Eating disorders and the feared self

In earlier articles we talked about the relationship between identity and obsessive-compulsive disorder. Specifically, I told you that the findings of some research in this area suggest that people with OCD give more credibility to a possible feared self (the kind of person I’d be afraid of becoming) than to their actual self (the kind of person I really am), and how that feared identity is linked to the content of the obsession. Well, according to recent research, the feared self might be a key element not only in the onset and maintenance of OCD, but also in eating disorders.

Exposure-based therapy doesn’t achieve the results we’d hope for in eating disorders, which has led many researchers to ask what other factors might be influencing these disorders and aren’t being taken into account when treating patients. Because of the similarities between OCD and eating disorders, it has been suggested that the feared self may play an important role in the development and maintenance of eating disorders. Given that Western culture promotes an ideal stereotype based on thinness while stigmatising excess weight (associating it with negative traits such as laziness, failure, unattractiveness…), it could be argued that people with eating disorders fear an overweight self, because they in turn associate it with negative traits. So the motivation of people with eating disorders might be not only to get closer to their ideal self (thin), but also to avoid their feared self (overweight).

To sum up the main findings of research on the feared self and eating disorder symptoms, these are the key points:

• It has been shown that there is indeed a relationship between the overweight feared self and eating disorder symptoms. What’s more, it seems that when dieting, what motivates people most is avoiding the overweight feared self, rather than the desire to be thin.
• These results tell us that people not only internalise a thin ideal self, but have also deeply internalised a feared self associated with being overweight.
• How much a person internalises their overweight feared self, and how close they believe they are to it, play an important part in how severe the disorder is.
• How close a person believes they are to that overweight feared self doesn’t seem to be objective; in other words, it’s independent of their body mass index.
• Both the thin ideal self and the overweight feared self were found to mediate the relationship between body mass index and body esteem, but the feared self played the bigger role.

OK, so what does that mean?

• It means that the feared self associated with being overweight or fat seems to be an important factor linked to eating disorder symptoms.
• That the perception of identity (the self) seems to matter more than the person’s actual weight and shape in these disorders.
• That avoiding a feared identity (overweight) is as important as, or more important than, pursuing the ideal identity (thin).

And why does all this matter? Because right now the feared self gets no attention at all in eating disorder treatment protocols, and that could be one of the reasons for the high relapse rate among these patients. It may be that fear of food, fear of fat and fear of gaining weight, all such well-known pillars of eating disorders, are part of a hive whose queen bee is the overweight feared self. If that were the case, we’d currently be getting the treatment of these disorders wrong. Why? Because these three fears are now treated as three pillars of the disorder, when perhaps they’re just the consequence of a bigger, core fear, that feared self, which current treatments completely ignore. To put it another way: maybe we’re cutting the weeds off at the stem instead of pulling them out by the root. No wonder they keep growing back, again and again…

As I’ve mentioned before, studies suggest that a weak sense of one’s own identity (in other words, a vulnerable self) could lead us to invest more than we should in that feared self. If so, then we’d also need to work (in both OCD and eating disorders) on helping the person strengthen their own identity, their self-concept.

If all this turns out to be true (as always, more studies in clinical populations are needed to replicate these results), a combination of treatments focused on the person’s own identity together with others focused on the feared self would be needed in treatment protocols for these disorders.

If you’re interested in the subject and want to dig deeper, here are the details of the original article, which gives a much fuller and more detailed explanation of the whole topic.

References

• Wilson, S. (2020). Fear of self in eating disorders. Journal of Obsessive-Compulsive and Related Disorders, 27, 100562. https://doi.org/10.1016/j.jocrd.2020.100562