Eating Disorders as a Way to Communicate with Dr. Elizabeth Hamlin
I’ll say it once and I’ll say it again: Eating disorders are a way to communicate.
Eating disorders are really not just about the food. They're a way to regulate and communicate emotions. By understanding what is potentially going on for someone via their eating disorder, we can use it as information to actually work toward healing.
Today I am talking with Dr. Elizabeth Hamlin. Elizabeth Hamlin, MD, is a psychiatrist, psychotherapist, and psychoanalytic candidate who has spent her career working intensively with patients with severe eating disorders. Dr. Hamlin has worked for many years on both inpatient and residential eating disorder units at Rogers Behavioral Health in Oconomowoc, WI, where she has also served as the medical director of the adult inpatient eating disorder program. Dr. Hamlin is clinical faculty at the Medical College of Wisconsin and teaches and supervises psychiatry residents on eating disorders and psychotherapy. Dr. Hamlin has published psychoanalytic papers and book chapters on eating disorders, including fluid restriction. She has presented regionally and nationally on the intersection of psychoanalysis and eating disorders. Dr. Hamlin is currently a psychoanalytic candidate at the Chicago Psychoanalytic Institute. She maintains a private practice in Delafield, WI.
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Fluid restriction
When we think about eating disorders, we are usually thinking about people who are restricting their food, so they don’t eat enough. We see them as people who are concerned with calories and weight. If anything, we encounter those who drink too much water in order to fill their stomachs and suppress their appetite.
But, on the flip side of that, we sometimes see people who will go to the other extreme of restricting fluids. Water doesn't have calories. Fluid restriction won’t change a person’s weight or body shape. Yet, people do it.
Why?
Big water feelings
Our society has a very different reaction to the idea of someone not drinking water. Hydration is a basic need. We let people drink water in situations that we wouldn’t let them eat. Water bottles are allowed in many businesses, events, etc., whereas food may be frowned upon.
Proof: Let the record show, that during this interview, I had my water bottle next to me but not my sandwich.
People use their bodies to communicate that they’re not okay. It's a way of communicating something about the person's mental state and their feelings. Fluid restriction is a very bold yet, desperate way to be heard and to get their point across.
Thirst traps
You know how I feel about language. The words we use are so important.
The term thirst has pretty specific cultural meanings. It’s used as slang, in a way that hunger isn’t. You’ve definitely seen this blasted all over social media - “Betty is so thirsty”, “That person is a thirst trap”. Hunger can exist on various levels, but when you say somebody’s thirsty or talking about thirst, is a very desperate feeling.
Getting louder
If we think about this in terms of non-verbal communication, when someone is not okay, their symptoms get louder and louder. For whatever reason, they feel like they can’t say it with words, because of past experiences, negative experiences, etc. So if their form of non-verbal communication isn’t heard, then their symptoms will get louder, and become more severe.
Reverse pep talk
Freud refers to the negative therapeutic reaction as a situation where someone is doing well because they are receiving the attention they need and the help they asked for. After a few months, the person reverts back to their old ways because they have been told that they are doing really well, and they stop receiving the attention and help they need. Sounds familiar?
It’s not a quick therapy fix.
We tell someone they are recovered, they go back to school, back to work, stop therapy, and all of sudden, they are drowning in their symptoms again. There is a sort of betrayal that happens because they've made the behavioral changes, and now those who were helping them, leave.
So instead, we should be saying “I know you are not okay.” If we see somebody making the behavioral change, instead of saying something like, “Yeah, I knew you could do it.” We should really be saying “Okay, you've done this and I know you're still not okay. You know you're still not okay, so we're not done yet.”
Where does this come from?
In situations where individuals have experienced trauma or come from environments where words seem disconnected from reality, communication can become challenging. Dysfunctional families often rely on indirect communication, fostering an atmosphere where certain things must be concealed, and trust is scarce. Especially for those whose trust has been shattered, particularly during childhood, opening up and expressing needs can seem risky.
Traumatic experiences, such as physical or sexual trauma, fundamentally alter one's relationship with their body. Similarly, children coping with chronic illnesses like severe allergies or early-onset diabetes may develop a sense of fear and mistrust toward their own bodies. These feelings of betrayal towards their bodies can lead individuals to develop eating disorders as a means of regaining control or expressing their distress, as verbal communication may not have been a reliable or valued form of expression in their upbringing.
Early interactions
Let’s look at Freud’s perspective. His theory is that the prototype for all relationships is rooted in the oral stage, where individuals make choices to either take something in or expel it. This is a simple choice that can manifest in various ways: taking something in, refusing it altogether, taking it in and then rejecting it, or retaining it without elimination.
These early interactions with the world, often predating the development of language, become a primary avenue for people to engage with their surroundings when verbal communication is unreliable or nonexistent.
Regarding the relationship between eating disorders and communication, Freud's perspective suggests that eating disorders can be viewed as a form of communication for emotions that cannot or will not be expressed verbally. Emotions can be overwhelming, especially for children, and parents play a crucial role in recognizing, processing, and helping the child understand these emotions.
Laying the groundwork
Even before language development, parents typically interpret a baby's cries and respond by addressing the underlying need, such as feeding when the baby is hungry. This early emotional communication lays the groundwork for the child's ability to cope with emotions as they mature and develop language skills.
Think about it - we aren’t seeing people having eating disorders at 3 or 4 years old. But what we do see are early childhood experiences clearly being so significant in their life choices. It’s laying the groundwork for future conditions. There is often a mistake in assuming that the only event of significance may have happened when we were 13. Instead, we need to look at all previous events that led up to the current situation.
This is my story, now what?
First, note that the response will be different depending on if someone is either in the illness or recovery phase, in terms of what they will need. If someone needs immediate help, to address purging, symptom reduction, increasing food, etc., then that has to happen first.
Beyond the initial intervention, it’s important not to give up on the path to recovery. Individuals who work closely with therapists to translate the emotions they attempt to convey through their eating disorder actions will stick to their path. They can use tools like journaling and art to discover underlying feelings.
However, the end goal is to translate these emotions into verbal communication.
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Tweetable Quotes
“When we think about the idea of not drinking water, people often have quite strong reactions to that.” - Dr. Elizabeth Hamlin
“It is missing the bottom of the iceberg, so you're dealing with the tip of it. Of course, it has to happen, and usually, it has to happen first, but what about the rest of it?” - Rachelle Heinemann
“People will verbalize that this is a thing that they do fear coming to pass, that if they eat, people will leave.” - Dr. Elizabeth Hamlin
“Usually there's not sort of one single event that was like, oh, this is the make or break.” - Dr. Elizabeth Hamlin
Resources
Where to find Elizabeth Hamlin, M.D.
https://drelizabethhamlin.com/
Additional publications from Dr. Elizabeth Hamlin can be found in: Psychoanalytic Psychology & The British Journal of Psychotherapy
Related Episodes
Episode 88. Did We Take Intuitive Eating Too Far?
Episode 81: What Do I Do About My Emotional Eating?
Episode 64: When Words Fail and Bodies Speak with Tom Wooldridge PsyD, ABPP, FIPA, CEDS-S
Episode 61: Why Your Past Matters
Episode 57: The Connection Between Trauma and Eating Disorders with Heather Ferguson, LCSW
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Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
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