Kimberley came to the New York Center for Eating Disorders and confessed, “I know I should try to recover from bulimia, but I'm not sure in my heart of hearts that I really want to.”

Her declaration reminded me of another patient, Emily, who admitted: “I really do want to lose weight, but I don't think I have enough motivation. I went to a diet organization, and the leader said if we weren't ready to give 100% to the program, then this place wasn't for us. I never went back.”

What Kimberley and Emily have in common, as do many people with eating disorders, is ambivalence about their wish to get better. Ambivalence is when you feel two contradictory emotions at once—the wish to get better versus the wish to stay the same.

Why would someone suffering from compulsive overeating, bulimia or anorexia not want to get better, if her eating disorder was causing such unhappiness and pain? The answer is that often an eating disorder becomes a safety blanket, a friend, a comforter, an obsession, and even an identity. To leave behind the overeating or the purging or the starvation can disrupt one's sense of self.

Learn how to be your own therapist. Answer the following questions as honestly as you can:

• If your obsession with food and weight were solved, what would you replace it with? What would you be thinking about instead? Would you miss it?
• Is your eating disorder comforting you in some way?
• Since when has your eating disorder been a coping mechanism for you?
• When you begin to get on track with your eating, do you unwittingly sabotage your progress?
• When people say that you look better, does that trigger anxiety that provokes renewed eating problems?
• When you start eating healthier foods, do you feel more emotional and vulnerable—more anger, depression, anxiety or loneliness?
• Do you worry that resolving your eating problem might upset an important relationship in your life?

Here are some clinical examples of how people expressed their ambivalence about getting better. Do you identify?

Karen was one of eight children. “When I became anorexic, my family gave me a lot of attention for the first time. Do I really want to give that up?”

Sandy: “All my life my mother has been depressed, and I've taken care of her. I've always been vigilant to make sure she's okay and not lonely. When she discovered I was throwing up, she began to take care of me. She had never been that concerned about me before. I feel guilty that I secretly love how our roles are now reversed, and that I have my mother for the first time. My bulimia helped bring this about.”

Sheila: “On my college break at home, my parents realized that I gorge at night and sleep all day, and they got worried. They told me that if I didn't stop my binges, they wouldn't let me go back to college. I'm secretly scared of college anyway. I don't know if I can keep up with the other kids. Maybe I really don't want to go back. This could give me the perfect excuse.”

All of these women desperately want to recover and feel better about themselves, but they also realize that their eating disorders have served a helpful purpose in their lives—they are a way of coping with the anxieties of daily living. Being obsessed with eating distracts them from wondering about the important questions of their lives: Who would I be without my eating disorder? What am I going to do to fill the void? How would I comfort myself or get comfort from those I love? Do I have any other passions in life that have been submerged?

When a person finds that self-analysis does not generate enough motivation or progress with the eating disorder, psychotherapy can be a helpful tool to get unstuck.

Sometimes, however, psychotherapists may become just cheerleaders who cajole a patient to change without appreciating the patient's underlying feelings of anxiety and ambivalence.

My patient, Nicole, had previously attended a therapy group to end her binge eating. The therapist declared that Nicole had a food addiction and should avoid foods with sugar and white flour. The therapist also decided Nicole was addicted to buying shoes and, as a requirement for continuing in the group, Nicole had to promise not to buy any more shoes. As much as Nicole tried to follow the therapist's recommendations, she finally left feeling defeated.

This approach to helping Nicole was doomed to fail because she was actually scared to get better. Her therapist was unable to help Nicole explore this fear and ambivalence and, instead, related to her in a totalitarian manner. Restricting Nicole's behavior, with food and with shoes, did not allow her to get in touch with the tug of war going on inside of her. A more compassionate and wise therapist would have validated Nicole's mixed feelings, brought them out into the clear light of day, and then explored ways to make Nicole feel better about herself other than through a destructive eating disorder.

In our next column we will discuss how to better understand feelings of ambivalence, where they come from, and what strategies you can use to free yourself from the tyranny of an eating disorder.

Written by: Mary Anne Cohen, CSW