Coping mechanism or adaptive function?

The subject came up in my therapy session on Monday- was an eating disorder a coping mechanism or did it instead simply have an adaptive function? I've been mulling it over since then, following various thoughts to and fro, trying to put my finger on the exact difference between the two, and where an eating disorder really lay on that spectrum.

When I was first diagnosed in 2001, the basic mantra I was given was that anorexia was a "maladaptive coping mechanism" and that recovery meant I would need to learn better ways of coping than starving, purging, and exercising. This I understood--if I was to get better, I couldn't keep abusing my body so horribly and expect to live. But my understanding of anorexia-as-coping-skill got quite muddled when the rubber hit the road.

The sessions with my ex-therapist would go something like this: she would ask why I was restricting, I would say I don't know, I'm fat, it seemed like a good idea, I eat too much, etc. Then she would ask me to think about what happened that might have "triggered" this. Sometimes there would be a specific event, sometimes there wouldn't. But I never deliberately thought: gee, my life is stressful and anorexia would help me cope. Let's stop eating.

Yet I couldn't totally deny the fact that my eating disorder had a "purpose," as it were. I felt better when I wasn't eating. I just...did. It loosened the straitjacket of anxiety and depression that held me captive, only to entangle me in something far worse. Eating the same paltry food each day felt soothing, and the hunger pangs became confirmation that I was at least doing one think in my life right. When my depression got bad, I literally lived for the hope that tomorrow I would weigh less. That got me out of bed in the morning. The exercise and accompanying endorphin rush hit both anxiety and depression at once.

But I still wasn't coping with life, and I knew it. I was trying to seal the hole in the Titanic with bubblegum- a noble endeavor, perhaps, but entirely futile. The ship was sinking, I was aware of this, but at least the bubblegum made me feel like I was doing something.

I don't consider my eating disorder a coping mechanism any more, because I don't see it as a choice. A coping mechanism is something you choose. I fell into the eating disorder because of the way I was wired and because of the culture in which I live, but none of this had anything to do with helping me cope. Anorexia had a lot to do with self-medication and my brain somehow figuring out the adaptive functions of prolonged malnourishment.

Perhaps these thoughts are little more than semantic hair-splitting; perhaps they're not. To me, the main difference is how much control and choice you have over your eating disorder. I wouldn't say I have none, because I obviously do right now. Yet when I am in the thick of anorexia, my behavior takes on a life of its own and I just kind of hold on. It's as if my brain has been hijacked, as sure as those planes on 9/11.

It's also true that I do need to learn better coping mechanisms so that there won't be as many adaptive functions for the eating disorder to fill. If I can learn to handle stress better, there won't be that pressing need to have it numbed by starvation. If I can learn better self-esteem, maybe I can find something more important to get out of bed for than the hopes of losing weight. If I can find fulfillment in life, maybe I can enjoy that full feeling after a meal without immediate thoughts of guilt and recrimination rushing in.

There is a place for learning coping mechanisms in recovery--but it's not to replace the anorexia.

9 comments:

Kim said...

This is a very interesting subject. I've thought about this before, though not as articulately as you have. This really hits the nail on the head:

"I was trying to seal the hole in the Titanic with bubblegum- a noble endeavor, perhaps, but entirely futile. The ship was sinking, I was aware of this, but at least the bubblegum made me feel like I was doing something."

I think I've clung to that "doing something" part of my anorexia. It's the productive busy-bee in me. Anorexia was a wonderful distraction. I guess, in that sense, it did help me cope. But I think what you say about choice and control is very illuminating.

Laura Collins said...

You've just nailed something I've puzzled unproductively over for a long time. That "coping mechanism" idea has always rankled me. It is hard to dispute that EDs have secondary benefits, and I think that's where the coping mechanism thing can serve to confuse the issue and stymie recovery.

But categorizing the ED as a coping mechanism IS calling it a choice. It is making it a poor response to normal circumstances. And it ISN'T normal circumstances. The thing one is coping with is a TSUNAMI, not normal life/response stuff. To call it a coping mechanism is to say that there was some other lifeboat in the water - and I don't think there is. I can only believe that people with this idea about EDs just, frankly, underestimate the enormity of what the eating disordered brain functions do to the rest of the brain. And I find it cruel that we concentrate on triggers and "better coping skills" as a primary treatment.

As an adjunct, as the final stage, as relapse prevention, as simply life skills that make life more livable: yes.

Thank you for the extremely clarifying distinction!

Micco said...

I think this post really reinforces eating disorders as addictions, especially in light of your last post. It's such a blurred line between a social drinker and an alcoholic, a "casual" dieter and an eating disorder victim. In the beginning, it IS a choice - because we're not nursed with a bottle of Jack nor taught to walk on treadmills - but I think what's interesting is when and why it stops becoming a choice and starts becoming a compulsion. I don't believe it's ever a fully conscious decision to "cope" via a dangerous behavior but more, as you suggest, circumstance, physiology, and society culminating in a dangerous experience making life FEEL more bearable. To write off addictions and eating disorders as MERELY coping mechanisms is an oversimplification; if it were really as easy as substituting one behavior for another, neither addictions nor EDs would have such a high recidivism rate. However, I do think you are playing at word gymnastics here. What is penicillin but a means of coping with pain? What is a diet but a means of struggling against weight? It's just, for the addict and the ED sufferer, what that pain is, what that weight means - they're two very different things, and therein lies the difference in what the behaviors are really addressing.

That said, I'm very intrigued by the neurological link between addictions, EDs, and OCD. I'm sure the satisfaction derived from the former two is similar to the satisfaction experienced by the latter: clearly, all of these conditions interfere with a person's everyday life, but the experience of these routines is still preferable to a life without them. No one would ever suggest treating OCD by telling someone to "just stop" (which frankly, I think is how the "substitute a different behavior" method comes off); and yet, one can't ignore the fundamental difference in the onset of OCD vs. addictions/EDs: choice. I would be very curious to see treatment approaches developed with this kind of perspective in mind.

Wendy O said...

Well said. There is too much oversimplification with this disorder, saying anorexia is a coping mechanism is one of many.

Lisa said...

My thoughts are provoked - this post was very well-written. Thank you.

A:) said...

This is interesting, but the thing that concerns me, is that you say you have no choice in illness -- that you cannot prevent becoming ill. Does that mean you have no choice in recovery -- that you are incapable of changing because you cannot control the pathology of the illness?

This is a grey zone I think. I wholeheatedly agree that ED's have biological origin and cannot be treated by therapy alone. I know you found it empowering to realize that AN was not a choice and not your fault and that this was liberating -- but my fear is that many could use this as an excuse to engage in their illness.

My arguement is always that, I have seen people recover on their own from very low weights and I have seen women enter IP programs at very low weights and embrace the program whole-heartedly. Many of these women went on to have full recoveries. This type of remission would be impossible if the illness (like cancer) was out of the individual's control. . .

Is an ED a purposeful coping mechanism? I would like to think that it can become a perpetuating factor of the illness once the ED is in motion -- like you said, it "feels good" and DOES relieve anxiety and may give the sufferer a reason to stay sick. However, the person needs to have the predisposition for the illness and find starvation enticing -- this only occurs in a minority of individuals, otherwise, the prevalence of EDs would be much higher.

Does a symptom need to have a trigger? I am not sure -- for some it could just be a preferable way of coping with life -- it is EASIER to stay ill than face real life.

I don't know, I'm rambling :)

A

Tiptoe said...

This is definitely a difficult question to answer. My theory has always been that the Ed evolves. I think it originally serves a purpose, similar to like a survival mechanism. However, that purpose changes in functionality over time.

I think there is always an element of "choice" somewhere. Whether that means providing "coping" is hard to say. For some people, it might be, for others not at all. We can't really make a generalization either way, and this is partly where the problem lies. It's probably one reason why people do try to simplify it to just a "coping" mechanism, or just about weight, etc.

I think the another problem is how the word "choice" is used. I think there are conscious, deliberate choices we make, and others that don't fit that realm necessarily.

700stories said...

This is great. I agree, my ED isn't a coping mechanism, though I know that when I am having a hard time coping with life it's easier to let everything else fall away and ferret into the disorder. S-I on the other hand, is definitely a coping mechanism. I choose to cut to lessen the stress and get a high.

Carrie Arnold said...

A,

Your points are very good, and I still grapple with much of this. What I'm realizing is that EDs aren't a matter of choice vs. no choice. I think there's a continuum of ability to choose. I agree- I have had moments of supreme clarity, even at my lowest weight, that spurred me to try and get well. But there were also plenty of moments when I was essentially unable to make that choice.

It's like if you're being robbed at gunpoint. Did you *choose* to give the robber your wallet? I suppose, because you didn't have to. But how much of a true choice was that?

I don't think there's a simple answer, and I don't think there will necessarily be just one.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote



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