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Key points
- Anorexia has the highest mortality rate––5-20%–– of any psychiatric illness and its incidence is increasing.
- Squelching anger can be associated with many emotional illnesses, including anorexia.
- Anorexics may conceal expressions of anger from themselves and others, believing they may damage others and themselves if expressed.
- Having key conversations with an anorexic about what makes them angry may improve their condition and itheir relationships.
Anorexia nervosa is a serious and debilitating medical and psychiatric illness. It has the highest fatality rate of any psychiatric illness, 5-20%. Anorexia has increased in every 10-year period since 1930.
The medical goal of treatment is to restore weight. The psychiatric goal is to discover why the person resorts to self-starvation and to correct the problem. This correction may inoculate the person from a recurrence of the illness in the future.
Psychological Explanations
There are many psychological accounts cited for developing anorexia. Sufferers may be perfectionists and overachieve. They may be very self-controlled people, especially with their emotions.
Some anorexics have a diagnosis of obsessive-compulsive disorder. They may have high anxiety and strive for thinness as an ideal. Coexisting with anorexia may be activities and environments that focus on body weight and image—modelling, ballet, gymnastics, or running. Anorexia may be a way to try to gain control of a part of one’s life. (medicalnewstoday.com)
Certain personality traits can be risk factors. The illness is associated with “low self-directedness [and low] assertiveness.” Anorexics can be deficient in showing positive emotions and can be self-effacing.
Bottled Up Anger
Some psychiatric and psychological illnesses arise from difficulties in sharing angry emotions. This may be the case for many anorexics, especially revealing anger to others, although they may conceal angry emotions even from themselves. Numerous reports discuss these observations.
In our clinical work, Homer B. Martin, M.D., and I have observed the ways people, including anorexics, are emotionally conditioned in childhood into roles in their relationships. Two of the most important are omnipotent roles and impotent roles. These roles reflect patterns of behavior originating in interactions with parents.
The roles differ in several ways. Some differences are in levels of self-esteem, ways of elaborating emotions, expectations for emotional support from others, ways of committing to others, personal values, and overall personal attitude in life. Anorexics may grow up learning that anger is not an emotion they are expected to have as a normal part of everyday life.
They may become super-agreeable, acquiescing people who conceal all but happy emotions from others. They may fear their anger will explode if they dare acknowledge it and that it will harm themselves and others, like a cauldron of exploding hot liquid.
One goal of treatment is to help them grapple with the problem of avoiding expression of angry emotions.
Ways To Help Anorexics Access Angry Emotions
There are some conversations you can have with anorexics that may help them get in touch with their anger in close relationships. Doing so may reduce their self-starvation.
Have a Shared Conversation
Tell them you want to discuss things that make them mad. They may say they never get angry. You may have to share examples from your own life of what makes you mad. Then, they may be able to share some of their own experiences, little by little.
Anger Is a Normal Emotion
Explain that anger is a normal everyday emotion that all people have. If they share something, even small and trivial about their anger, it is a step forward.
Talk about Anger in Relationships
Gradually work the discussion around to what creates increasing anger, especially in relationships with close family members.
3 Questions to Ask
As you hear him or her bring up anger examples, ask these questions:
- How do you show your anger?
- How do you feel like showing your anger? What would you like to do or say to the person you are angry with? Again, you may have to give examples from your own life.
- What holds you back from showing or sharing how mad you feel? Anorexics (and other omnipotent role people) often fear hurting someone else’s feelings or displeasing them. They have been emotionally conditioned to believe others’ feelings are more important than theirs.
Connect the Dots Between Angry Talk and Fear of Hurting Others
As you have a dialogue with an anorexic, mention how important it is to share and talk about angry feelings, especially with people they fear upsetting. In any relationship, their job is not to put others’ feelings before his or her own.
Explain why it is important to share such emotions: Holding in anger can lead to many forms of emotional problems and illnesses, including not eating. It is best to get them to share verbally what makes them mad. Telling another person what you feel will not harm you or them. It may liberate you emotionally.
At first an anorexic person may be uncomfortable with a discussion anger. Hopefully, it will get easier over time and with effort. He or she may ask you to meet again to talk about anger. You can always invite him or her to do the same.
