ABSTRACT: Typical treatment for eating disorders involves
ego building and cognitive redecision therapy; existential systems-oriented
therapy. But eating disorders are holistic dis-eases. The root
of the disorder is a mistake in self-image. They reveal the relationship
of a self to the world who either can’t get enough, or for whom any input
is too much. Since we must all eat to live, being out of balance
with food means being out of balance with nature. The CRP process
dissolves old patterns of self-image, of relationship with food, and rebuilds
ego by first restructuring consciousness at the sensory root or primordial
level. REM journeys facilitate creative self-organization.
CRP for disordered eating is not just for those with clinical
disorders, or even food cravings for carbohydrates, fats, or sweets.
Poor dietary and sleeping habits lead to hypoglycemia, subclinical depression,
fatigue, insomnia, and poor concentration, disrupt daily life, strain relationships,
and even jeopardize careers. Self-esteem, self-control, mood, and
eating are intertwined, so what a person eats or feels is wrongly metabolized.
What we eat affects whether we are happy, sad, irritable, moody, alert,
or sleepy. If you want to feel your best, you have to eat your best.
Children can also benefit from CRP: 1 out of 3 children are overweight
and in danger of obesity; children are 30% heavier than they were 10 years
Gross disturbances in eating behavior are characterized as eating disorders.
Clinical syndromes relating to food include anorexia, bulimia, and obesity.
They are all marked by an uncontrollable obsession with diet and weight.
This preoccupation with food can lead to such outward signs as poor complexion,
dull hair, eroded teeth, or tired eyes. Sometimes an eating disorder
is secondary, resulting from substance abuse or depression.
For both the starver or the binger, the disease becomes the identity.
Regardless of the eating disorder, it manifests in increased feelings of
anxiety, depression, alienation, helplessness, fear of fat, and vulnerability
to impulsive behaviors. Even though they may have begun with simple
dieting, often these disorders are progressive and manifest a distinct
set of signs. Whatever begins the dieting spiral, imbalances created
in the body’s chemistry are the major reasons why the eating disorders
progress. There is a natural nerve-chemical basis for the eating
pattern that can eventually become all-consuming.
Subclinical disorders may exist in those of normal weight whose lives are
marked with obsessive thoughts of food and with strong desires to eat,
coupled with severe, controlled restraint. Poor diet is related to
moodswings, fatigue, stress, hostility, depression, poor concentration,
memory loss, and sleep problems that can interfere with enjoying life.
Dietary chaos is harmful; wildly fluctuating blood sugar can lead to a
variety of diseases.
What you eat affects thinking profoundly: (1) the level of neurotransmitters
in the brain that regulate mood and mental processes; (2) development and
maintenance of brain cell function and structure; (3) the insulating sheath
around nerve cells that speeds messages; (4) the level of enzymes which
enhance brain functions; (5) the amount of oxygen the brain receives; (6)
the rate of accumulation and removal of cellular debris; (7) the ability
of brain cells to transmit electrical messages.
Links between mood, eating patterns, and nerve chemicals are very strong.
Even if psychological issues initiate the condition, hormones and nerve
chemicals are turned topsy-turvy as a result of eating disorders.
Disorders might be fueled by neurotransmitters gone amok because of dieting
spirals (Somer, 1995).
Serotonin and endorphins are powerful shapers of personality and mood and
have been associated with food-mood problems, from food cravings to PMS
and Seasonal Affective Disorder (SAD). Self-starvation and binge
eating are fueled by powerful internal chemicals, which though out-of-balance
can return to normal levels. Low serotonin levels are implicated
in binging and purging; whereas elevated serotonin may suppress appetite
in anorexia. Endorphin levels are elevated after a purge. Anorexics
are addicted to the endorphin-induced rush that comes from dieting and
Subclinical manifestations of disordered eating include insomnia, “the
blues,” yo-yo dieting, food abuse, addictive overeating, and uncontrollable
food cravings for fats, sugars, or carbohydrates. They become problematical
when self-esteem, self-control, mood and eating become entwined and rebound.
There are links between sugar and the brain chemicals that influence who
we are, what we do, and how we think and feel.
Food abuse, or emotional overeating has antecedents which lead to behaviors
which have real consequences. Reasons other than simple hunger for
nourishment precede this eating. Restrictive diets can swing the
pendulum to binges which follow, and fear of food can develop. Irrational
beliefs are part of the process and include all-or-nothing thinking, overgeneralization,,
shoulda-coulda, labeling, etc. Misconceptions include “Food is
love;” “Food is responsbility;” “Food is reward;” “Food is fun.”
Blood sugar levels directly affect our appetite and energy level.
Excess caffeine can lead to chronic sleep deprivation. Drinking is
another source of toxic intake: alcohol and other depressants suppress
a phase of sleep called REM, during which most of our dreaming occurs.
Dieting can leave you sleepless. Less REM sleep is associated with
more night awakenings and a more restless sleep. Alcoholics REM sleep
is low and they spend little or no time in the deepest phase called delta
Some treatments for full-blown eating disorders focus on underlying dynamics
and stress the importance of individual therapy. Some practitioners
recommend long-term dynamic psychotherapy, others reducing symptoms immediately
through the use of brief strategic therapy. Others focus on family
dynamics and stress the usefulness of treating the family system.
Obviously, there are approaches to medical management of these disorders.
Simple obesity is conventionally considered a physical disorder, not generally
associated with any distinctly psychological or behavioral syndrome, however
psychological factors may have influenced its etiology. Psychological
factors can affect physical condition.
Anorexia and bulimia are apparently related disorders. Anorexics
develop a fear of food and a horror at the act of eating. Confined
to a rigidly ritualized pattern of behavior that leads them toward voluntary
starvation, they deny that they are too thin, even to the point of death.
Its issues are control and dependency needs, perfectionism, and boundaries.
Anorexia is fatal in 5% of those with the chronic disorder.
Diagnostic criteria (DSM-IV) for anorexia include the following:
A. Refusal to maintain body weight over a minimal normal weight for
age and height, for example weight loss leading to maintenance ob body
weight 15% below that expected; or failure to make expected weight gain
during period of growth, leading to body weight 15% below that expected.
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one’s body weight, size, or shape
is experienced, e.g., the person claims to “feel fat” even when emaciated,
believes that one area of the body is “too fat” even when obviously underweight.
D. In females, absence of at least three consecutive menstrual cycles
when otherwise expected to occur (amenorrhea).
Anorexia nervosa is a condition usually affecting adolescent and young
adult females in which the patient may literally starve herself to death,
even though experiencing intense desires to eat. She usually expresses
fear of gaining weight and denies that her emaciated condition is a problem.
The condition is frequently associated with schizophrenia. 33% of
parents have a diagnosis of primary affective disorder, more prevalent
among female relatives of patients.
In the relentless pursuit of thinness, the anorexic may use laxatives,
enemas, and diuretics to attain her elusive image of perfection.
Street drugs, such as cocaine, speed, or heroine may create a chemically
induced anorexia by disordering eating and sleeping patterns and initiating
a chemical spiral of appetite suppression.
There are obsessive-compulsive antecedents to the onset of relentless anorexia:
(1) The (pre) anorexic experiences her parent(s) as depleted, exhaused,
dependent (upon her), and insubstantial. (2) She develops fear of abandonment
and mistrust. (3) She defends against these fears by becoming contemptuous
and angry. (4) She becomes afraid of and ashamed of her feelings
of contempt and anger and believes she may damage her insubstantial parents.
She represses her feelings and becomes overpleasing, overcompliant, even
controlling with her own nurturing behavior. She vicariously enjoys
the care she offers others. (5) She turns to external order to feel
secure, ritually and compulsively arranging her possessions. Since
she lacks existential trust, all decisions become crucial and fearfully
made. (6) Rigidly executed rituals provide a sense of safety and
increase in number (Levenkron, 1982).
Anorexia’s companion disease, bulimia, can be separate from anorexia or
can coexist with it (bulimarexia). In bulimia, the horror of food
takes a weird turn in the form of uncontrollable, usually secretive, binging.
The bulimic can consume between 2,000 to 50,000 calories at a sitting,
then the huge amount of food is vomited back up, stressing the digestive
system and whole body. Impulses to binge and purge bring about basic
physiological changes, including dehydration, electrolyte imbalance, hypoglycemia,
dental and gastrointestinal problems, and insomnia. DSM-IV criteria
for bulimia nervosa include these characteristics:
A. Recurrent episodes of binge eating (rapid consumption of a large
amount of food in a discrete period of time.
B. A feeling of lack of control over eating behavior during the eating
C. The person regularly engages in either self-induced vomiting,
use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
in order to prevent weight gain.
D. A minimum average of two binge eating episodes a week for at least
E. Persistent overconcern with body shape and weight.
Binge-eating is usually chronic and intermittent with periods of normal
eating. Bulimics plan eating binges where food is eaten secretly
or as inconspicuously as possible. It is gobbled down rapidly with
little chewing. Abdominal discomfort, social interruption, induced
vomiting or sleep may end the binge.
The binge/purge cycle brings on depression and disparaging self-criticism.
Purging may burn and rupture the esophagus and over time lead to a severe
medical problem and internal bleeding. Laxatives and diuretics are
abused in attempts to control weight fluctuations. Bulimics are also
at risk for other addictive behavior involving sedatives, amphetamines,
cocaine, or alcohol.
CONVENTIONAL TREATMENT OF EATING DISORDERS
A typical eclectic two year treatment program of interdisciplinary therapies
and interventions takes place in three phases: (1) the initial stage
of first six months, (2) the middle stage of six to eighteen months, and
(3) the final stage 18 months to two years.
The treatment program for anorexia (Andrewartha, 1982) contains the following:
1. Immediate confrontation of the suicidal nature of the anorexic
with simultaneous defining of the food issue as a symptom of a control
2. Immediate definition of the treatment program being two years
with implicit reliance on the therapist for that time.
3. Close and continuous medical supervision.
4. The use of male/female co-therapy team.
5. Intensive therapy (4 to 6 times a week for the first 6 months
with a gradual reduction to weekly group sessions).
6. Minimal involvement with the family of origin or their substitutes
but intensive family therapy with the parent projection in the client’s
7. Considerable regressive work utilizing reparenting principles
to achieve a healthy separation.
8. Major redecisions around the above script issues.
9. Lots of humor.
Therapy for all eating disorders revolves around redefining food issues,
control issues, weight beliefs, self-worth, and fat issues.
Medical management for anorexia and bulimia includes risk assessment, current
medical condition, and anticipated behavior. There is close collaboration
between the internist and the psychotherapist.
Management of refeeding is initiated in high risk patients with 50% weight
loss, symptomatic hypoglycemia, hypothermia, significant EKG abnormalities,
and clumsiness. When voluntary feeding is insufficient, by tube or
intraveneously. While anorectics can be extremely frustrating, the
recoveries possible are as spectacular as any in medicine.
EATING DISORDERS AND TRANSACTIONAL ANALYSIS
TA approaches eating disorders with a variety of perspectives, an existential
systems-oriented treatment. Some clinicians use the Redecision model,
while others use Reparenting techniques, or Berne’s emphasis on social
control. Work is done in both individual and group settings.
Family therapy and educational programs, and group therapy programs are
designed specifically for eating disorders they address.
The most important questions here are: (1) What are some of
the dynamics which underlie the various problems related to food and eating?
and; (2) What enables people with symptoms of anorexia, bulimia,
or obesity to decide to change?
In treating people with eating disorders, it is important to recognize
and deal with fat issues as well as eating issues. Fat issues and
eating issues often support different script decisions, which show up at
three levels of impasse.
Recognizing and dealing with fat issues (Griffin, 1985), negative body
image, and the self-loathing that accompanies this image is an important
part of treatment. Fat issues will not magically disappear once a
person starts eating appropriately. In fact, these unresolved fat
issues will probably prompt a relapse into old patterns of binge eating
and starvation. All this is linked to boundary issues, and the meaning
of food and size.
Common beliefs which contribute to the misuse of the eating function include
perfectionism, perceiving the world in either/or dichotomies, if-then perils,
and perceiving self in detrimental comparisons.
Since food must be mastered several times a day, it is important that the
client see herself as responsible for her cure. Anorexics steadfastly
deny and minimize the severity of their illness. They can be uninterested
in or resistant to therapy.
Control must be experienced as emanating from inner sources if the bulimic
is to become able to encounter food with pleasure and confidence (Vognsen,
1985). The therapist avoids direct attacks on the problem behavior,
and doesn’t try to end bulimic behavior by advice, exhortation, or confrontation.
Putting an end to habitual binging and purging is not unlike changing other
addictive behavior. They must be persuaded to stop the practice in
question and then be encouraged through the ensuing period of discomfort
and occasional panic. Treatment changes perceived helplessness, allowing
spontaneous or willfull reassertion of control of eating.
Although anorexia, bulimia, and obesity have apparently different symptomology,
they are closely related through common underlying problems stemming from
injunctions and constellation of early decisions. Eating disordered
individuals often have extremely low self-esteem and feel powerless, often
having the sense that autonomy and a clear sense of self was thwarted in
early childhood. They have fears of abandonment and rejection (Solomon,
Injunctions revolve around developing an autonomous self: Don’t Feel,
Don’t Be You are primary. Bulimics frequently have double scripts
of contradictory messages: Hurry Up and Grow up at an early age, then Don’t
Grow Up as an older child. Anorexics get the admonishment Don’t Exist,
Don’t Be Sexual and counter-injunctions to be perfect and to please and
take care of others. The obese get Don’t Be You and Don’t Be Sexual.
Active listening to the client’s general needs is essential, rather than
enforcing an agenda. Food and Weight related talk varies with the
patient’s nutrtional and general physical state. Failure to confront
nutritional issues may imply to the patient that the therapist fears the
disease and is abandoning her to its effects.
It is paramount the therapist does not become obsessive with the patient
about eating. Anorexics frequently engage others in endless discussions
of food, reinforcing the precoccupation with eating and avoiding discussing
feelings. She thus attempts to overpower the therapist. Extorting
promises to gain weight are counterproductive. Free time is potential
time to obsess and become anxious. Patients’ big fear is that refeeding
will start them on an out-of-control gaining spurt.
The most counterproductive behaviors by the therapist are, first, dependent
communications, and second, abandoning communications from therapist to
client. Dependent communications seek reassurance from the patient
to the therapist that therapy is working; abandoning statements are those
that ask her to assume premature autonomy. These kinds of statements
replay parental behavior, and imply the therapist is also insubstantial
and cannot help her. This leads to retreat into the compelling magical
system that is her illness (Levenkron).
EATING DISORDERS AND CONSCIOUSNESS RESTRUCTURING
Deepak Chopra (1989) has revisioned eating disorders from the holistic
“To explain this paradoxical illness, one has to drop the distinction
between mind and body and think of one system, the ‘bodymind.’ This
is because an eating disorder is a holistic disease, the cruel opposite
of holistic health.”
Whether a person is compulsively too fat or too thin does not depend primarily
on how much food she takes in. The drive to embody a particular pattern
comes from the existential sensory self-image, which patterns the bodymind.
A memory is picked up and stored in the body, in a particular conformation.
It is generally recognized that for the chronically obese, diets do not
solve the problem because the brain of the person is always sending out
overpowering signals for too much food. Unless some change takes
place at a very deep level, the messages stay the same and are triggered
compulsively as a self-defeating tactic. The intellect is powerless
to change these distortions in self-image. One part of the personality
struggles to maintain rationality while another creates wildly irrational
How we react to thoughts of food set up either waves of revulsion or desire,
or cycles of repulsion and gluttony. The thought and the reaction
come together, and there is no place to drive a wedge between them.
The thought and the molecular changes it creates are one.
The thought is the molecule; the molecule is the thought. And this
irresistible impulse constitutes the person’s whole inner reality.
She is her disease for the moment. Struggles to change this thought
are futile and patients feel guilt over “causing” their own disease.
But there is a third component in this process which is silence that lies
deeper than thought, and it is there that a cure may be found. The
person’s sick memory has gotten into her chemical system. The nonmaterial
memory becomes embodied there in the whole person. Memory has built
some matter around itself, forming a specific pattern. Your body
is thus the place your memory calls home.
Like other addictions, food addiction is a distorted memory, one that subverts
the natural rhythms of life including eating, elimination, and sleeping.
With all the chaotic shifts of fluids and chemistry, thinking and mood
vary substantially, leading to functional difficulties.
Many clients have come for CRP for seemingly unrelated reasons (other adjustments,
alcoholism, etc.) and found that as a side-effect, often lifelong-struggles
with food and weight changed for the better automatically. Their
tastes and desires just automatically changed to more healthy patterns
as their systems became more harmonious and in balance.
The commonality between all the overcontrolled or out-of-control eating
disorders (anorexia, bulimia, obesity) is a sensory failure to perceived
and maintain an optimal level for their blood sugar, so that cells can
get the nourishment and energy they need.
Other nutritional deficiencies, such as B vitamins and zinc aggravate hypoglycemia.
Even Mercury from dental fillings is a culprit.
Rising and falling blood sugar levels create mood swings that contribute
to general emotional chaos and feelings of incompetence. Independent
studies show that starvation leads to obsessive thinking, accelerated by
the act of dieting, leading to a spiral of malnutrition and compounded
obsessive thinking. This disordered thinking is the first area therapy
This sensory failure extends to create confusion about the boundaries of
the body. All their thoughts and feelings are filtered through a
brain starved by disordered over- and undereating. What possibly
links improvement in related conditions such as alcoholism is once again,
a link with the metabolism of sugar in the body. The body treats
refined sugar and alcohol in a similar manner -- toxic shock.
Paradoxically, low blood sugar causes “neurosis” and neurosis causes low
blood sugar (Fredericks, 1985). Low blood sugar creates a plethora
of psychosomatic symptoms: sinus trouble, allergies, constipation, dandruff,
poor circulation, digestive disturbances, forgetfullness, palpitations
of the heart, rapid pulse, muscle pains, numbness, blurred vision, muscle
twitching, itching and crawling sensations, gasping for breath, blotchy
skin, sensitivity to sunshine, and falling hair.
Emotional troubles include nervousness, sleeplessness, being edgy and subject
to uncontrollable fits of temper, difficulties in concentrating, hypochondria,
mild agoraphobia, and a completely unjustified, constant feeling of
“something terrible about to happen.”
Many of these symptoms arise because blood sugar is too low to support
the nervous system and the brain. Low blood sugar, and an overactive
pancreas, can turn an otherwise balanced person into an apprehensive hypochondriac.
It creates intolerable anxiety, unjustified fear, internal feelings of
shakiness, nightmares, weak spells and insomnia (awakening 3-4 hours after
falling asleep and being unable to return to sleep).
It can imitate or aggravate epilepsy, migraine headache, peptic ulcer,
rheumatoid arthritis, delinquency, and asthma. It can directly cause
alcoholism, and could possibly lead to drug addiction. Alcoholism
inevitably will worsen low blood sugar and intensify nutritional deficiencies
in a vicious circle.
Low blood sugar itself can cause compulsive drinking! A strong desire
for sugar is characteristic of alcoholics who alternate between periods
of sobriety and abysmal intoxication. They eat enormous quantities
of candy while sober -- always when sober, never when drinking. Many
are able to break their habit once hypoglycemia has been treated.
All alcoholics are subject to low blood sugar, if not as a cause, as a
result of the substitution of alcohol for food. Treating it may benefit
any compulsive drinker, even if cure of the compulsion does not follow--which
Severity of the dysfunction is irrelevant as even little deficits can create
big problems. Mild hypoglycemia can create severe symptoms; severe
hypoglycemia can manifest as comparatively mild symptoms. The overactive
pancreas produces the hormone that helps us to burn sugar, and the amount
at work in the body is critical. Too little of this insulin results
in diabetes. But the overreactive pancreas makes too much insulin,
and can produce shock, dizziness, cold sweats, irritability, shakiness,
anxiety and even collapse.
All forms of sugars (and alcohol) stimulate the overactive gland even more,
and to compound it, the condition creates a craving for sweets. Diabetes
can result when an overactive pancrease exhausts itself. But the
misbehavior of the gland is only a symptom, too, rather than a cause, and
we still don’t know what makes it go berserk. Continual stress is
a probable culprit in initiating hyperactivity. Anxiety can touch
off low blood sugar and forms a vicious circle since low blood sugar causes
Consumption of more than a hundred pounds of sugar a year looms as the
most probable cause. The average person eats a teaspoonful of sugar
every thirty-five minutes, twenty-four hours a day; almost 1 cup daily;
104 pounds per year!
One form of low blood sugar arises from and causes monotony, boredom, a
sense of aimlessness, and lack of a feeling of achievement. According
to Fredericks, a “flat glucose-tolerance curve,”
“is the disturbance in sugar metabolism that comes about when a person
is, for instance, forced into an occupation in which he finds neither zest
nor challenge. The tension is low-grade; so is the upset in the dynamics
of the management of blood sugar. . .pre-hypoglycemia...when the person
finds no challenge and no sense of achievement in pursuing his (inescapable
duties); and the body responds to the deficit in mental and emotional challenge
by not attuning itself to the demands made upon it, with the result that
there is an imbalance created between the function of the adrenal glands,
which elevate blood sugar, and the pancrease, which lowers it.”
“This results in a chronic half-starvation of the brain. The sugar
levels in the blood do not dip low enough to cause blackout, nor rise high
enough to permit efficient function, and the person is only half-alive,
existing in a twilight zone where constant fatigue is the symptom of his
emotional sit-down strike.”
It would seem the body rebels against monotony and tedium and lack of fulfillment.
Lack of zest leads to a lack of sugar for the brain and constant mental
and emotional fatigue result. Lack of zest deprives the body of stimulation
needed to keep the nervous system in tone, and this leads to lack of sugar
which creates and compounds fatigue. The question becomes, “Are you
tired or are you tired of what you are doing?” Young executives,
who show the flat-curved hypoglycemia profile, feel trapped and complain
of fatigue, loss of zest, and boredom.
When the pancreas is quieted, no longer overstimulated by sugars, the adrenals
have the capacity to return to normal functioning. The body can counter
sudden deviations from the normal level of about two teaspoonfuls in the
bloodstream. However, it cannot tolerate a continued deviation--whether
in the form of consistently overelevated blood sugar levels--or, what is
even more threatening, consistently depressed blood sugar levels.
There are at least two people suffering silently from low blood sugar for
every one affected by diabetes. Even a fasting-overnight blood sugar
test doesn’t reveal the daily swings in levels, so many go undiagnosed.
The pancreas has simply been oversensitized to sugar and is overactive
producing insulin or underactive in producing glucagon, the hormone that
is anti-insulin in its effect.
This is the response to too much prodding of the organ by the brain and
the nervous system and to too much tension and anxiety, producing an imbalance
of nervous impulses reaching the pancreas or a related disturbance of the
function of the liver in meting out its stores of reserve sugar.
Black coffee pushes reserves of sugar into the bloodstream, which
challenges both pancreas and adrenals, causing low blood sugar. Coffee
with sugar is even worse.
It is easy to see how personality and behavior can be changed since the
brain and nervous system are on a constant, stable, small supply of sugar.
But our systems were never meant to handle the overavailable high doses
we get in modern life, from largely hidden sources. Three
times each minute, the brain completes a series of chemical reactions in
which sugar is converted into energy.
CRP can effect changes at the quantum, neurological, and chemical level
which can reinstate homeostasis. Individuals find that they automatically
change their eating patterns and their desires for certain kinds of foods
once consciousness restructuring begins.
However, a little basic education in nutritional requirements goes a long
way in correcting any nutrional disosrder, once the irrational aspects
of the syndrome are being addressed. Taking daily suppliments certainly
doesn’t hurt, and can jump-start the psychological work tremendously by
providing the body the raw materials it needs for its chemical factory.
We are indeed what we eat, and the maxim of the computer-age holds:
“Garbage in, garbage out.”
Andrewartha, Graham, “Anorexia nervosa: three case studies of TA treatment,”
Transactional Analysis Journal, Vol. 12, No. 2, April 1982.
Fredericks, Carlton, New Low Blood Sugar and You, Putnam Publishing Group:
New York, 1985.
Griffin, Stephanie, “Eating issues and fat issues,” TA Journal, Vol. 15,
No. 1, January 1985, pp. 30-36.
Levenkron, Steven, Treating and Overcoming Anorexia Nervosa, Charles Scribner’s
Sons: New York, 1982.