Loss of Self-Concept in Eating Disorders and Obsessive Compulsive Disorder (OCD)

Individuals with eating disorders and obsessive compulsive disorder frequently suffer as much from loss of self-concept as much as they do from the more obvious symptoms of their disorders. This is only one way in which these disorders are similar, but one that can easily be overlooked by friends and family because it's often difficult to admit that one feels empty inside or doesn't know who one really is: This is a lack of self-concept.

Quietness, withdrawal, unexplained tears, self-doubt, ambivalence, not knowing what they feel and confusion when asked what they are feeling can sometimes be tips that the individual spends a fair amount of time wandering in a fog. Some people even say they don't know what they did all day, yet it doesn't quite sound like the out-of-body experience of dissociation. Many people who have these disorders to any degree actually have ideas about they'd like to do with their lives -- interests, aspirations, dreams -- but don't usually follow through on these. Sometimes, what they describe are old interests, aspirations and dreams, the ones they used to have before the disorder moved in to live. "The fog" has wiped out the self-concept, a self-concept that may have only begun to be developed in the first place.

Encouraging action on such hopes may be met with a blank stare, self-deprecation or an explanations of too much fear or fatigue, even when it seems that the person has recovered from most of the blatant symptoms. It's important to remember that building self-concept often takes time and many small steps, something like bulding a castle from a pile of small round stones.

There's been a lot of speculation about whether the disorders are manifestations of the same thing, largely because of a range of similarities; the disorder as a control mechanism, self-created rules, that they sometimes co-exist or follow each other, obsessiveness and more. Yet, to what extent there is actual neurological similarity remains unclear.

What anxiety specialists do tend to know, though, is that we must start where the client is, true in so many ways in counseling and psychotherapy, but especially when trying to help someone with an eating disorder or OCD to take those small steps. The steps are primarily two-fold; doing and processing. The doing starts with tapping into whatever motivation the person has left to take small risks by trying new things and building on what used to be enjoyed or of interest. The processing is talking through those experiences in terms of what aspects the person liked or didn't like, learned about him- or herself, what skills were used or could have been used and so on, following the experiences. This process of turning the person towards self-awareness can be an arduous path for both the individual and the psychotherapist/counselor, but one that needs to be taken -- one pebble at a time.

The castle of self-concept, for most of us, can get chinks knocked out of it, turrets added and even erode under certain circumstances. After all, this castle of self-concept is built in the air and therefore subject to all kinds of changes due to our inner and external experiences. Yet, most of us don't lose so much of our self-concept that it stops us from living our lives the best we can. Understanding that, for many with OCD and eating disorders, this task of building self-concept is a fearsome and more formidable one than most of us have ever faced is essential knowledge for professionals who work with people who have these disorders. When families and friends of people with these disorders understand this too, and perhaps slow down enough to meet the person with the disorder on the path now and then, they too help in the person's recovery.