Teen Eating Disorders
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The Many Faces of Denial


Bonnie sought help to stop a 25-pound relapse. She had by-pass surgery five years ago at the weight of 380. Four years after the surgery she hit a low of 160, and after two skin removal surgeries she was proud of her new look. But in the past year she began to graze on bread, cheese, popcorn and wine, attributing this to a spike in anxiety. As a 60-year old elementary school teacher, she was under pressure to take courses to receive new certifications. The stress of teaching and studying left her feeling overwhelmed.

She described the initial post-surgery period as magical, discontinuing meal planning or tracking, eating small amounts, feeling satisfied, rarely feeling hungry. At the point that she was wearing normal size clothes, a kind of cockiness set in. As the work pressures mounted she felt less joy from teaching and told herself: “what is wrong with rewarding myself with some snacks?”

Bonnie used a variety of rationalizations and justifications to explain the return to old excessive eating patterns. Among them were: Keeping a food diary is tedious so I’ll do it in my head instead of on paper. I know I’m out of control but I’ll start dieting on Monday. I deserve a reward – look at all the aggravation I have to put up with. I’ll just have a little in order to keep from feeling deprived. If any of these thoughts sound familiar, you may have to confront your use of denial – a serious threat to long-term success.

The Nature of the Problem

Initial discussions with Bonnie were designed to cultivate respect for the reality of her problem. Several principles were emphasized:

1) Her problem was more about food than it was about weight. If weight loss is to be maintained, she had to change her fundamental relationship with food. Eating needs to shift to the role of nourishment and not be in the role of reward or escape from stress.

2) The problem is lifelong, not temporary. For the rest of her life her job is to keep food in the new role. Losing weight doesn’t create the option to “click off.”

3) The food problem is relapse prone and compulsive. High-risk eating situations need to be anticipated or avoided. Keeping snack foods in her classroom is a set up. Telling herself that popcorn is an innocent safe snack can be the start of grazing on it all day long.

4) There is a lifestyle connection to compulsive eating. Bonnie’s lack of intimacy and support in her life made her more likely to use food as a substitute for companionship.

In time Bonnie began to accept the many forms of denial she was using. Here are some illustrations of the common faces denial can have.

Experimenting With Control

Relapse often is set up by what is called, “apparently irrelevant decisions,” small choices that seem innocent at the moment, minimizing the risk they may pose. One of my clients bought cookies she thought she didn’t like, but felt she needed to have for the weekend guests. She did not see them as a threat to her control because she preferred other types of cookies, thinking, “If I have one or two, no big deal.” But having them in the house created urges. She began to graze on them and eventually had the whole bag, learning that control may mean keeping the environment free of temptation.

Maintaining a High Risk Lifestyle

A client was one of four good friends who lived in different cities in the United States. Once each quarter they reunited by picking a city to visit, with the principle activity being a week of sampling new restaurants. He came to accept that this food based “hobby” of his was contradictory to his stated goals of losing weight and keeping it off, and eventually replaced it with golf lessons and volunteer activities. Good intentions and high motivation can be trumped by a hazardous lifestyle.

Complacency/Overconfidence

Often relapse is triggered by a kind of cockiness that comes from success. After a significant weight loss, clients may justify a shift of priorities. “My family needs me more now. With my weight down 50 pounds it will be OK to spend less time planning meals.”Imagine that with every positive behavior (a meal plan, an exercise session) it is as if you took a brick and cemented it to the previous brick. In the end, with each successive pro-health action you build a wall that stands between you and compulsive eating. Recovery, then, is the commitment to engage in all the necessary actions that maintain a wall of separation between you and your compulsive potential. If, through over confidence or a shift in priorities, you discontinue the healthy strategies, down comes the wall. You and food are now enmeshed, and your eating spins out of control.

Rationalization

A client who was more than 100 pounds overweight minimized his food abuse with various justifications. “I just eat too much while watching T.V. I don’t use food; I just like the taste of it. Why deprive myself of my only pleasure after a bad day? I’ll start a diet eventually anyway.”

These are examples of “addictive logic” – an inner voice that says, “it’s OK” whenever there may be some hesitation or questioning of the compulsive cycle. This type of thinking effectively builds a protective wall around the food use, wards off challenges or threats to its existence, and enables it to be acted out in the moment and into the future.

The Failure to Self Diagnose

Imagine that successful weight control is something that rests on a table of strong legs and a sturdy top. The table is built from an honest and accurate understanding of the problem and related treatment strategies. This consists of the core principles I worked on with Bonnie: The problem is food, not weight. It is chronic, relapse prone, compulsive and lifestyle related. Embedded in the problem is the tendency to wear blinders, to deny these essential truths, and therefore to deconstruct the table on which recovery is built.

Webster defines addiction rather broadly as a condition of having given oneself up to a habit. While there may be some debate in the professional community as to whether compulsive eating is an addiction, in my clinical experience I have found it to be, at minimum, “addictive like.” The self-destructiveness of addiction often doesn’t make much logical sense, and begs the question: what keeps an addiction going? Denial breathes strength and life into addictive behaviors by leading to a lack of attention, dismissing the nature of the problem and what is needed for recovery. This can never be the platform for success, and must be confronted with a supportive, educational, and persistent approach. Be willing to do what Bonnie did. By recognizing denial, you are empowered to let it go.

Lee Kern, M.S.W., L.C.S.W., is the clinical director for Structure House, a residential weight loss facility in Durham, NC. Kern leads the post-bariatric surgery program. Designed for patients following weight loss surgery, the program offers surgery-focused medical assessments and personalized eating and relapse prevention plans. For information, visit www.structurehouse.com or call 800-553-0052.