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Section 13
Externalized Self-perceptions

Question 13 | Test | Table of Contents

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In the last section, we discussed three difficulties in employing the family of an anorexic client for treatment.  These three family treatment difficulties included:  inability to dissociate; eating strategies; and allowing for client independence.

In this section, we will examine three concepts related to redefining identity in anorexic clients.  These three identity defining concepts include:  exposing the false self; allowing the self; and self-neglect.

3 Concepts in Redefining Identity

♦ Concept #1- Exposing the False Self
The first identity defining concept is exposing the false self.  In my experience with anorexia, I have found that the majority of clients were relatively happy and satisfied prior to their weight loss and dieting.  It is when they reach the age in which they are encouraged to begin to conform to a certain image that society has developed that they begin to lose their identity altogether.  This societal identity I refer to as the false self, an identity that has not been naturally formed, but has been forced into existence by external forces. 

Girls seem to be more susceptible to this pressure than boys because the general model for the epitomical female is one who focuses on makeup, shopping, and appearance.  Rarely are girls confronted with images of role models participating in character building activities.  On the other hand, boys are more often encouraged to take on activities that challenge their bodies and minds. 

Jane, age 17, had been programmed early on in her childhood to believe in a certain image of women.  Her mother, Sadie, had been entering her into beauty contests since the age of five and had consistently encouraged Jane not to engage in "boyish" activities. 

Sadie stated, "Girls have an obligation to appear beautiful at all times!  They are the source of beauty in this world and any girl who does not fulfill that obligation might as well be a man!  Proving your womanhood is more important than learning mathematics.  How will algebra get Jane a husband?" Jane too echoed her mother’s conceptions.  She stated, "I may have taken this weight loss thing too far, but it’s not a crime to look good.  I don’t have a brain I can depend on, so I have to use my looks." 

I stated, "Jane, this obsession with beauty is exactly the source of your anorexia.  You have given into a false self which has been designed expressly for you by your mother.  Instead of creating an identity all your own and of your own mind, you have borrowed one from others.  Your anorexia is your attempt to create a self outside of your mother’s influence.  Tell me, when you started losing weight, it felt good knowing that your mother no longer had a say in who you were, didn’t it?" 

Jane stated, "Yes!  I felt independent and strong for the first time in my life!"  I then replied, "In order to help you overcome this anorexia, you need to develop a true self that can replace the identities that have tried to overtake you."  Think of your Jane.  How is his or her false self contributing to his or her anorexia?

♦ Concept #2 - Allowing the Self
The second identity defining concept is allowing the self.  Anorexic clients obviously do not feel comfortable in their own skin. They believe themselves to be worthless and cannot comprehend that other people find them any less so. This belief in imperfection drives the perfectionist client to continually strive for the ultimate image, a task that quickly becomes monumental as the client’s standards increase. This negative self-image is obviously one of the core problems facing an anorexic client. Believing they are not "worthy" or deserving of a good image of themselves, they retreat into their disorder which confirms these internalized beliefs.

♦ Technique:  Accepting the Positive
 Kelly, age 16, had lost 20 pounds in three months.  In addition to depression and anxiety, Kelly experienced a depleted self-image.  She stated, "This body is a complete waste of space!  I can’t get it to do anything I want it to!  It’s like having a bad hair day, only it’s a bad body day."  Many clients, even when they are complimented, deflect the comments.  This not only alienates the compliment-giver, but also strengthens the internalized negative self-image. 

To help Kelly reverse her negative self-image, I suggested she try "Accepting the Positive," a role playing exercise in which Kelly is trained to accept and absorb compliments.  In the first stage of the exercise, I played the compliment-giver, and I asked Kelly to find ways in which to accept my compliments instead of deflecting them.   I stated, "Kelly, you made an excellent point today in class."  Kelly then stated, "Oh thank you.  That’s such a nice thing to say."  In the second stage of the exercise, I asked Kelly to practice complimenting herself out loud. 

Kelly stated, "That was such a great paper you wrote, hon.  I’m so proud of you."  To personalize the compliment, Kelly used such nicknames as "hon" and "Sweetheart" which made the exchange more genuine.  By practicing these automatic responses, Kelly can begin to overcome her other, more negative automatic responses.

♦ Concept #3 - Self-Neglect
In addition to exposing the false self and allowing the self, the third identity defining concept is self-neglect.  Self-neglect can arise in even the mentally healthy.  There is an internally held belief that to achieve success is to deprive the body and mind of certain pleasure, and clients with anorexia augment this belief.  In addition to rejecting the self, they reject any activities or pleasures that may expand the self.  In essence, the anorexic identity weeds out any competition for attention and forces the client to focus on only one aspect of themselves. 

Olivia, age 18, had given up many of her favorite activities after the onset of her anorexia.  Once highly involved in student government and community volunteering, Olivia completely removed herself from her outside activities.  Because of this, her anorexia had become the sole consuming aspect of her life and attention. 

Olivia stated, "None of that other stuff matters!  It’s all frivolous distractions.  I have more important things to worry about than just whether or not I win the chess match!"  I stated to Olivia, "But when you focus all your attention on losing weight, your self-esteem also becomes wrapped up in losing weight.  Yet the feelings surrounding these feelings are negative, so your self-esteem becomes negative as well." 

I asked Olivia to take up her hobbies once again.  Not necessarily the stressful activities such as the student government, but the more relaxing hobbies such as chess playing.  By re-accepting these hobbies, Olivia can better redefine her identity.  Think of your Olivia.  What hobbies has he or she given up to make room for his or her anorexia?

In this section, we discussed three concepts related to redefining identity in anorexic clients.  These three identity defining concepts included:  exposing the false self; allowing the self; and self-neglect.

In the next section, we will examine three additional techniques that I have found useful in treating anorexic clients.  These three techniques include: Mirror Mirror; Character Definition; and Restructuring Automatic Thoughts.
Reviewed 2023

Peer-Reviewed Journal Article References:
Bers, S. A., Besser, A., Harpaz-Rotem, I., & Blatt, S. J. (2013). An empirical exploration of the dynamics of anorexia nervosa: Representations of self, mother, and father. Psychoanalytic Psychology, 30(2), 188–209.

Frank, J. B., & Thomas, C. D. (2003). Externalized self-perceptions, self-silencing, and the prediction of eating pathology. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 35(3), 219–228. 

Groth, T., & Hilsenroth, M. (2019). Psychotherapy techniques related to therapist alliance among adolescents with eating disorders: The utility of integration. Journal of Psychotherapy Integration. Advance online publication.

Obeid, N., Carlucci, S., Brugnera, A., Compare, A., Proulx, G., Bissada, H., & Tasca, G. A. (2018). Reciprocal influence of distress and group therapeutic factors in day treatment for eating disorders: A progress and process monitoring study. Psychotherapy, 55(2), 170–178. 

Pila, E., Murray, S. B., Le Grange, D., Sawyer, S. M., & Hughes, E. K. (2019). Reciprocal relations between dietary restraint and negative affect in adolescents receiving treatment for anorexia nervosa. Journal of Abnormal Psychology, 128(2), 129–139.

Taylor, M. B., Daiss, S., & Krietsch, K. (2015). Associations among self-compassion, mindful eating, eating disorder symptomatology, and body mass index in college students. Translational Issues in Psychological Science, 1(3), 229–238. 

QUESTION 13
What are three concepts related to redefining identity in anorexic clients? To select and enter your answer go to Test.

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