Oh my gosh!!! sounds like it's written about me - lol! eery!!! Thanks for the helpful response!!! I was sitting here wondering how i escaped having anorexia, since all the personal traits sounded so incredibly familiar - but now it all makes more sense.

I was wondering what those words were supposed to be??!!, I am reading these "one session" I get it, I don't want to start over. My father passed away on memorial day this year, I completely loved my father, but he was a control freak until his very last days, I spent my life pleasing him and growing up with the fear of God and all of the things (too many) you mentioned in your last post. My mother fiesty, yet quiet and good at guilt trips, in fact laid one on me today. I have tons of questions about this subject (ED) and am not sure where to begin. I really hate to think I have an ED when I am already trying to process rape. Interesting about the two types of therapy where the therapist should form BONDS, it was made very clear to me about "he is not my friend and we will never be friends" I understand the boundaries stuff, but it would be nice to know that the person I am confiding my most sacred things in might also one day be called FRIEND.

I revised the post with the illegible gibberish in place of quotation marks, and deleted the original post, which is why this seems out-of-sequence.
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Oh, yes! In fact, OCD is an early clue to an eating disorder to the eye of a trained therapist. That's a "label" to describe the "I have to do things right or it'll be disastrous"-thinking of the ED sufferer.

Just for fun, here is something I wrote when I was working with ED in therapy. I began to notice certain repetitive traits in the families of origin of ED--rules and beliefs--that leaped out at me. Some of this is paraphrased from Alice Miller's work on child abuse, but it's not copied; I composed this in response to what I saw in ED families (you also see these rules in sexual abuse/incest families). BTW, you don't have to be the actual person with the ED to live in these rules; you could also be the sister, mother, or daughter of an ED sufferer and recognize them!

The child is responsible for the parent's anger. You must anticipate your parents' needs and feelings, and adjust yourself around them.

The parent must always be protected, not confronted. Rules cannot be questioned, and the child must assist other family members in "peace-keeping" by encouraging quiet submission to how things are.

The child's life-affirming feelings pose a threat. Thus, a child must not become rowdy, impulsive, rambunctious, or powerfully emotional. "Stop your crying or I'll give you something to cry about" and "You shouldn't feel that way, that's ridiculous."

The child's will must be broken as part of the maturation process. Having childlike traits as an adult is evidence of flawed growth, not inner spirit. "You're X years old - you need to grow up and take control of your life now, putting away those foolish dreams."

Hatred can be done away with by forbidding it.
Anger can be banished by direct order, too.

A feeling of duty produces love/autonomy produces guilt. "I'm not angry, I'm...disappointed." The child is there for the parent, rather than the parent for the child. As long as you detect and react to the needs of others, you will be valued in some way.

Independence or rebellion becomes taboo ("don't confront Dad; you'll only make it worse!")

Being told you are loved is more likely after you have performed some act that conforms to the parent's expectations of duty and correctness.

Parents deserve respect simply because they are parents.
Indeed, all adults must be respected and obeyed. (molesters LOVE kids raised with this rule!)

Children cannot say "no," unless it's to deprive themselves of something.
Children are undeserving of respect because they are children.

A pretense of gratitude is preferable to honesty and genuineness.

A high degree of self-esteem is harmful.
A low degree of self-esteem makes a person altruistic and kind.

An angry parent will abandon their child or neglect their child's needs until that parent's anger subsides. Thus, children learn that anger equals rejection, and become frightened of making a mistake that might "cause" their parent to storm away from them. The child grow up to fear becoming angry themselves, from a belief that "my anger makes me like an abuser."

Obedience makes a child strong. Success is measured by accomplishment, not by inner quality of life.

Tenderness, doting, and vulnerability are harmful and feminine. Indeed, all traits labeled "feminine" are devalued and stereotyped.

Severity and coldness are good preparations for the real world. "Building character" becomes code for harsh treatment.

The way you perform and appear is more important than the way you really are.
Your failure will embarrass the family.

The body is dirty and disgusting; sexuality is dangerous and must be subdued.
Strong feelings are harmful and must be repressed so you do not lose control.
If the most powerful family figure does "lose control" of their feelings, it was caused by the carelessness of the less-powerful subjects in the family.

Parents are creatures who have mastered their drives and guilt, and thus are always right.
Self-care is selfish, as long as any other person's needs remain unmet.

Don't tell people outside the family about anything that dissatisfies you with the family. Protect the family image.

People outside the family will not connect and bond with you from genuinely altruistic motives; they do so in response to secretly wanting something from you.



P.S.: in the early days of ED treatment, most people focused on the "overbearing and hysterical mother" as the root cause. I never felt this was true, and rebelled against using that hypothesis/bias in my own therapy. I did see, however, a lot of recurring traits of controlling, cold, and narcissistic FATHERS in ED families. An Lo! and behold, if I don't come across this just today (in a book I've read 3-4 times since 2002):

"Even though early researchers focused on mothers and mothering, over the last few years there has been more emphasis on the role of fathers in the development of eating disorders. One issue where the effect of the father's role has been discussed is when a father applies his sense of values, achievement, and control to areas where they are misinterpreted or misused. For example, achievement and control should not be values to strive for in the area of weight, body image, and food." (Dr. Costin, p. 171)

As for the OCD stuff, there is a psychological AND medical component. Medically, OCD relates to serotonin errors in the brain, and drugs like prozac seem to work well with OCD and ED as long as the patient's weight is at normal limits (prozac doesn't work in malnourished patients). Psychologically, it fits hand-in-glove with the ED sufferer's "quiet desperation" to do things precisely right: organizing, mirror-checking, counting, tapping patterns, teeth-grinding patterns, etc. This is a symbol for the greater fear of being "wrong" as a person--a living mistake--and hoping to compensate by finding a combination of correct performances and actions. Thus, the emphasis not only on ritual, but on care-taking and nurturing of others.

One of the issues I am addressing in therapy is a ED I have had for years, it has come and gone in different degrees of severity. I don't remember it actually becoming a issue til about one year after my first rape at 14. I started eating only certian things like cottage cheese and sunflower seeds because I felt they were safe foods. I lost a good deal of weight and was raped again at the age of 17, it was after this that I found myself putting weight back on as a form of self defense. If I was fat no one would be sexually attracted to me so I would be safe. I went up and down in weight over the next ten years mainly by starving myself on a very limited calorie diet or binging. I would find myself very sexually active during the times I would be "dieting" and allowing myself to take many unsafe sexual risks. During the times of bingeing I would be celibate to the point of not even exposing myself to any enviorment that would expose me to anything at all sexual.
At the age of twenty eight I went on a "healthy" eating program that included training with a private trainer three days a week. I lost weight quickly but was doing it the good way. I started back to my old ways of clubbing and having numerous meaninless sexual encounters and using alchohl and drugs to take all my inhibitions away. I found it harder to keep up with the expectations I felt from my trainer and friends and family during this time so I turned to purgeing and using excessive amounts of laxatives and diuretics, I was also spending more amd more time excercising. I kept at this for a couple of years straight and I thought nobody was the wiser, I thought I kept it hidden and all under control. I had a couple of episodes that I felt like I was having a heart attack, the last one in front of my BF. I tryed to excuse it away as something else but she confronted me and said everyone knew what I was doing. I refused to admit it. I did slowly start taking myself out of the clubbing and sexual encounters as I was expierencing accutes symptoms of depression and was starting to have sucicidal thoughts. I have managed to not allow myself to fall back to these patterns but still find myself only seeing black or white when I am dieting. I put so much pressure on myself to succeed that I will use whatever means nescarry.I realized a couple of years ago what I was doing when I put weight on was to use it as a shield around myself so I would not be approached and there for challenged back into my former life of unhealthy sexual activity.
I am currently working with my therapist trying to look at food as just something I need to live like water instead of a shield or a enemey. I won't say it is easy , in fact every day is a challenge where I take a step forward and then two back. I still struggle with urges to purge especially if I am feeling bad about myself. My hope is one day to look at food as a substance that I need to nourish my body and not some kind of crutch that I use.

I want to clarify one thing: when I list those rules and beliefs, I am not necessarily implying that the parents of an ED sufferer have imposed those rules. Sometimes they have, but sometimes those are the beliefs of the individual sufferer herself, and the family may be truly baffled why she thinks this way when it may not represent the actual family beliefs. If a parent of an ED sufferer, for example, were to read that list of rules, s/he might be shocked with a sudden realization of these beliefs--which s/he has never even questions before now--or they may be confused by the list, having never seen a ghost of these beliefs anywhere in their family.

The job of the therapist is to help explore whether this list represents the ACTUAL family (unspoken) constitution, or whether it represents the beliefs of the specific ED sufferer herself. Either way, inclusion of the entire family is necessary in her successful treatment.

Later, I'll describe the type of therapist and therapist's role in successful treatment of ED.

I want to clarify one thing: when I list those rules and beliefs, I am not necessarily implying that the parents of an ED sufferer have imposed those rules. Sometimes they have, but sometimes those are the beliefs of the individual sufferer herself, and the family may be truly baffled why she thinks this way when it may not represent the actual family beliefs. If a parent of an ED sufferer, for example, were to read that list of rules, s/he might be shocked with a sudden realization of these beliefs--which s/he has never even questioned before now--or they may be confused by the list, having never seen a ghost of these beliefs anywhere in their family.

The job of the therapist is to help explore whether this list represents the ACTUAL family (unspoken) constitution, or whether it represents the beliefs of the specific ED sufferer herself. Either way, inclusion of the entire family is necessary in her successful treatment.

Later, I'll describe the type of therapist and therapist's role in successful treatment of ED.

Wow, I have avoided this post because I don't have an eating disorder...I have trouble using ED after working in Urology for 16 years...for me ED stands for erectile dysfunction.

Based on the list, I feel like my family was used as the model. Someone asked a question farther up in the out of context segment, and I'd like to ask it again,

Based on the list of behaviors, if a person doesn't have an eating disorder, [or OCD for that matter], can the same traits/characteristics show themselves in the form of another disorder?

I'd also like to know if there are "degrees" to an eating disorder, and to OCD. Like, if a person is a "nervous eater", or if they can't leave home without checking irons, hair flat irons...at least twice before locking the door (and checking it twice)?

Another question....regading the therapist....how would one broach the subject of "Are you my friend" and not sound like you are one step away from stalking your therapist? I mean, how do you have that conversation that lets the therapist understand that this is the way you understand a relationship with her/him should be? Is that in a text one might take a copy of to a session and bring up the topic?

Sorry, just one more. If the family is dead, or out of the sufferer's life, can she be successful on her own in therapy?

After becoming a bit to attached to my first therapist it has been drilled into me by multiple other therapists and psychologists that a therapist is never supposed to be your friend or have any relationship with you other than a professional one. I can't tell you how glad I am that my first therapist kept things professional, even when it was obvious that I wanted to be his friend. It is so hard not to become attached and too easy for someone with that kind of power to take advantage of a situation. In addition, once you have a friendship, you have more to lose and therefore it is much harder to disclose things about yourself that might reflect badly on you. In a professional relationship, you pay the person and they give you advice and comfort as needed, no matter what is going on in your life at that moment.

ED's are often concurrent with OCD, panic disorder, anxiety disorder, depression, or PTSD--not all at once, mind you; that's just a list of common co-occurring diagnoses. For someone to be diagnosed with a true eating disorder, one has to match the medical criteria, as opposed to having an unsatisfying or occasionally-disordered relationship with food. It's the medical consequence of the disorder that earns it the diagnosis, as opposed to being, say, a "nervous eater." If that nervous eater experienced health problems or disruptions in normal life because of that habit, THEN it would be a disorder. And yes, the double-entendre of "ED" has (humorously) occurred to me. I'll use "AN" and "BN" to indicate "anorexia nervosa" and "bulimia nervosa," and "EDS" as shorthand for "eating disorder sufferer." Incidentally, males with ED have ED in both forms!

As for the friendship issue...This isn't something that's universal. I've worked with 500+ rape victims, but I don't have 500+ survivor friends from that pool--I have about a dozen, very carefully selected. I nurture and value those friendships beyond words, and thus the term "tribe" is my favorite description. To be blunt, being a (former) patient is not sufficient to become my "friend;" I am very cautious and I specifically CHOOSE that relationship (as we all do with our friends). I have to feel very comfortable with the client's understanding of the relationship, that she won't believe it represents an inappropriate interest in her (or by her for me--I have had to deal with stalking clients before), that her support system (husband, parents) understand the dynamic--they know me, they appreciate and support the friendship. She has to know my wife, Tonya, and share a mutual respect between them. The therapy has to have ended before a "non-clinical" dynamic can even begin. And, frankly, she has to feel there is something I can offer to her, that SHE would benefit, from an ongoing friendship/mentorship/support relationship. If she is weary of me, or feels I have no benefit to her life at that point, why should either of us expend the energy to hallucinate otherwise? (this seldom happens; it's not arrogant to acknowledge that positive, un-exploitative, mutually-equal, nurturing, and comfortable friendships with a healthy male are usually rare for my patients, and thus not something an enlightened survivor would let casually slip away. If she were that cavalier about a GOOD support system/friendship--with anyone, not specifically me--I'd be more concerned about her lack of foresight into self-care than about my own place and feelings).

I remember Victoria commenting to me once, "I wish we hadn't met as therapist and patient. I think we would have been really good friends." I responded, "we have to remain in this role during your treatment. But when you graduate, would you like to join with other other survivors in group activities where I am included?" Notice the careful wording here: the emphasis is on connection with SURVIVORS, not with seeing ME, and in groups. She agreed, and when this proved to work very well for her and me, and when we were both satisfied that the boundaries were healthy, this has evolved to a friendship where she can call me several times a week for an hour just to visit, joke, talk about our lives, and discuss hobbies, etc. I had dinner at NILY's house with her family last night, and stayed until 11 PM just visiting and joking. I don't see ShayMarie as often these days due to her current life circumstances, but I have had, and her mother as well, over to my house visit and we still enjoy occasional times where we sit and talk late into the night. In each of these friendships, the bottom line is that even though they are all there for me when I need them, that is not their function. They owe me NOTHING, and the fact that they (and I) were lucky enough to be in group therapy together doesn't mean I'm supposed to keep running their lives. They do offer me support at times, but that's voluntary of them, not an obligation or responsibility. Ultimately, it is MY code of ethics that governs my conduct still, and requires me to be fair, and not to exploit, manipulate, or time-monopolize any of them. They are in this friendship because they have chosen me as a friend, not for any other reason.

I have to follow my own rule, too, which is "I won't work harder at this than you will." That means I will not/cannot persist in emails, calls, and texts that aren't reciprocated, or else it becomes an imbalanced form of attention rather than a mutual collaboration between equals. At that point, the ethical clinician would back off, restrict his/her own approaches, and remain passive (but available) until the other person (former patient, current friend) re-initiates contact. The dynamic has to be mutual to be fair and equal, or else it becomes unhealthy. There can be NO passive-aggressive response: "Well, gee, why should I be nice to you now? You can't called me in three weeks?" Nuh-uh. I have to be loyal, available, and positive, unless she clarifies that her interest in the friendship can changed or ended.

One very firm boundary I have: I do not emerge into a non-clinical friendship with patients who have Borderline Personality Disorder. The clinical dynamics are so complicated, and the explosive vicissitudes of the relationship are too risky for me and for her. That's not a bias coming from dislike or preference on my part, it's an awareness that the work cannot succeed in that non-clinical relationship and I have to say, "I appreciate working with you, but this relationship ends at this point." Of course, that is seldom satisfactory to the BPD patient, who feels personally abandoned and rejected (thus the very rationale for my NOT staying in the relationship). And in ANY case, I cannot offer therapist-like services to any person online, because we do not have a formal contract as patient/clinician in this setting. On DS, I can offer my opinions, I can show support, I can answer informational questions, and I can interact as a co-member. But my therapist badge stays at work.

ED's are often concurrent with OCD, panic disorder, anxiety disorder, depression, or PTSD--not all at once, mind you; that's just a list of common co-occurring diagnoses. For someone to be diagnosed with a true eating disorder, one has to match the medical criteria, as opposed to having an unsatisfying or occasionally-disordered relationship with food. It's the medical consequence of the disorder that earns it the diagnosis, as opposed to being, say, a "nervous eater." If that nervous eater experienced health problems or disruptions in normal life because of that habit, THEN it would be a disorder. And yes, the double-entendre of "ED" has (humorously) occurred to me. I'll use "AN" and "BN" to indicate "anorexia nervosa" and "bulimia nervosa," and "EDS" as shorthand for "eating disorder sufferer." Incidentally, males with ED have ED in both forms!

As for the friendship issue...This isn't something that's universal. I've worked with 500+ rape victims, but I don't have 500+ survivor friends from that pool--I have about a dozen, very carefully selected. I nurture and value those friendships beyond words, and thus the term "tribe" is my favorite description. To be blunt, being a (former) patient is not sufficient to become my "friend;" I am very cautious and I specifically CHOOSE that relationship (as we all do with our friends). I have to feel very comfortable with the client's understanding of the relationship, that she won't believe it represents an inappropriate interest in her (or by her for me--I have had to deal with stalking clients before), that her support system (husband, parents) understand the dynamic--they know me, they appreciate and support the friendship. She has to know my wife, Tonya, and share a mutual respect between them. The therapy has to have ended before a "non-clinical" dynamic can even begin. And, frankly, she has to feel there is something I can offer to her, that SHE would benefit, from an ongoing friendship/mentorship/support relationship. If she is weary of me, or feels I have no benefit to her life at that point, why should either of us expend the energy to hallucinate otherwise? (this seldom happens; it's not arrogant to acknowledge that positive, un-exploitative, mutually-equal, nurturing, and comfortable friendships with a healthy male are usually rare for my patients, and thus not something an enlightened survivor would let casually slip away. If she were that cavalier about a GOOD support system/friendship--with anyone, not specifically me--I'd be more concerned about her lack of foresight into self-care than about my own place and feelings).

I remember Victoria commenting to me once, "I wish we hadn't met as therapist and patient. I think we would have been really good friends." I responded, "we have to remain in this role during your treatment. But when you graduate, would you like to join with other other survivors in group activities where I am included?" Notice the careful wording here: the emphasis is on connection with SURVIVORS, not with seeing ME, and in groups. She agreed, and when this proved to work very well for her and me, and when we were both satisfied that the boundaries were healthy, this has evolved to a friendship where she can call me several times a week for an hour just to visit, joke, talk about our lives, and discuss hobbies, etc. I had dinner at NILY's house with her family last night, and stayed until 11 PM just visiting and joking--my wife, her, her husband, their daughters, our sons! I don't see/talk with ShayMarie as often these days due to her current life circumstances, but I have had her, and her mother as well, over to my house to visit and we still enjoy occasional times where we sit and talk late into the night. StillScarred has come by to visit in my home, and met other survivors she hadn't even know before. NONE of this is "enmeshment". In each of these friendships, the bottom line is that even though they are all there for me when I need them, that is not their function. They owe me NOTHING, and the fact that they (and I) were lucky enough to be in group therapy together doesn't mean I'm supposed to keep running their lives. They do offer me support at times, but that's voluntary of them, not an obligation or responsibility. Ultimately, it is MY code of ethics that governs my conduct still, and requires me to be fair, and not to exploit, manipulate, or time-monopolize any of them. They are in this friendship because they have chosen me as a friend, not for any other reason.

I have to follow my own rule, too, which is "I won't work harder at this than you will." That means I will not/cannot persist in emails, calls, and texts that aren't reciprocated, or else it becomes an imbalanced form of attention rather than a mutual collaboration between equals. At that point, the ethical clinician would back off, restrict his/her own approaches, and remain passive (but available) until the other person (former patient, current friend) re-initiates contact. The dynamic has to be mutual to be fair and equal, or else it becomes unhealthy. There can be NO passive-aggressive response: "Well, gee, why should I be nice to you now? You haven't called me in three weeks!" Nuh-uh. I have to be loyal, available, and positive, unless she clarifies that her interest in the friendship can changed or ended. People have busy lives, I am not at the center of those lives, and when one of "the tribe" needs me to be there, she knows I will be.

One very firm boundary I have: I do not emerge into a non-clinical friendship with patients who have Borderline Personality Disorder. The clinical dynamics are so complicated, and the explosive vicissitudes of the relationship are too risky for me and for her. That's not a bias coming from dislike or preference on my part, it's an awareness that the work cannot succeed in that non-clinical relationship and I have to say, "I appreciate working with you, but this relationship ends at this point." Of course, that is seldom satisfactory to the BPD patient, who feels personally abandoned and rejected (thus the very rationale for my NOT staying in the relationship). And in ANY case, I cannot offer therapist-like services to any person online, because we do not have a formal contract as patient/clinician in this setting. On DS, I can offer my opinions, I can show support, I can answer informational questions, and I can interact as a co-member. But my therapist badge stays at work.

Thanks for the info....my question regarding therapists and frindship was based on your comments in #11...the concept that rape trauma is one situation where patient/therapist bonds are part of the therapeutic dynamic, as opposed to being disallowed because of the therapy.

Other than that, I understand the concept. I just had never seen it stated that it is 'expected'. That is why I asked, because I was under the impression, that unless therapy had stopped, there was an invisible line that must not be crossed. I questioned text supporting the comments in #11, because of that alone. I personally am really comfortable with the relationship I have with my therapist. His wife, also a PhD, shares the complex with my thearpist, so I know them both.

I wasn't asking so much from a 'how do YOU do it' as a , how should the masses do it.

From ALL of this...everything I have learned about rape trauma, eating disorders, OCD, BPD....all of it, it amazes me the impact the father has on the development or worsening of symptoms. That's where I was coming from when I posted the "She'll Need You" post for Future Fathers Everywhere. I was one who needed a father desperately.

but in reply #11 you said a therapist is SUPPOSED to form a bond.
what happens if you can't?

yes mockingbird, that was where my question came from too. We must have been writing at the same time. I have never heard anyone say that it is required to have a personal relationship with a therapist before.

When I re-read what I wrote, it sounds kind of like I am asking for a 'text' to prove or disprove your point Matt. That is certainly NOT what I mean. I believe you, I just was thinking is my therapy is being shortchanged by a lack of friendship with my therapist, I wanted to know if a book was out there that I should take in to a session and ask for his opinion... sorry, it reads like I doubt you, I don't.

Also, in therapy-speak....complex means alot different than what I am trying to say about my therapist and his wife....LOL! I mean to say they share the same BUILDING complex...have side-by-side offices. Although they may have a group of mental disorders of which I am not privvy, I didn't mean to suggest as much. (hehehe)

Yes Shen, I believe our questions sprang from the same comment on here. I thought I had understood it, maybe we just misunderstood it together.

Ditto Shen on I had never heard that anywhere before and I thought it was a nice concept, although as I'm typing this, I've not told my friends what I've told my therapist so I guess he shouldnt be my friend (or I wouldnt speak at all) make sense? Matt I realize you cannot be an "online" therapist it's just nice to bounce things off of you because you are so trusted and you "get it" not to mention your wealth of knowledge!!