr. Zucker has developed a skills program called Off the C.U.F.F. (Calm, Unwavering, Firm and Funny) that helps them recognize and attend to their own needs, and by example, show their child how to do the same thing. It also helps them react swiftly to signs of impending roadblocks in their child’s recovery. One of Dr. Zucker’s most popular tools is recognizing and mastering the “Eating Disorder wave”. The “wave” refers to a brewing emotional tsunami, the rising wall of intense feeling that can overpower a child and knock her off her feet and back into the disorder if parents don’t intervene in time. Learning to read subtle emotional cues and react swiftly, it turns out, is a highly effective way to prevent relapse or continued self-destructive behavior.
Dr. Zucker’s program has been so successful that it has been adopted by hospitals and eating disorder treatment centers around the world. A manualized version of Off the C.U.F.F. is also available.