Background: A high correlation exists between eating disorders and childhood trauma. In order to survive, parts of the self are split off. The impulse toward body dysmorphic disorder, compulsive over-eating, fasting, purging, or bingeing is imbedded in these dissociated parts which must become conscious in order to heal the eating disorder.
Introductions
Introduction of presenter
Overview of topic and structure of presentation
Definitions of Dissociation
Connection between trauma and Dissociative Identity Disorder
Definition of Dissociative Identity Disorder
Dissociation in Eating Disorders
A milder form of Dissociative Identity Disorder: “Mild Multiplicity”
Mild Multiplicity as falling in between the bounds of normalcy and extreme dissociative disorder.
Mild Multiplicity contrasted with DID as defined in the DSM
Kobrin’s formulation of Mild Multiplicity as a development of Freud’s and Eric Berne’s division of the parts of the self
Description of the parts of the self in eating disorders
What the parts of the self represent i.e. Roles in the family of origin, unconscious ideas and beliefs, forgotten traumatic experiences
The challenging and affirmative parts of the self
Causes of Dissociation in eating disorders
Chemical, genetic, and personality factors
The dysfunctional/abusive family
Correlation between childhood and teen sexual abuse and eating disorders
Cultural and societal factors
The Development of the dissociation
Eating disorder behavior as building on and exacerbating the dissociation
The role of brain structures and neurotransmitters
Serotonin, dopamine and the reward system
The role of shame, guilt and the loss of identity
Difficulties with attachment
Aspects of Dissociation: Lack of connection with the body, emotions, the authentic self, others, community, the world, and a higher purpose and meaning in life
Treatment Approaches and the Therapist’s Role
Stages of treatment
The importance of therapist/patient bonding
Introducing the dissociative element into the therapy
Accessing memories of abusive situations
Steps in accessing and working with the parts of the self
Finding and Naming the parts
Acceptance of the parts
Compassion for the parts
Connecting with the Affirmative parts
Dialoguing with the parts
Integrating the parts
Focusing on the eating disorder as a creative survival method
The necessity for flexible, imaginative, and varied approaches
Empowering the patient
Useful alternate approaches
Trance work – EMDR and hypnotherapy
Journaling and free, associative writing
Art therapy, collage, and sandtray
Role play
Self-help as vital for the therapy: Mediation, journaling, artwork, etc.
When treating eating disorders, awareness of dissociation is important. Eating disorders are a form of Dissociative Identity Disorder where the self splits into parts for emotional survival. Trauma survivors block out an awareness of unresolved trauma, creating dysfunctions such as addictions and eating disorders. Increasing attention has been paid to the relationship between traumatic experiences and the development of an eating disorder.
Kobrin coined the term "Mild Multiplicity" to describe dissociation in eating disorders.
If a Dissociative Identity Disorder is a ten, Mild Multiplicity is from a six to an eight. With Mild Multiplicity, dissociation is restricted to eating disorder behaviors. Berne's 1 formulation of the introjected Child, Adult and Parent Parts is a useful theoretical base to describe dissociation in eating disorders. This is incorporated into Mild Multiplicity. The Natural Child, expressive and joyful, disappears. The guilt-ridden, emotionally hungry Adapted Child acts out with dysfunctional eating. The functional Adult Part is overwhelmed by the Adapted Child and Critical Parent (a harshly negative self-concept). The Good Parent and Natural Child are undeveloped. In Mild Multiplicity, far more Parts than Berne’s are formulated, reflecting unconscious elements i.e. family roles or traumatic experiences. The parts are given personalized, imaginative, and symbolic names by the patient to combat the knee-jerk activity with food. This allows the disassociation to emerge to consciousness. Examples of named parts that patients have discovered and personalized are: War Zone Child, Black Hole, Binge Dragon, Problem-solver, Earth Mother, and White Light. Steps in managing the Parts are discussed. The primary cause of Mild Multiplicity is the dysfunctional family and sexual and physical abuse. Eating disorder behaviors exacerbate Mild Multiplicity, with a lack of connection with the body, authentic self, and the world. Treatment approaches go beyond the medical disease model to incorporate symbolic approaches such as art and writing therapy, and role-play. Successful therapy includes therapist/patient bonding, self-help homework, and trance work such as hypnosis and EMDR. Bringing the parts to consciousness remedies dissociation and alienation of the eating disorder.
1 Berne, Erik. (1964) Games people play: The Basic Handbook of Transactional Analysis. New York: Ballantine Books.
Shoshana Kobrin, MA, LMFT, has a Masters degree in literature, and completed her Masters in psychology at John F. Kennedy University, Orinda, CA. She specializes in food and weight issues and eating disorders, and has counseled in this field for 29 years. A continuing education provider for therapists and nurses, she authored articles on food and weight, eating disorders, and women’s issues as well as The Satisfied Soul: Transforming your food and weight worries. Love, anger, power – and food! will be available in September 2013. Kobrin teaches and offers presentations, workshops, and retreats to public, professional, and corporate organizations.
