Eating disorders

Eating disorders

Anorexia

"I would like to be fog so no one could find me"

Elias Canetti

Anorexia

Anorexia is characterized by a refusal to maintain body weight above or at thenormal minimum for the patient's age and height. Patients (usually young girls), have an intense fear of putting on weight even when already below normal weight. Weight loss is achieved by reducing the amount of food eaten and also using other strategies such as excessive physical activity, using laxatives and induced vomiting.

Girls affected by anorexia tend to perceive reality through a distorting enlarging prism, perceiving their body as over-inflated and with a constant fear of failure that makes them very disciplined at school or at work. They may have amenorrhea (absence of menstruation) because of the weight loss, or in pre-pubescent girls, a delay in beginning menstruation from being underweight.

Psychological therapy focusses first on weight-gain through work that directly involves the parents before confronting the personal, social and intrafamily aspects of the problem.

Anorexia is a search for control that imprisons the person through food. In fact, it is used as an attempt at emotional self-control. It is the pateint's "emotional anaesthetic".

Bulimia and binge eating

"If you permit it you can give it up, if it is not, it will be inescapable."

G.Nardone

Bulimia and binge eating

Bulimia is another eating disorder characterized by an unrestrained tendency to binge caused by an uncontrollable pleasure of eating and then the fear of losing control. Restricting "forbidden foods" in meals leads the patient to the need to transgress or lose control.

Consequently, patients are usually overweight or oscillate in their weight, using laxatives and sometimes induced-vomiting. They may be at risk of developing vomiting disorder, which will be described later. It is usually associated with high anxiety generated by the feelings of guilt surrounding loss of control and body dissatisfaction.

It is not the stomach that they seek to satisfy, but another kind of inner emptiness: the sense of interior emptiness we all feel when we are homeless, helpless, scared, or directionless. The emotional needs that rule over the patient's mooddriving to want to fill that inner emptiness, which they will do with food, alcohol or any other substances. This can not satisfy the emotional needs permanently, so they will eat more and more often and in greater quantity.

The patient thus becomes trapped in a vicious circle, seeing no way out oralternative way to follow. But there is a way. Often the problem involves depression, so the treatment will be focused not only on recovering a healthy food balance but intervening in the way the patient perceives and reacts to others and to the world.

Vomiting

"The true mystery of the world is the visible, not the invisible"

Oscar Wilde

Vomiting

This disorder works in a totally different way to those described above.

Vomiting disorder does not exist in the classical literature as a syndrome per se, but rather as a symptom that may be present in anorexia and bulimia.

Following intervention research process conducted by the Centro di Therapy Strategica di Arezzo in Italy on thousands of cases of successfully-treated eating disorders, it has been revealed that vomiting behavior evolves from a being a mere method of weight control or a conseque of guilt after binge eating, into an end in itself, transforming the "eating and vomiting" in a ritual based on gratification.

In some cases the patient asks for help directly because they want to recover other pleasurable sensations. In other cases the family intervenes as the patient may have no interest in eliminating the pleasure of vomiting that is occupying their life.

Phobia

"People are not born fearful, but become it"

G. Nardone

Phobia

A phobia is an exaggerated and irrational fear of a certain situation or thing.

From an experience which may be conscious or unconscious, the person 'categorized' the situation or item (eg. spiders or enclosed spaces) as dangerous. The result? The person starts to avoid it and constructs a fearthat they did not have.

Over time, the monophobia could become disabling, especially in the evasions that the person tries to solve the problem by avoiding what they fear.

Avoidances gradually build a more complex problem: generalized phobia.

A vicious circle is created: "I'm scared, so I avoid, but by avoiding I stoke up fear."

Social phobia

"Declared fragility becomes a fortress"

Giorgio Nardone

Social phobia

This is a modern problem that has been structured as a result of the multiple and constant demands to which people are subjected daily. In a competitive world, who is not at the height of all the circumstances is not taken into account, socially disappears.

Hence comes a (healthy) initial concern that requires each person to strive to give the best of his/ herself.

The problem arises when it becomes an obsession: the fear of failure. From that time, these thoughts become an obsession, which ends up generating physical reactions (sweating, face coloring, stuttering, etc.) that the person, by the same concerns that others realize, tries to control. This is how she/ he loses control and with it, the self-confidence. "The more I try to have control, more I freak out."

Panic atack (anxiety)

"There is nothing more apt to deceive us than our own judgement"

L. da Vinci.

Panic atack (anxiety)

When a person feels fear it manifests physically in the body through, among other symptons, increased sweating, heart rate, tremors and stereotyped movements. All these signs are important and healthy because they alert the body so it can react to a situation perceived as dangerous.

Fear becomes a problem when these reactions exceeds a certain limit and are transformed into terror and panic. This produces a such feeling of loss of control in the sufferer that they believe they might die.

After the first experience, the patient begins to be in a state of alertness to the possibility of suffering another panic attack. This leads them to adopt two possible 'solutions': avoid the situation where they feel vulnerable to another attack or decide to confront this situation, and try to control their physiological reactions. This fails as "the excess of control actually causes the loss of control."

Fixed obsessions

"An obsession lived to satisfaction is destroyed by its own excess"

E.Cioran

Fixed obsessions

Obsessions are extremely rigid and such rigidity is manifested in the sufferer's constant attempt to have control over everything.

The idea of having to control everything starts generating anxiety and fear.

Some obsessive people must have rigid control over a particular aspect of their environment, for example, the order of the house. For others, the obsession is a fixed idea, such as the thought of being a failure at work.

In any case, when sufferers attempt not to not to think about that idea, they fall foul of the paradox of "thinking of not thinking is thinking twice."

Obsessive- compulsive disorders

"You yourself have dug beneath your feet the abyss you are now in"

G.Nardone

Obsessive- compulsive disorders

The problem in these people is that their control is too well controlled.

Unlike an obsessive, an obsessive-compulsive person is compelled to act in a certain way in in order to dispel the obsessive idea.

That 'act' itself becomes the problem bacause, though repetition, it becomes a ritual that creates the new belief: "If I do not do the ritual, the idea will not disappear, the anguish will persist, then I will have to do the ritual."

So the trap is built.

Hypochondria

"I'm like a broken puppet always looking with the eyes inward".

E Cioran

Hypochondria

In cases of hypochondria, too, there is fear of facing an idea, in this case of having a disease.

In some cases, the fear is of having a disease in a specific organ; in other cases, of having any kind of disease.

Hypochondriacs try to control all the sensations and signals of the body to supress symptoms that may make them think they have a disease. This behaviour ends up feeding the idea of having a serious illness.

This behaviour ends up feeding the idea of having a serious illness.

Body dysmorphic disorder (BDD)

"Nothing is too much, just enough"

Giorgio Nardone

Body dysmorphic disorder (BDD)

BDD is another good example of diseases that have evolved as a consequence of changes that occur in the modern world.

As in the case of obsessive people, the BDD emerges from the fear of an idea: the obsessive idea of physical appearance.

From this idea, the sufferer tries to correct everything they believe is wrong with their appearance. Ultimately, they come to cosmetic surgery.

The problem is that after each surgery, they find there are still things to correct. It starts as a grain of sand on top of a mountain that, by the time it reaches the bottom, has has become an avalanche.

Alleged psychosis/ Presumed autism

"The label is what creates the disease,"

Nardone & Portelli

Alleged psychosis/ Presumed autism

Brief Strategic Therapy prefers the word 'alleged', as starting with the assumption that a patient is psychotic becomes a self-fulfilling prophecy. The patient and people around them get caught up in the feeling of helplessness and inability to change.

In cases of delirium, the first step in treatment is to accept the distorted reality of the patient as if it were real in order to show that their suffering is understood.

Upon entering the "delirium" of the patient, it is possible, from within, to seed some doubts about what the patient considers absolute.

Thus, the belief can be deconstructed without being aggressive, indeed by understanding their suffering and their subjective reality.

In the case of autism, delayed maturation of the patient may be mistaken for true autism.

Paranoia

"From a grain of sand is built a mountain under which the person is buried"

G. Nardone

Paranoia

Paranoiacs do not recognise that they have a problem, but rather are convinced that other people are wrong and that everyone is against them.

Because of this, they are enraged against the world, charged with an anger that sometimes manifests (eg as complaining, aggression or violent or disproportionate reactions) and sometimes they rail against themselves. In this latter case, sufferers can become embittered, withdrawn and resentful towards others.

The person wants to change the others because they do not correspond to what he/she wants and expects from them.

Depression

"The night is long, that never finds the day"

W. Shakespeare

Depression

Unless there are physical or physiological origins, Brief Strategic Therapy considers depression is not a condition of the person but rather the consequence of some event (a loss, a big frustration, a trauma, etc.).

In that sense a patient is not considered to be inherently depressed but rather in a temporary state of depression.

A person in such a state is one who is always waiting: waiting for themselves, for others and for the world.

Withdrawal and victimization are always present in sufferers.

A person in this mood can become isolated because people around them, eventually, get bored of the position of victim, always lamenting all the misfortunes that happen to them. That reaction from the other people is, for the depressed, a confirmation of their misfortunes, without realizing that they themselves have built that reality.

Post Traumatic Stress Disorder (PTSD)

"Nothing fixes a thing in memory as intensely as the desire to forget it"

Michael de Montaigne

Post Traumatic Stress Disorder (PTSD)

In greek, the word TRAUMA means INJURY.

In other words, a trauma can be defined as negative "corrective emotional experience", which introduces a 'catastrophic' change in a person's life, opening a crack in their sense of reality and personal balance.

Developing a disorder depends on how the person reacts in the of face the traumatic event; in other words, their "coping reactions."

What distinguishes people who develop PTSD and those that simply experience temporary stress, is that the former organize their entire lives around the trauma.

Past can not be changed; what can be changed is the effect that it has on the present.

Borderline

"I'm like a river in spate that carries away everthing in its path."

Anonymous

Borderline

Borderline disorder is characterized by subjects that have conflicted relationships, unstable moods (in same day experiencing different emotional moods) and intense emotions. The may have abrupt changes of character, lacking any good cause.

Those affected suffer from dysphoria, which is characterized by mixed feelings of anger, anxiety, depression, despair, jealousy and self-hatred. Sufferers often turn to substance abuse and self-destructive behavior trying to keep these intolerable emotions under control. They can be extremely impulsive, often harming themselves through abusive behaviors, for example by overspending, indulging in compulsive sex, or developing an eating disorder.

Patients with borderline disorder often present with many and varied sympotoms, With Brief Therapy the problems problems are treated in order starting from the least disabling.

Dependency disorder (Addiction)

"The limit of pleasure is a greater pleasure"

G. Nardone

Dependency disorder (Addiction)

Addiction is a complusion based on pleasure. Firstly, we have to treat the physical dependence and then continue with therapy sessions. The patient profile has changed in recent years: drug users with a history of polydrug use, suffering from associated diseases, without education and unemployed, no longer represent a majority of cases. A broad range of profiles are encountered.

The intention is to motivate patient to begin to do something about their substance abuse. It is not a substitute for those who have a high level of dependence. Rather, the goal is to reduce damage that may result from the continued use of substances and provide patients with the tools to change their basic attitudes and manage their various underlying problems.

The content of the interventions will vary depending on the type of substance, the severity of the problem and the desired result.

Sexual disorders (masculine and femenine)

"No one can live without pleasure"

Santo Tomás de Aquino

Sexual disorders (masculine and femenine)

Sexual problems arise when the conscious mind begins to control a natural and spontaneous process, depriving the person of feeling pleasure resulting in a fundamental dissatisfaction. Generally, they try to seek pleasure and seek it in a voluntarily way, not finding it or denying it for fear of losing control and go with it. Therefore, they prefer to renounce the pleasure.

In treating this disorder it is important to rule out physical causes or substance abuse.

  • Femenine:
  • - Sexual desire disorder
  • - Sexual arousal disorder
  • - Orgasm disorder (anorgasmia)
  • - Sexual pain disorder (dyspareunia and vaginismus)

  • Masculine:
  • - Sexual desire disorder
  • - Sexual arousal disorder (erectile dysfunction , impotence)
  • - Orgasm disorder (premature and delayed ejaculation)
  • - Sexual pain disorder

Jealousy

"Who seeks shall find "

Sophocles

Jealousy

Excessive jealousy ('pathological'), can be structured and constructed following:

- A change of the couple's life, in life itself, surgery of one of the couple, change of job, a promotion, etc

- Investing all of themselfin a relationship. For this reason, the person neglects everything else in their life.

Anyone who over-invests in one thing p can reach a moment of 'madness' when they realise they have nothing else, and if they were to lose what they do have, they would lose everything.

The fear and constant insecurity of losing the other leads to building a self-fulfilling prophecy: in the end they lose the object of their jealousy.

Pathological Doubt

"Doubt is the engine of knowledge. It is also the springboard to obsession"

G. Nardone

Pathological Doubt

Sufferers feel a strong mental despair generated by questions that they are constantly asking themselves.

These are questions with more than one answer which is the main reason why people try to answer them. They have the illusion they will find a single answer without realizing that these responses are those that increase the infinite chain of questions - answer, question - answer, question - answer, question - answer ...

Doubt causes the search for an answer using the criteria of a rational procedure, which is unable to resolve doubts. This conflict between unsolvable questions and answers that fail to reassure causes a mental maze able to generate - as in previous cases - extreme suffering.

Again we face a dangerous trap, trying to find the right answers to wrong questions.

Others

If you feel some discomfort, even if it does not strictly match any of the difficulties mentioned before, consult me. Human experience is a continuum and does not always fit into categories.