I am really angry. My parents are accusing me of having an eating disorder, which I do not have. Now they say I can’t go away to college unless I gain 20 pounds! Twenty pounds! I think I will lose my mind if I cannot get away from their incessant nagging.

I have researched anorexia on the web. People who have it look emaciated and simultaneously believe they are fat. I am neither skeletal nor fat! I am slim, like the rest of my friends, nothing more, nothing less. What they may not understand is that I am constantly hungry, which is my response to stress, just like other people get headaches or stomach pains. If I were to eat whatever I wanted to eat, or whenever my parents were “at me” about eating, I would look like a blimp.

I thought maybe if I wrote to you, you would post something to show my parents that they are wrong. Frankly, they are the messed up ones, wanting their own daughter to look unattractive, especially to boys. As usual, they are trying to control me. It is infuriating. Can you please settle this?

Dr. J replies:

I can certainly hear how angry you are at your parents.
It would be helpful to try to separate out several issues that seem intertwined at present.

Eating problems are extremely prevalent in this culture, especially in young women, although some men have them as well. You may not meet the most stringent technical definition of anorexia, so you are correct about refuting that diagnosis. However, eating disorders exist on a spectrum, ranging from intrusive preoccupations with food and dieting, to serious, even life-threatening caloric restriction. Body image disturbances accompany anorexia as well. Other eating disorders, again on a spectrum of disturbance, involve binge eating, eccentric eating behaviors and bulimia ( cycles of binging and vomiting).

Even though you may not meet all the criteria for anorexia, at least not at present, you still fall someplace along the spectrum of eating disordered behavior. Some of the feelings and issues you describe are commonly part of the picture. I am struck by your feeling of horror at the thought of gaining weight, and I suspect that you are reacting to the injunction to gain weight, as much as to the number of pounds your parents suggest. I gather that as this moment you are experiencing your family as intrusive and manipulative, so food has become a way in which each side struggles for power and control.

I have no way of determining whether you are slim in a normal way, or slim in a distorted way, as you do not mention your height and weight. However, it is not my place to establish that, but if you distrust your parent’s assessment, perhaps another caring adult would have an opinion on this. Your family doctor or the school guidance department might be helpful consultants. Be aware that distortions in body image are present in most disordered eating syndromes, and but also occur without disordered eating in other syndromes. For example, men who are losing hair may feel they are already bald, or attractive people may feel ugly.

While you are clearly astute in assessing that your anxiety triggers hunger, you may also be hungry because you are restricting your food intake unnecessarily. I wonder about other aspects of your life style, ranging from skipping meals, or eating in unhealthy ways, to compulsive exercise or sleep deprivation.

Successful weight regulation is complex and involves eating adequate protein as well as eating in patterns that do not inadvertantly trigger the body into “starvation mode”, thus reducing the amount of calories that can be consumed without weight gain. All calories are not created equal in the sense that different foods eaten at different points in the day may be more or less likely to be “burned off” as opposed to “stored” as fat. There are as yet poorly understood genetic predispositions to weight gain. Finally, hormones as well as certain medications can also effect metabolism.

You and your parents are in a power struggle, a power struggle you can always win if you ignore the cost of your victory. If you view eating as a surrender to them, then of course you will resist eating. It is helpful that you know yourself well enough to know that hunger is your response to anxiety, but it is unclear what conflicts are producing that anxiety. People are anxious for both conscious and unconscious reasons. It sounds like your fear of losing control of your appetite, which may be a magical way of controlling something
else, such as your anger, may be leading you to compensate by maintaining too tight a control. I would wonder if you could figure out some some capacity for moderation without rigidity. Occasional “indulgences” might even reduce your chronic hunger. Sometimes simply reminding yourself that your body is trying to alert you, via hunger, to some other source of concern can make a difference. It is a subtle but important shift to value your body as kind of radar giving you helpful information, as opposed to an enemy you must defeat.

I dated this guy for about 2 months and I thought, ”Wow, this could really work”. He even seemed enthusiastic about being the step-dad to my two young sons. We started planning this vacation together with the boys…taking them to Disney. I was so thrilled because this is something my husband would never have done. My ex… he was an avid golfer…he would say, “ Trust me, I’ll be better with the kids when they are older”…yeah…when they were older he left altogether. But that was probably for the best.

Well, anyway, the worst possible thing happened. A week before we, meaning the new boyfriend, my boys and me were supposed to leave, he called and said he had to talk to me. He sounded tense and serious. I thought something was wrong with his Dad (because he Dad was supposed to go in for some bypass surgery) but no…he said it was about us. So,I got a babysitter for that night and met him for coffee.

My heart was pounding and my tongue felt like a wad of cotton…but I was actually clueless about what was coming. But it was bad. He said, “Listen, I need to take a break. I can’t go on this vacation with you, or with the kids…I can’t step into this Dad role…we’ve been playing house…we hardly know each other…I’ll call you sometime…OK?…maybe we can be friends…” In retrospect, I wonder if there were “signs”…but at the time I was completely shocked. Should I have seen this coming?

Dr. J replies:

I don’t get the sense that you are good at reading the subtle cues by which couples signal one another about escalating involvement and attachment. While symbiotic or parasitic modes of relating truly are deadening, avoidance of vulnerability and interdependence does not help relationships develop “to the next level”, whatever that level may be. I would particularly caution about confusing sexual passion and genuine connection. In fact, when two people are not becoming friends at the same rate that they are having sex, gradually, the sexual passion will diminish. The very factors that constituted the “glue” of the early relationship must be supplemented by growing trust and genuine intimacy.

Intimacy problems and fears are universal. Yours are just more obvious, because you are not in a committed relationship, but I assure you many marriages suffer equally from a lack of true intimacy. Without any specifics, I can suggest some of the issues which make intimacy difficult to achieve and even more challenging to sustain.

These are offered in no order…what is salient for one person may be less salient for someone else. Becoming close to someone means letting them see aspects of you which you feel are undesirable, and perhaps even letting them in on what you consider your “deep dark secrets”, the parts of you which make you feel vulnerable, out-of-control, or weak.

There is no intimacy without risk and multiple moments of courageous self-revelation, and it takes courage precisely because there are no guarantees that your partner can embrace all of you, including what you struggle with in yourself. But such disclosures, properly paced, can build deep trust and texture in your love.

Another fraught arena concerns power and the ability and willingness to negotiate and compromise. Particularly as relationships have less defined gender roles, partnerships require empathy, flexibility, and willingness to modify comfortable patterns. Being able to do what you want when you want to do it may constitute autonomy for the single person, but can “selfishness” in a couple.

I think relationships are “living” systems that develop, just as people develop. As couples spend time together, the inevitable idealization of early infatuation is replaced by a fuller knowledge of the other. So, often couples pull away at the point where some of this idealization falls away. At such junctures, sometimes there is some sense of disappointment, and the uncomfortable awareness that the disappointment can go both ways.
This is a sensitive time, requiring some hope and faith that these feelings will evolve into a less idealized but also more substantial and realistic notion of what makes your partner “tick”. Intimacy requires that each partner tolerate being in a relationship in whch they are not seen as “perfect” and in which their partner is not “perfect” either. This in turn may require not only some healthy self-acceptance but also the capacity to forgive. However, these revised notions lack the fragility of idealizations and are far more likely to lead to feelings of being truly seen and hence truly loved.

Again, to return the questions implied at the beginning of this vignette,(and I realize you probably don’t want to hear this), a relational or interpersonal form of therapy might really be helpful, something which examines the “here and now” in the room, and which helps you identify the particular issues which jeopardize intimacy for you. While people often want to solve their “issues” without outside help, the key pieces of the puzzle are often not consciously available. Or, someone can’t put what they “know” into words to discuss it with someone they already trust. The existence of an unconscious means we can’t always figure out our own “stuff”. But that is precisely what relational therapies are good at, and hence it is their “beauty” in unlocking and revealing fears of intimacy.

I do not hesitate to tell “white lies”. For example, I’ll say “I’m busy” to avoid an unwelcome social request. I’ll say I wasn’t home when I didn’t want to answer the phone. I don’t think about the fact that it could be urgent. Most things are not really urgent. In the course of a recent conversation, someone I respect asked me if considered myself an honest person. I realized that I paused…I didn’t just say “yes”. In fact, we both noticed it. The conversation went on like nothing notable had happened. However, privately I felt unsettled. I think of honesty as so important. Yet, I wonder if I am an honest person. It seems like it should be a straight-forward question, “yes” or “no”. What do you think?

Dr. J replies:

Many things which seem straightforward “on paper”, are in fact nuanced and complex. I don’t think honesty can be isolated from motivation and intentionality but there are those who would disagree. Certainly, decisions about social behavior do require reflection and honesty with one’s self. I would urge suspicion in most claims to be doing something deceitful for someone else’s benefit. I think personal integrity can co-exist with “white lies” in the service of tact or sparing minor emotional injuries. However, untruths should never be undertaken lightly, as it is a “slippery slope” to more serious betrayals.

I would urge you to consider whether a particular “white lie”, unexpectedly discovered, would significantly damage your relationship. Would you be prepared to take responsibility for the consequences?

Over time, most lies and secrets have a way of surfacing. People who tell many white lies at some point forget one of them, and are then justifiably perceived as untrustworthy. So the outcome of something thoughtless and casual may be extremely serious.

“White lies” also deprive you of the opportunity to learn if you have underestimated someone. Relationships grow when such small risks are met with empathy. There is nothing more precious than trust. Once broken, it may never be repaired. So, tell a “white lie” at your peril, and strive to be as honest as you can. Not surprisingly, the more intimate the relationship, the higher the stakes for
integrity and the more difficult it is to sustain.