I have a client who binges and purges whenever she’s stressed. If this describes you, consider this: What if it’s the best way you know of to cope with the vicissitudes of life? What if you’re trying to save yourself from worse pain by these actions?

I don’t know if you know the story of Aron Ralston who cut off the lower half of his arm to free himself from being pinned by a boulder in the Utah desert. I remember hearing his story and thinking that he believed amputation to be his last resort or he wouldn’t have done such a painful thing. Most people, I assume, probably agreed.

Ralston’s heroics drifted into my consciousness when I was talking to my client about her stress-induced binges and purges. I asked what words came to mind when she thought about them and she blurted out, “Disgusting, repulsive, shameful, foolish, disheartening, and stupid.” She began to cry, chastising herself for continuing this behavior she claimed she hated with all her heart. Then she admitted that hating her behaviors meant hating herself.

I brought up Ralston’s story and she said, she’d heard vaguely about it. “What a brave man,” she commented. “I never could hurt myself like that even to save myself.” After waiting a beat, I asked if she saw any parallels between her behaviors of bingeing and purging to cope with the emotional suffering in her life and Ralston intentionally inducing pain to free himself from the emotional suffering of possibly dying in the desert.

This led to spending several sessions discussing how bingeing and purging, though “disgusting” to her, have been her best shot at coping for most of her life. She’d started in order to quell her terror listening to her father beat her mother. She continued in junior high school when her peers teased her for being fat. She found relief when her favorite brother overdosed from drugs at the age of 18. And today she binged and purged because she never developed better ways of coping with the miseries of life.

Long story short, my client eventually recognized that her eating disorder was as honorable as any other self-directed way to take care of her pain. Misguided, yes, but no less purposeful and noble in its intent. The good news is that she’s slowly learning to manage her pain in better ways. She doesn’t always succeed, but what’s different when she doesn’t is that she views her dysregulated eating without shame and contempt. When she binges and purges now, she tells me that she’s coping the best way she knows how. And I couldn’t agree more.

Best,

Karen

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