Most individuals with an eating disorder are more than dissatisfied with their appearance when they look in a mirror. Regardless if they suffer from anorexia nervosa, bulimia nervosa, or binge-eating disorder, and regardless if they are truly underweight, normal weight, or overweight, it is common to one say they feel they are ugly, disgusting and even horrified with their appearance and they hate the way they look. And when a family member, friend or acquaintance makes any comment such as, “but you look so good,” “you’re looking better,” “you’re looking healthy,” or “your beautiful,” the eating disorder individual has a negative internal reaction that may either be expressed or held inside. This is often one of the most common experiences that outsiders and people who have never suffered from an eating disorder, find difficult to understand.
The reason an eating disorder sufferer often hates what they see in the mirror is because the reflection that they see goes beyond the outside appearance. Wether they consciously or unconsciously are aware, the person in the mirror is a total representation of who they are including not just how they look on the outside, but how they feel on the inside. With an eating disorder, the all-consuming ED thoughts about food, weight, body image, calories, etc., drives an intense internal distress. This distress coupled with the resulting emotional states of depression, anxiety, and overwhelm, and mental fatigue and feelings of low-self esteem, low confidence, and fears of disappointment and judgement, lead to an “ugly inside,” which the ED sufferer experiences, but the outside observers cannot see.
When an innocent person who makes a positive comment about a person with an eating disorder, the greater the disparity between the outside appearance and the inside appearance is, the more negative the internal reaction is to the ED sufferer. Thus, saying, “you look so good,” to one who internally feels so bad, unconsciously results in the ED sufferer feeling entirely misunderstood. A common thought process is, “why doesn’t this person see how much I hurt?” When this occurs, the subconscious drive to engage in eating disorder behaviors may arise in an attempt to have a more “sick” appearance on the outside that is more closely resembles what one feels like on the inside.
Furthermore, the closer the emotional bond is with the person making the well-meaning comment, the greater the negative internal reaction will be with the sufferer. Thus, a parent or spouse who makes such a comment will likely encounter a more intense reaction than the same comment from a distant acquaintance. This is because the ED sufferer would expect a close family member to be more aware of how they feel compared to an acquaintance. For the sufferer, a parent or spouse should know how bad they feel. To say, ” you look good,” “look healthy,” or are “beautiful” means that the parent or spouse does not understand them, how they feel, or what they are going through. It gets interpreted as a disconnect and the well-meaning comment backfires in its intention.
In treatment, experienced ED therapists will often give guidance to family and loved ones in the nuances of the ED language and lingo in an attempt to avoid the traps and slippery slopes of talking to an ED. Much of the dialogue of ED includes trick-questions with no-win answers. “How do I look today?” “Does this make me look fat?” “Do I look like I gain weight?” are all set-ups where no matter what the response is, results in the wrong answer to the bewildered respondent. “So what do I say,” is the question parents, spouses and loved ones ask. To simplify in this post, the advice is to learn to respond in a manner as if you’re asking about what is happening on the inside of the ED sufferer. So when one is asked, “How do I look in these pants,” it is important to notice the tone of the question and the body language of the individual and attempt to respond accordingly. “Honey, you look a bit worried, how are you feeling?” “You look upset, is everything ok?” “You’re smiling today, are you having a good day?” It is true that even this may lead to frustrations at times with comments such as, “you’re not answering my question,” and “you just don’t want to say I look fat,” but still this is the general tone that works best through the recovery process.
It is important to note that recovery is about narrowing the gap by helping the inside heal and feel better to match a healthy outside, while the ED drives tries to make the distraught inside match a sick outside. With recovery and when the gap between how one looks on the outside and how ones feels on the inside narrows, the “trick-questions,” will subside and well-intentioned comments are handled more appropriately. – Dr. Jeffrey DeSarbo