By Heather Hower, Researcher, MSW, LICSW, QCSW, ACSW
The focus in the eating disorders field (indeed, in all of psychiatry) is usually on diagnoses, symptoms, and related impairment. There has been little research, or even discussion, about negative traits that were present during the eating disorders illness, which can be utilized for positive effect during and after the eating disorder recovery. This is particularly important in that, for the majority of people, these traits will persist throughout their lives regardless, and efforts need to be made to ensure that these characteristics are employed for good vs. evil.
Jenni Schaefer, BA, and Jenny Thomas, PhD, collaborated on their book, Almost Anorexic. In it, they provide a table of general eating disorder traits (e.g., perfectionism, obsessive-compulsiveness, sensitivity to emotional pain, intelligence), anorexic traits (e.g., persistence, low risk-taking, attention to detail, preference for routine, ability to delay gratification), and bulimic traits (e.g., impulsivity, risk-taking, need for new experiences, intolerance of routine). As an exercise, they request that individuals check off the traits that fit for them, identify their goals for the next 6 months, and then list the traits that will help them pursue their goals. Given my personal history of anorexia, I identify with all of the anorexic traits, as well as all of the general eating disorder traits.
My anorexia emerged when I was 12, triggered by professional ballet training. Over time, like others, I have learned to personify and separate the voice of eating disorder (“ED”) from my own. “ED” constantly yelled at me, told me that I was fat, I needed to count/restrict my calories, over-exercise, weigh myself, and sacrifice everything else in my life for the goal of being thin. Eating disorders run in my family, and along with a history of anxiety disorders, genetically predisposed me to develop them.
My anxiety disorders emerged prior to my anorexia, and in some ways, still have trait remnants after my anorexia recovery. I was overanxious as a child, and an earlier “worrier” about many things that were out of my control. This pattern continues today.
I correspondingly became a perfectionist, rationalizing that if I could focus on order, details, and exactness, I would have more control of what was around me (I still have this trait). I remember in early childhood that I strove to be “perfect” in all areas; earning high grades in school, keeping my room clean at all times, trying to make my parents proud, be the well-liked “BFF” for several friends, and to have the thinnest body in ballet class. I had extreme, unattainable standards of performance, and intolerance of mistakes; I took the expectations of my parents, teachers, and ballet coaches, and then ramped them up a notch such that I over-emphasized my own, higher, self-imposed standards. When my friends would tell me to “just relax and have fun” with them, I told them I couldn’t; it was really hard for me to take a break from my routine of school and ballet, I didn’t like when things changed in my life, and I would rigidly push back against others. “ED” seemingly calmed me by promising me that the best way to be “perfect” was to look the part on the outside by being very thin; if I could control my body, I could control everything else, and I will have achieved my “perfect” goal.
In the educational domain, I graduated third in my high school class, where I was the only student to attend an Ivy League school. I then attended graduate school at Berkeley, earning coveted internships and research/clinical scholarships. In the occupational domain, I received every job offer I ever applied/interviewed for. In my pre-professional ballet company, I earned multiple principal dancer roles early on, placed well in several international ballet competitions, and I was hired to dance professionally after high school at The Washington Ballet.
My temperamental trait of perfectionism was certainly a vulnerability for my anorexia onset, but it is also responsible for many of my achievements in different areas of life following my recovery in 2012. I have learned to adapt this trait for long-term successful outcomes, and I view it as a personal strength.
Perfectionism is an ongoing trait that defines me. The challenge for me is to recognize the times when it is alright to do a “good enough” job vs putting in more time and energy than is needed for a particular task, but I am getting better at this over time. Overall, I feel that my perfectionism gives me a sense of accomplishment, it increases my self-esteem, and it provides meaning in my life in that I am making a difference to others. I have learned to use it to my advantage.
Attention to detail has always been important to me. Today, I am the person in our research groups who handles the minutiae of planning presentations and editing/submitting papers.
Preference for routine gave me a sense of security in anorexia. I have adapted that preference to mothering my 5-year-old daughter. I understand the benefits of having a basic routine for her and myself in terms of her sleeping, feeding, playing, schedule. We are both more regulated and pleasant to be around when we are in our routines!
Sensitivity to emotional pain has been a double-edged sword. I felt very “raw” when I had anorexia and tried to numb it by starving. However, following my recovery, it enables me to detect those emotions in others, connect with them, and respond to their pain.
Intelligence allowed me to rationalize my anorexia as a way to cope with my overwhelming emotions and express my pain to others through my body (vs. my words). Despite my severe malnourishment, I excelled at school, ballet, and work, which enabled me to continue to function well in the eyes of others. In recovery, I am grateful that my now nourished brain is able to think clearly, make decisions, and focus on important life goals vs. those of anorexia.
After years in recovery, I still identify with all of the anorexic traits, but I am doing my best to channel them in a productive manner.
Editor’s Note: At FEAST of Knowledge, there was a panel discussion that included information on TBT-S (Temperament Based Therapy with Supports). This post ties into Temperament Based Treatment as a concept.