Drawing Parallels to Addiction in the Treatment of Anorexia Nervosa

In 2022, many people have a pretty good working understanding of what an addiction is, or what being an "alcoholic" means. We may personally know someone who has struggled with drugs or alcohol in this manner, have provided mental health support for someone for this reason, or have experienced it for ourselves. However, not everyone equates eating disorders with addiction. It's hard to blame them, as eating disorders are not listed as or associated with addictive behaviors in most professional talk. However, I hope this blog can shed a new light on some similarities between anorexia nervosa, and addictions pertaining to a substance of choice.

 Mechanisms at Play

For starters, let's begin with thinking of the function that addictions serve. The drugs of choice help one escape reality, ease emotions, feel safe, feel happy, or to feel nothing at all. Eventually, neurotransmitters in the brain demand these substances so that they may release in manners that will provide those "rewards" felt while under the influence. So, how does this pertain to anorexia nervosa?
Many people believe this disorder is about control, weight, or body image, which are not "wrong" answers by any means. However, there is often so much more to the purpose of starving. When the brain is starving, it's going to dull some sensations: whether it's fear, anger, or anxiety to name a few. It can make you feel safe, as nothing can raise a strong emotion from you. It can make you feel happy, as you are in control of, or are "good at" something in your life. It can make you feel comfort, as it has "helped" you many times before. It can make you escape your own reality.

Anorexia: Tangible Action
Do these sensations sound familiar? Additionally, when we talk about things like self-harm addictions, we notice that people get addicted to doing something about what they feel, providing a tangible sensation of pain, of punishing themselves, of expressing what they're feeling through their body. When someone decides to starve their body, muscles, and brain, they are doing just those things. They may be shrinking their body to show others what they can't put into words. They may be using that hunger pain as something tangible to cry about. They may be punishing themselves, as they believe food must be earned. Those neurotransmitters that were begging for that extra run or the lack of fuel are now creating a storm of their own in those in anorexia recovery.
 

Food: Not the Problem
It's important to recognize these similarities in mechanisms, in order to treat effectively. As counselors or eating disorder specialists, we cannot simply talk about the food, the body, or the weight, and expect the brain to no longer crave the sensations it's become accustomed to. Just as we cannot simply talk about the drugs or the alcohol, we must talk about what is driving it all. The way someone may try to "drink away the pain" of losing someone, sadly, "starving away the pain" works all the same. On a not always conscious level, these acts can often be forms of self-sabotaging or self-destruction, if the one struggling doesn't believe they deserve to have or accomplish good things. We must be competent as counselors to see past the surface level of the food, just as we do with substances.

  A Difference: Finding Balance

With all of these similarities, as counselors, we must also acknowledge the differences. Some of these differences are concrete, while others have been drawn from perception. We must remember that with addiction counseling, we want our client to be able to stay away from the "bad thing." Their goals may be to say no to drugs and alcohol, to stay away from environments where there are drugs and alcohol, or to learn how to be around these things without "giving in." There are also those occasions where clients seek to find the "middle ground" of having it, but not too much. Of course, this comes with it's own sets of challenges, making it often not the first goal of choice in recovery. Unfortunately, this method is the only option in eating disorder recovery.

 "Just say 'No'" vs. "Say 'Yes' Often"
The bottom line is that the "bad thing" with anorexia can't exactly be avoided. The addiction at hand may be to an empty belly or a long run, or the combination of both. This means that the scary item of food cannot be avoided, but rather used in an appropriate manner. The exercise can't just be taken out, as it may be vital for health. This begs the question of, how to incorporate just enough food, or just enough exercise, without tipping the iceberg into too much or too little. Staying invested in eating disorder recovery is tough enough, now the client's have to have a little taste of it every day?

  Not-So-Obvious Triggers
We must remember, as counselors or eating disorder therapists alike, to acknowledge this difference. While the "scary" component in addiction is staying away from the substance one has felt they used to survive for so long, the scary component with anorexia is having to actively put something into your body, and learning to eat more when you feel that you've survived for so long this way. You cannot avoid situations where food is present like you would with alcohol, as food is a necessity for life. You cannot avoid seeing exercise, as your neighbor jogs by you on the way to work.
Though people tend to understand that you shouldn't talk about your drinking over the weekend with your friend who's now sober, many people don't understand the parallel with anorexia. Talking about your new diet, exclaiming that you've lost 5 pounds, complaining that you'll have to "work this off tomorrow" after Thanksgiving dinner, or bragging about your awesome workout is a direct parallel to the example mentioned, yet it does not seem so obvious.
As a counselor, we must be conscious of the triggers in our words, our appearance, or our environment. Just as we wouldn't want to be drinking a beer with our client who is an alcoholic, we may not want to "show off" our skinny frame with our clients. We may not want to have our salad out on our desk. We might not want to advertise our black coffee. All of these examples can be completely unsettling to our client that is already living in a "proana" world.

 "I'm Anorexic."
Finally, I'd like to talk about the distinction in language. In the AA or NA world, it's very common to hear someone identify themself as an alcoholic or an addict. This distinction is because whether you are sober or you are not, you may always struggle with this disorder, and therefore may always identify with it. The addiction may seem to uproot or take over your whole life, making this identifier seem fitting. However, professionals in the eating disorder realm do not support this language often. For example, counselors may often ask their clients to use the words of, "I struggle with anorexia. I have anorexia," rather than saying "I'm anorexic."
The logic behind this is so that the disorder doesn’t take over the self. It helps the clients in therapy for eating disorders identify with other meaningful things in their life. However, why is this different? Anorexia sufferers may also struggle with triggers and urges to engage in eating disorder behaviors for a lifetime as well. It may, too, uproot their entire life. Why must they change the language that seems natural to them? As clinicians, I believe we need to have this conversation with our clients. Some may love the idea of separating the self from the disorder, but what about the ones who feel invalid if their whole sense of self must be separated?

  Keep Learning. Keep Growing.
As professionals, I believe it's important to ask questions and to seek to learn more. This includes learning from our clients. This includes taking the lead from our clients on language, the purpose their eating disorder is serving, and our awareness to the daily struggles they may face. If that new-to recovery-client walked in your door this month, or you are that new-to-recovery eating disorder warrior, I hope this blog has helped you to feel more confident in the understanding of anorexia nervosa treatment moving forward.  

About the Author

Thank you for taking the time to read this blog. My name is Maria Ortiz, and I'm currently a counseling intern in the end stages of earning my Masters of Science in Clinical Mental Health Counseling. I am also personally in recovery from an eating disorder. With goals to become a Certified Eating Disorder Specialist, it is truly my passion to provide awareness, education, and therapeutic services regarding all things eating disorders. The road to recovery can be one of the most challenging processes one may ever face, and I'm grateful that my story led me to helping others find their hope again.