CASE STUDY 3

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Externalising the Eating Disorder It is helpful to separate the person from the eating disorder. This emphasizes that it is the eating disorder that is the problem, not the person living with it. An eating disorder can be a very strong driving force that can cause a person to behave in ways that are not usual for them. This many involve secrecy and lying, and even aggression, frustration and anger. This may also involve self-destructive behaviours that are seemingly irrational, such as a refusal to eat and compulsive exercise. This can be difficult to understand for both the person with the eating disorder and their loved ones. Separating the person from the eating disorder can help you to see the eating disorder as having a separate voice and thinking pattern to the individual. This will help the individual to feel that the eating disorder is the problem and will provide relief that they are not the problem. This helps to remove feelings of blame, guilt and shame, and means that the individual may be more open to confide in you about what is happening for them. If the eating disorder can be seen and addressed as separate from the person it means that together you can stand and look at the problem. You can develop more of an understanding of the eating disorder and its intricacies whilst not judging the individual. This will help the individual to consider what they actually think about what the eating disorder is saying and will help them to begin to challenge it. Separating the person from the eating disorder involves speaking about ‘the eating disorder’, rather than addressing the individual as if the eating disorder is part of them. When discussing treatment plans and goals, talk about the eating disorder as a 'thing' - an entity in itself - that can be controlling of the individual and in some ways harmful. Examples of externalising the illness

• "Our job on the ward is to give you back some control over the ‘eating disorder’ and keep you healthy no matter what."

• “You are here because the ‘eating disrder’ has made staying healthy impossible for you."

• “How much of the time is the ‘eating disorder’ in control of what you’ve been eating?”

• “What does the ‘eating disorder’ tell you about yourself?” • We've spoken about the ways that the ‘eating disorder’ can seem

like a best friend to you. I wonder if you can see any ways in which it is making life harder for you?"