Psychodynamic Causes


1.      A lack of coping skills: This means that there is an inability to manage life in a practical way. Often there is an inability or lack of skill to deal with an emotion, to identify and name it, to process it and to cope with it. Individuals with eating disorders and/or disordered eating mainly deal with their problems through an excess or restriction of food and/or exercise. Most of us lack coping skills for at least some areas in our lives. Besides eating, other oral coping mechanisms may include smoking and/or drinking. Instant gratification as opposed to delayed gratification is prevalent. This is the sense of time urgency and an inability to wait; a sense of wanting everything now! 
2.      They fail to recognise and respond adequately before it is too late because of a lack of appropriate skills. For example, in a stressful situation, the obese person reaches for and eats the doughnut without thinking about any other options. This brings us to the next point.
There is a failure to stop and think because the appropriate skill is often inhibited by fear, anxiety or deeper issues.    Any emotion can prevent an individual from actually using a practical skill to deal with the situation. Emotions are trigger factors which can either get in the way or they can signal that an action is required. 
3.      *Poor self-esteem: The sense of self is invested solely in how much or little the individual weighs and how s/he looks. Often it is difficult of this person to give credit if a kilogram of weight has been lost because there are still 15 kilograms to lose. Mood might depend on looks or feelings for a particular day. A slight increase or decrease in weight as reflected on the scale can change the person’s whole outlook in spite of any positive feelings prior to weighing. These are manifestations of a poor self-esteem.
4.      *There is a lack of confidence but this is often body specific. Some individuals can be quite high functioning in other areas of their lives but they are not confident about their bodies.   They feel particularly threatened in situations which require that they look physically good e.g. going out to a function.
5.      *There is a poor body image and the body mage itself is often distorted. A distorted body image is a specific phenomenon. It means that when you look in the mirror and you weigh 45kgs you believe that you weigh 65kgs. It is a distortion, not a slight maladjustment. Someone with a distorted body image looks in the mirror and does not see the reality. The severely overweight person seldom realises how big s/he is, while the person with anorexia nervosa always thinks s/he is overweight. 
6.      *There is an obsession with weight and/or food and the approach to this is often extreme, or all-or-nothing, good or bad, black or white. The person constantly thinks about food. Being obsessive as well as being all-or-nothing are both defense mechanisms. All-or-nothing behaviour can be assessed by the “diet mind-set”. E.g. “I am either on diet or off diet”, “I will be 100% compliant when I’m on the diet, but will eat as much as possible when I am not on diet”. This all-or-nothing thinking is usually applied to other areas of the person’s life.
*The negative effects of dieting and the media play a prevalent role in poor self-esteem, the lack of confidence, a poor and/or distorted body image, as well as obsessions with food. One is constantly bombarded with new fad diets or models that look thin. The average person tries to model him/herself on this and loses touch with how s/he wants to look and what is A realistic size and shape.
7.      There is a feeling of isolation. There may be a lack of understanding from friends, family and society. There is sometimes rejection by a spouse, family, friends and society, which results in feelings of loneliness and isolation. Frequently some professionals do not understand the complexity of the phenomenon. There are ardent attempts to change the symptom and a tendency to ignore the deeper dynamics. There may even be employment discrimination and labelling such as “lazy, sloppy, out of control, self-destructive”. Unfortunately, it is not surprising that these negative labels can be internalised and that the person then lives up to the label.
8.      Emotions. This is a bit of a chicken and an egg situation. Is the emotion that is being expressed a result of the problem, or the cause of the problem? What comes first, the cause or the effect? For example, was this person anxious, frustrated, depressed, scared, or bored (to name but a few) before the eating disorder and/or disordered eating started or has the emotion been exacerbated by the eating disorder and/or disordered eating?   
All emotions may contribute to, or be the result of the eating disorder   To name a few these may include depression, anger, boredom, emptiness, loneliness, feeling devalued, helpless, inadequate, stressed, or fear. These emotions need to be controlled and because the person with an eating disorder and/or disordered eating does not have the coping skills (point 1) the eating disorder pattern becomes the coping strategy. Emotions that are not dealt with are shut off, but do not go away. They come back when you least want them to or expect them to. Food or purging or exercise is merely a way to restore a sense of equilibrium. Food is also a tool for expressing emotions or feelings as a reward or punishment. For people with an eating disorder and/or disordered eating, food does not equal food.   Food is not eaten for sustenance. Food is a comforter, a friend, a dummy, a foe.   In summary, the relationship with food is distorted.
9.      There is denial of and poor communication with regards to feelings and needs. Poor communication causes other problems in relationships and issues are not dealt with as they happen. 
10. There is an inability to trust in themselves, their needs, their wants, their feelings and in others.
11. Boundaries.  They cannot say no to themselves or to anyone else.
12. There is an inability to make choices. The ability to make choices is something we learn from a young age. Someone who is functioning at a very primitive level of functioning will struggle to make choices.
13. Personality Disorder: It is inevitable that some people will have found different ways of coping with their personal issues. A personality disorder is a long-term, fixed pattern of relating that interferes with how a person functions. The assessment of a personality disorder should be made by an appropriately trained professional such as a psychologist or a psychiatrist.


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