Dying to Please: Anorexia, Treatment and Recovery, 2nd Edition

199 Pages·2009·0.98 MB·English

by  Avis Rumney

Dying to Please
SECOND EDITION
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Dying to Please
Anorexia, Treatment
and Recovery
SECOND EDITION
A R
VIS UMNEY
McFarland & Company, Inc., Publishers
Jefferson, North Carolina, and London
LIBRARYOFCONGRESSCATALOGUING-IN-PUBLICATIONDATA
Rumney, Avis.
Dying to please : anorexia, treatment and recovery / Avis Rumney—
2d ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-7864-4378-9
softcover : 50# alkaline paper
1. Anorexia nervosa. 2. Anorexia nervosa—Treatment. I. Title.
RC552.A5R85 2009 362.196'85262—dc22 2009010506
British Library cataloguing data are available
©2009 Avis Rumney. All rights reserved
No part of this book may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopying
or recording, or by any information storage and retrieval system,
without permission in writing from the publisher.
Cover photograph©2009 Shutterstock
Manufactured in the United States of America
McFarland & Company, Inc., Publishers
Box 611, Jefferson, North Carolina 28640
www.mcfarlandpub.com
Acknowledgments
I am grateful to my parents, Philip and Charlotte Wadsworth, for
encouraging me to seek treatment in 1978, for their support during my
early years in therapy, and for the love and concern they bestowed on
me to the end of their lives. I am thankful to the staff and clients at
Cathexis Institute who contributed to my early recovery. I feel blessed
and helped immeasurably by my twin brother, Adrian Wadsworth, and
the friends, colleagues and therapists who have contributed to my jour-
ney in the 25 years since the original edition of this book was published.
The richness of my life I attribute to the many unique and wonderful
people with whom I have had, and continue to have, a treasured con-
nection. I am grateful to my editor, Frances Lefkowitz, without whose
help and encouragement this book would still be a sheaf of papers col-
lecting dust on a shelf. And I give special thanks to my life partner, Larry
Fritzlan, for his presence as an unfolding gift in my life.
v
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Table of Contents
Acknowledgments v
Preface to the Second Edition 1
Introduction 7
Part One: Anorexia
1. The Paradox of Self-Annihilation in Service of Self-Preservation 11
2. What Is Anorexia and What Causes It? 16
What Is Anorexia Nervosa? 16
How Prevalent Is Anorexia Nervosa? 17
What Causes Anorexia Nervosa? 17
Is Anorexia an Addiction? 23
3. Uses and Misuses of the Internet 25
4. Disorders That May Accompany Anorexia 28
Depression 28
Anxiety and Anxiety Disorders 29
Body Dysmorphic Disorder 31
Bulimia Nervosa 32
Alcohol or Drug Addiction 32
Personality Disorders 33
5. Some Attributes of Anorexia 34
Perfectionism 34
Competition 38
Unresolved Grief 43
Immature Sexuality and Relationships 50
Distortion of Body Image 61
Part Two: Treatment and Recovery
6. Understanding Recovery 75
What Constitutes Cure? 75
Challenges in Evaluating Recovery 76
The Foundation of Recovery: Development of a Coherent Sense of Self 81
My Journey Towards Self-Development 83
7. Approaching Treatment 89
Essential Components in the Treatment of Anorexia Nervosa 89
vii
viii Table of Contents
Considerations in Treatment 90
Aspects of Treatment 91
8. Therapy for an Anorexic 98
Psychotherapeutic Modalities 98
Experiential Modalities 113
Psychopharmacology 137
9. Therapy for Families and Family Members 143
Family Therapy 143
Therapy for Individual Family Members 148
10. 12-Step Programs 155
11. Intervention 161
Epilogue 167
Appendix A. Treatment Centers for Eating Disorders 169
Appendix B. Resources for Information and Referral 176
Bibliography 179
Internet References 186
Index 187
Preface to the Second Edition
Much has changed in the 25 years since I wrote the original text of Dying to Please—in the
world, in our culture, in technology, and in our understanding of eating disorders. A revised
edition seemed warranted—indeed, overdue—because of the evolution of thinking about eat-
ing disorders and the proliferation of new options and resources for treatment.
In addition, my own perspective on anorexia nervosa, both professionally and personally,
has evolved. I wanted to share what I have learned from my colleagues and clients about recov-
ery from anorexia in the past two and a half decades. I also wanted to bring current my own
personal journey of healing and recovery, which has entailed deeper levels of inner work than
I could possibly have envisioned at my first writing. While the text of the original volume
remains valid, it is incomplete. My intention in this edition is to summarize some more recent
treatment directions, provide an updated Directory of Organizations, andexpand on my per-
sonal story of recovery.
Sadly, eating disorders are more prevalent in the United Statesthan they were 25 years ago.
Girls of younger and younger ages have become weight-obsessed. Fat-phobic fourth graders now
diet and pre-pubescent girls are primed to critique their bodies. The incidence of anorexia,
bulimia and binge eating continues to increase, with estimates suggesting that as many as 25
percent of Americans now suffer from some form of disordered eating. While diagnostic and
treatment capacities have improved, deaths from anorexia have also increased (or are more
accurately recorded).
Furthermore, childhood obesity (which does not indicate presence of an eating disorder
but can result from an unhealthy lifestyle) has become a national health concern and statistics
have risen dramatically for the occurrence of heart disease and diabetes—both conditions result-
ing in part from the freedom, which for some becomes an obsession, to choose non-nutritious
food in excessive quantities. And this is happening in a country where 15 percent of the popu-
lation has insufficient food. These facts suggest that something is sorely amiss regarding our
values with respect to food, weight and lifestyle.
Meanwhile, technology has advanced exponentially. The Internet has propelled the world
into a new era of communication and information dissemination. The sheer quantity of facts
and resources available and the speed of data transmission are mind-boggling. However, this
accessibility to profuse resources has a down side. Among the countless sites with guides for
better living are some with equally explicit directions for perpetrating self-harm. Websites have
sprung up which support anorexics in furthering their disease. Chat rooms abound where
anorexics can share their secrets for stifling hunger or manipulating weight for medical weigh-
ins and applaud each other’s efforts at self-starvation.
Fortunately, treatment options for eating disorders have multiplied, and resources for infor-
mation about eating disorders are also plentiful on the Web. Cognitive behavioral, psychody-
namic, and family systems therapies have been refined and applied more consistently in the
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