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Dissociation and Eating Disorders: Restoring the Shattered Shards

Friday, February 28, 2014: 2:50 PM-4:50 PM
Sawgrass (TradeWinds )

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.


     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.

Primary Presenter:
Shoshana Kobrin, MA, LMFT

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.

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