First, my confession: I lied to a patient yesterday, and I feel the need to come clean; it’s not my norm to lie. I told this new client struggling with an eating disorder that I have never lost a patient—and that I am determined to do all I’m able to keep my patients safe.
The truth is a bit different. I’ve lost one patient in the 26 years supporting patients with anorexia, bulimia and binge eating disorder. And while statistically one patient is a tiny percent of the thousands of individuals I’ve seen over the quarter century, one lost patient is one too many.
I think about her every time I open my dresser drawer—she gave me a gift just two weeks before she left this world—following my compliment of the shirt she was wearing. She knew I’d get a kick; she wore it to amuse me, for sure. I don’t think it was a parting gift; her death was rather impulsive.
And I think about her whenever I bike ride past the train station upon whose tracks she ended her life. She was being treated by a qualified eating disorder team and by all accounts she was doing quite well—based on what she shared with us, at least.
Objectively, her eating had normalized and medically she was stable. I can’t recall now just how long it had been since she had purged, but she was doing well enough that we were spreading visits out a bit.
I’m not quite sure why I lied. Perhaps I wanted yesterday’s patient to know how determined I am to keep her safe and to know that one way or another I’ll support her and work with her to recovery. Maybe it has to do with my sense that Dahlia’s death was not because of her eating disorder, but her depression. Was it even a lie when her cause of death was not directly due to her eating disorder? Regardless, it made me think about this topic of lying, particularly as it pertains to recovery.
Years ago I had a new patient who, after introducing herself, immediately shared that she is a pathological liar. And that she steals. It’s a bit of a conundrum, then, to know if I should believe her. And should I hide my purse when I head out to retrieve some materials from the next room? Do I trust her—ever?
But more typically, I encounter patients whose lying is slowly revealed and we both need to make sense of it. And we both need to learn to move on after they’ve lied or mislead.
Daniel found himself in a bind several months ago when I proposed he increase his intake given his inappropriate weight loss. He looked me right in the eyes and emphatically swore he’d stuck with the recommendations from the preceding week—every single one of them. Yet he was well aware why he had lost weight. And he didn’t want to admit that he was struggling with following through with my recommendations. He silently hoped that his method of skimping on his intake would still hold his weight steady—even though I advised him otherwise. And now, if he agreed to my new add-ons, he’d have to lie again—because he had no intentions of eating more. Now he regretted lying as things had gotten quite complicated.
When this happened again some weeks ago, I knew that his eating disorder was at work and could not be trusted. Yes, Dan wanted to recovery, to head off to college, but his eating disorder had a voice all its own. I made sure that he was returning for medical assessments to help verify his progress—as his eating disorder was not tolerating his being honest with me. Surely he didn’t like not feeling trusted. Yet this was the only way I could begin to trust him again and keep him safe.
Sometimes lies aren’t so apparent. You know, like the lies of omission. “So you had the sandwich and the glass of milk?”, I’d confirm. “Yes, and the fruit”, she’d add. But only when I probed further with “And how much of the sandwich did you manage to get through?” did I hear “less than the half”. Or, when I asked about how the exercise limits were adhered to and told that she stuck with the agreed upon 30 minutes, for example. But when I asked “And what was the maximum time spent exercising?” I heard “Well, 40-45 minutes—on most days”.
And then there’s the lying to your self. You look at the cereal and you think surely that’s about the right amount, when truly you know that your portioning falls short. Or you ignore the fact that gardening and compulsively cleaning count as exercise too. You underestimate the number of planned binges or your need to throw out food so no one knows you even bought it and ate it, and you eat mindlessly so you can even fool yourself about your eating.
Your therapist can better explain the role lying plays for you and why you rely on it. But from my perspective, your feelings of shame about eating, of not being deserving, and of needing to be in control are just a few of the contributors. You want to please us providers so we won’t abandon you and truly you’d like to believe you’re doing as well as you state you are.
But like the boy who cried wolf, you leave us struggling with trusting your word. It makes it hard to know just when we need to offer more guidance and support if things always sound great. I worry when you say that things are always going perfectly—really I do. How will you learn to pick yourself up when you slip if you never share your struggles?
I know this is hard. Nobody talks about it. But as a provider who is determined not to lose another patient to an eating disorder and its comorbidities, I urge you to push yourself to be honest—on your food records, in your sessions, about your difficulties. Volunteer the answers—even if your doctor or your other providers don’t know enough to ask. Tell your supports when your struggling. Hiding beneath your binging, your restricting, or your purging with vomiting or exercise or laxatives is only lying to your self.
I came clean. Now it’s your turn.
Thanks for your honesty. And thanks for reading and commenting.