Vulnerability and Eating Disorders

Vulnerability is an emotion that affects individuals suffering from eating disorders in a multitude of ways. It is the opposite of being in control and a state of mind not particularly comfortable for people suffering from this mental health issue. Feeling vulnerable is an uncomfortable feeling for many of us, but even more so for individuals suffering from an eating disorder. Not feeling in control often acts as a trigger that begins the destructive cycle of disordered eating. A trigger is any input that a person receives; either from their environmental or an internal thought that creates an uncomfortable feeling.

It is important to note, for these individuals their eating disorder is what allows them to cope with emotions. As a whole, individuals suffering from an eating disorder tend to view things in black and white terms; meaning their behaviors and thoughts are either right or wrong/good or bad. This strict thinking pattern leaves little room for ambiguity. Ambiguity is not only part of being vulnerable, but also part of everyday life, so it is important to learn how to navigate through it.

To illustrate how the above works let’s look at the cycle of binging and purging in a person suffering from bulimia nervosa. As mentioned earlier, an eating disorder is a way for an individual to temporarily escape unwanted emotions. They are able to avoid their feelings because all their focus is on controlling what they eat and how much of it they choose to keep in their bodies. The ritual surrounding their eating disorder overshadows their underlying feeling of being vulnerable and allows them to feel in control.

Ways to help your client manage vulnerability:

What I have found useful in working with these clients is to set them up for success. How I accomplish this begins in my first session with them: I usually spend the sessions building a foundation the client and I can refer back to throughout their journey. As many therapists know, relapse with eating disorder clients is not uncommon and is why it is important to have pre-established measures of personal success. To illustrate how the above works, I will use one of my clients as an example. In my first session with Amanda we worked to develop three objectives she wanted to focus on regardless of what life was throwing at her. These objectives were meant to help her remain focused and allow her to celebrate small achievements. Amanda’s three objectives were:

1)   To speak her mind even if she was afraid to
2)   To go for a walk when she felt an urge to binge
3)   To attend one support-group meeting a week

About a month into counseling Amanda came into my office and was visibly upset. She had binged and purged the night before. Halfway through the counseling session she told me her boyfriend had broken up with her over the weekend, which made her feel extremely vulnerable. Moreover, Amanda felt her life and efforts towards her recovery were ruined. This setback was a great opportunity for me to pull out the list of objectives she established in our first meeting. Together we reviewed her list, which allowed her to focus more on the positives and less on her break-up. As we worked through the three objectives she began to acknowledge that she was making progress and that all efforts were not lost. More importantly, Amanda saw how even at times when she felt vulnerable there were parts of her in control and capable.

I find it extremely valuable to establish measurable objectives early in the counseling relationship especially when dealing with individuals suffering from an eating disorder. Therapists have a greater chance of helping their clients overcome destructive patterns if they create an environment that sets the individual up for success. Regardless of the mental disorder or problem at hand a therapist can increase the chances for change if they know what they are dealing with, which in this case was the feeling of vulnerability.

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