Tales From The Therapist's Couch: 'Her obsession with food is a torment, yet it gives her a feeling of power, of being in control'

A slim woman in her late forties has been coming for psychotherapy for about 10 months. She requested therapy because of feeling "stuck and blocked". She has an intensity about her, and a longing for perfectionism, which both helps and hinders her in life and work.

A slim woman in her late forties has been coming for psychotherapy for about 10 months. She requested therapy because of feeling "stuck and blocked". She has an intensity about her, and a longing for perfectionism, which both helps and hinders her in life and work.

One day she arrives looking shattered and tearful. She talks about work difficulties, and then breaks down and sobs. When she is calmer she tells me that something she had kept secret for a long while has been found out. "I feel so ashamed," she explains, "because for years I've been hiding my problem with food. Even from myself, in a way. Last night I thought I was alone, but my husband had come home. I'd had a bad day and was doing what I haven't done for a long time: bingeing, then making myself throw up. And there he was, standing in the bathroom doorway, looking horrified."

This woman is one of millions, and like most women with a hidden eating disorder, she is reluctant to let go of her secret, to admit just how unhealthy for her mind and body it is. She had managed to keep it hidden because in the eyes of the world she doesn't have a problem. The painfully skeletal body of someone with severe anorexia, or the overburdened frame of a compulsive eater, are visible signs of their inner distress. But for this woman and many like her, a secret regime of moderate self-starvation andbouts of bulimia or laxative abuse enable her to maintain a fairly constant weight.

Over the weeks, she tells me just how obsessed with food she has been: how she agonises over what she has eaten, might eat, would like to eat. If she gets through the day on only an apple with no one noticing, she feels high. Her obsession has, until now, been private. In eight years of marriage, her husband never guessed. The obsession is a torment, she acknowledges, yet it gives her a feeling of power, of being in control. This is why she is reluctant to give up her secret. That would mean having to do something about it and, like any addict, she is enslaved.

Look in any bookshop for reasons why any woman (it is mostly women) might have an unhealthy relationship with food and you'll find myriad personal, social and political explanations. Psychoanalytic theories tend to highlight an experience of powerlessness as the trigger for most eating disorders. Control over food becomes synonymous with control over life. In the turbulence of adolescence, when young women go through a rush of difficult feelings, alongside having to cope with a rapidly changing body, instances of anorexia and/or bulimia are particularly rife.

This woman remembered almost to the minute when her food obsession began. She was 15, lying in the bath and feeling self-conscious about her body, which she thought looked fat. She felt envious of a prettier, slimmer friend. She recalled an overwhelming feeling of self-disgust. That evening she ate her first minimalist meal. By the time she was 16 she had fallen from 10 to eight stone. Because her weight was never critically low, she managed to persuade everyone that there wasn't a problem. She was just losing puppy fat. So began the obsession that dominated her life for 30 years.

There is only one treatment that really works: the person has to want to give up their secret obsession. For this woman, letting go of her secret and admitting to herself that she had an unhealthy relationship to food and her body was the biggest step. Very slowly, she began to loosen the obsession's hold on her and learn to enjoy her body and its appetites rather than punish it as greedy.

For many women, however, an unhealthy relationship with food is unlikely to be challenged. Women who weigh themselves too often, diet too often and obsess about food are part of the norm. As long as our culture perpetuates images of unnaturally thin women as desirable, women will try to change their lives by changing the shape of their bodies.

elizabeth.meakins@blueyonder.co.uk

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. None of the above clinical material refers to specific cases