It could be as simple as having a therapist who is reluctant to make the diagnosis directly to the patient.

It could be as simple as the therapist being afraid to tell the patient of the diagnosis. Also, when the traits do not subside following treatment, they stop being traits and become the disorder.

are you a therapist, too?

Heckle is a licensed counselor. And her answer is correct, per published clinical information. For more, see "Borderline Personality Demystified" by Robert O. Friedel, Perry D. Hoffman, Dixianne Penney, and Patricia Woodward at http://tinyurl.com/5srgk6

Heckle is a licensed legal counselor, and thus trained in abnormal psychology--not as a clinician, but in order to fulfill her professional competencies. And her answer is correct, per published clinical information. For more, see "Borderline Personality Demystified" by Robert O. Friedel, Perry D. Hoffman, Dixianne Penney, and Patricia Woodward at http://tinyurl.com/5srgk6

I think I've been misunderstood when I talk about the bond that the therapist and patient need to form in treatment of ED. The term "friendship" became the default shorthand for this forum, and that may be a misleading term to use. The term "collusion" may be a better label.

Summary of how the therapist works with the EDS:

1. The therapist needs to help each patient uncover the adaptive function or purpose that their ED behaviors serve.

2. With genuine empathy the therapist experiences past and present with the patient, as though both of them were "in the trenches together." The therapist serves as parent, guide, teacher, and coach. You do NOT see this extensive bond in other forms of therapy, and non-ED therapists would balk at the very suggestion.

3. It is the therapist's task to uncover what developmental arrests or deficits exist for each patient, and to help "re-parent" the patient so s/he gains the needed functions for self-growth.

4. Through modeling, as well as through analyzing and managing the transference relationship, the therapist assists the patient in internalizing missing psychological functions such as the ability to express feelings, the ability to self-soothe, and the ability to internally validate oneself.

5. As strange as it might seem, a therapeutic task in treating ED patients is to get the patients dependent on the therapist instead of on their eating disorder. The next step is to wean them off the therapist and onto other relationships in order to meet their needs. Weaning patients off the eating disorder is much harder than transferring their relationship with the therapist to healthy relationships with others.

Critical techniques for successful treatment:

Alliance with the patient.
Sustained empathy.
Patience and long-term thinking (ED treatments can last 2-5 years).
Limiting control battles.
Making behavioral agreements.
Challenging cognitive distortions.
Balance between nurturing and being authoritative.
(I can say more about any of these, if asked).

These are the same skills one must use in rape treatment, too. I personally use what is called a "psychodynamic" approach, with some aspects of cognitive-behavioral therapy (CBT) included. As you can see, finding a therapist who not only understands this treatment philosophy, but is willing to invest that amount of time and concern, is VERY rare. That is why most clinical treatment for ED's costs around $1000/day in specialized treatment programs!

Consequently, many families try to get by with the minimal, and less costly, treatment options instead. Relying on a nutritionist alone is a grave mistake, and college campus counselors are seldom trained in ED treatments. Most therapists in our health care system rely on the "one hour a week" outpatient sessions. Dr. Carolyn Costin, an expert in treatment of EDs, has written about the role of a nutritionist in ED treatments. She warns that anyone can call themselves a "nutritionist," and that does not necessarily make them a licensed registered dietitian (R.D.). And not RD's are trained to work with eating disorders. Dr. Costin says, "when working with eating disordered individuals, a treatment team is important because the psychological issues involved in the client's eating and exercise patterns are so intertwined. The nutritionist needs therapeutic backup..."

Dr. Costin even proposes a hypothetical statement that a GOOD nutritionist would give in response the interview question, "what is your basic philosophy in treating EDs?" Her endorsed answer:

"I believe that food is not the problem, but a symptom of the problem. I work with long-term goals in mind and don't expect immediate changes in my clients. Over the course of time I will discover and challenge any distorted beliefs and unhealthy eating and exercise practices you have and it will be up to you to change them. I prefer to work in conjunction with a treatment team and stay in close communication with its members. the team usually includes a therapist and may include a psychiatrist, a medical doctor, and a dentist. If (the proposed client) is not currently in therapy, I will provide feedback on the need for therapy, and if needed, refer you to someone who specializes in the treatment of eating disorders."

An anonymous member wrote me:

"Regarding EDS I went through a very stressful thing Friday night and yesterday I didn't have power all day (which sometimes I like, living by candles and cooking on open fire, except that I don't cook) Seriously though, today I didn't eat all day, one because I was doing yard work and two I wasn't hungry, but when I finally sat down and ate something, I started thinking about Fri night and I went and threw up, I know at that very moment I was very frustrated thinking about it, about injustice and nothing will be done about it. I was actually angry at myself and questioning the reasoning behind the incident. What in the brain does this or what in the brain of a rape victim does this. (what chapter in the book) It's like something engrained in me since I was raped, to be mean to me.(I am working on that)It's like theres no justice so I can do something about this? Make sense? This is not a weight issue for me, I'm 5'10 165, I'll never be a little person and I know that. Does any of this sound sick?"

It doesn't sound sick. I teach my patients that every choice and action represents an inner need that's trying to be met. That means you were using food/appetite to express a need, and to form a logical connection between that need and your only way to respond. When you feel so powerless, it's hard to feel you have choices and options, so you become limited in how you react to stress.

Rape is a serious way to lose power. It teaches a woman that she has no control, even over her own body, and that nothing about herself is solely under her own domain. With one exception: the inner world. That becomes the ONLY part of a rape victim that she might feel she can manage, so she exerts self-control via her appetite and food. Other women might crave control through sex, through cutting, through smoking, through drinking, through suicide, etc. For you, food has become the symbol for self-power.

The comment about "injustice that nobody is doing anything" about is VERY interesting to me. A lot of EDS have thoughts like that--I mentioned earlier the common sensitivity of an EDS to injustice, social issues, family pressures, etc. This is why you often find EDS in "helping professions"--nurses, teachers, therapists, crisis workers, child care, etc. Think about it: the most serious injustice you have ever personally experienced is your own rape. Automatically, your body becomes a target for emotions about power, control, isolation, betrayal, and femininity.

A rape victim who is mean to herself is very common. I find in group therapy that rape victims are compassionate to every other person but herself; she can forgive others, understand others, love others, and pass boxes of tissues to crying others, but she refuses to care for her own needs in the same ways. The purging is a highly symbolic act of expelling the very matter of self-care/nourishment. It has nothing to do with pounds, ounces, or beauty, does it? It's about feeling like you don't deserve to be cared for, that other issues are so much more important, right? Do you feel like your own pain is so trivial, and you are selfish to even let it affect you, when others have it so much worse?

I'd bet money on the answer.

You should have bet money, you'd be a rich man! That was alot to absorb. In reading that it brought something up for me that goes way back like sixth grade and my mother taking me to a diet center, why I cannot remember, I don't remember asking to go and I wasn't a heavy kid. Anyway you hit the nail on the head (I'm sure as always) about being in a service profession, I am used to fixing everything but cannot fix this and within the last two years had the harsh realization that I cannot fix or save anyone (that was hard) I was raped by a stranger who was never caught and that's injustice to me, of course the way, I reacted and dealt with the whole thing didn't help that fact, I'm learning that, that was the only way I knew how to at that time, and I carry alot of self blame for that, a whole other story.. I haven't always binged and purged but recently since I started therapy this year I seem to be doing it more and more and especially when something happens (that I have no control over). Of course I did the alcohol and using sex as well. I'm a control freak when it comes to my work especially and in everything else I'm 100% or nothing. You are so right about the pain, I didn't talk about any of this for 11 years, i didnt want anyone to know and it became like just like it will go away some day. Until I was stopped dead in my tracks which brought me to therapy.You wrote alot there that I want to touch on.

Bingeing and purging during therapy...Pretty common, in fact. I have to warn ED families to expect the symptoms to worsen at first, or else the family gets annoyed and scared and concludes I must be doing awful work! But if food is a symbol for self-care and emotional power, it makes sense: too many feeling; stuff them down or get rid of them.

There are some good books I could suggest if you want to continue. I really like "Desperately Seeking Self", a woman's journal/poems about her recovery process...

"Gaining: The truth about life after eating disorders" by Aimee Liu
"It's Not About the Weight: Attacking eating disorders from the inside out" by Dr. Susan Mendelsohn
"Learning to Be Me: my 23-year battle with bulimia" by Jocelyn Golden

I have all of these and have read each of them. All but the last one are sitting beside me on the desk right now!

Do you recommend doing both of these things hand in hand, working through rape recovery and EDS, I guess I am wondering if this is a true EDS or something I am using right now and some in the past to deal, which I know it is, I'm just thinking out loud and I guess to be honest, It just seems like another issue to deal with and it seems overwhelming. I know you said in a previous thread they do go together. Man this is hard stuff.

I don't have an ED as such, but my eating habits are very bad, and i know it started after the rape. I am a glutton, sometimes i don't eat for a day or 2, but then i over eat, i mean an enormous amount of food, i am not hungry, i just 'stuff my face' then i feel bad and don't eat again for a day or 2, the cycle never ends. No one knows about it, i do it secretly, always have. I am so ashamed of myself, i have tried to eat a daily healthy diet, but it doesn't last, i go back to stuffing my face even though i am not hungry. And of course i am obese, morbidly obese as the doctor calls it.
:_(

i think this goes back to the issue of being kind to yourself, and nurturing yourself. give yourself credit for trying to eat healthy.

now that we're all talking about eating habits...i might as well join in.

when i was in hs i was 5'6" or 5'7" and 130 lbs. my mom always told me i needed to lose weight. kept food away from me. it got to the point where i had to go to a friends to eat a good meal during my fresh and soph year of high school. some time during senior year i only ate once every few days, and ran every day. i was in great shape, and i kind of miss the figure i had then. when i moved in with gary and starting taking zoloft i gained 40 lbs. now i can't lose it for the life of me. i wish i had that back, but i don't want to go back to be unhealthy. just happy and fit. or i'll just take happy for the moment.

Zoloft is notorious for weight gain issues. Many of the drugs have that side effect...except Effexor XR, it has more a tendency toward weight loss. It has a warning on it regarding anorexia. Many physicians in my area won't prescribe it if the patient has any eating disorder history.

I agree with the earlier post about it not being a body image issue at all. I think it is a control issue. I believe that is one reason the 'lists' associated with EDS and trauma are so similar. Both are issues of loss of control and an attempt to regain it. (as I write this I am sitting here eating malba toast and cream cheese...totally heart-healthy....not).

In healthcare, I have seen alot of anorexia and bulimia over the years. I have never seen it in a person where that was their only issue.

Nadine...you make a couple of statements that make me want to hug you (piture me hugging you)...one, you adopt the title 'glutton'. To me, that is a very harsh term. It denotes the Biblical attitudes regarding the deadly sins....sloth, gluttony... Don't do that to yourself. If you have a problem with willpower and control of what you eat, at least be kind in your description. When you adopt terms like gluttony it's like self-defeating.

The second thing you state is that "No one knows about it, I do it in secret". I know you have had therapist issues, and I am not sure where you stand with that, but, your therapist and your medical doctor should know this. They should be reaching out to you in an effort to assist you in weight loss goals for health, and in healthy eating habits, for the bingeing that you started ....after your rape....
Tell me you don't NOT think these are connected.

I am glad you have been actively reading this thread because I think more of us border on a true EDS than are actually diagnosed as having one. I may be in that number although it is not my body size that is so much the issue. I am 5'6" tall and weigh 154#, but I am not at a healthy weight for my health status. I do eat foods with every proven cause of raising one's cholesterol, and mine is dangerously high. My total cholesterol, at last check was 398.....my "bad cholesterol" for me should be under 100...mine was 311. Yes, genetics is the major cause, but I have Type 2 Diabetes, and, part of my "issue" with food is being TOLD what I can and can't have. I take a mental stance that "you won't tell me.....", and it is much to my detriment. So, I don't qualify for a true EDS, but, I suffer the same consequences.

I hope we all gain inspiration and information from this thread. I know I have already.

Hey Nadine, in rants you wrote how you hated poor sentence structure...check out the double negative in paragraph 5...."You don't not"...that is sentence structure only found in the deep south. LOL.

I'm embarrassed....mostly because it took me almost four hours to spot it.

Did I mention that people with eating disorders tend to nitpick? It's the OCD portion of the disorder.

I'm sorry; I couldn't not mention that.